You should now be able to insert the bougie into the trachea and then remove the scalpel.

Some advocate the use of a tracheal hook or tracheal dilator to aid insertion of the bougie and tube.

Bleeding is common. If you are confident that you are in the trachea it is important to continue and establish an airway. Your tube also helps tamponade any bleeding. Vertical incisions bleed more because the dissection is larger. Swabs may be useful.