NASOPHARYNGEAL AIRWAY (NPA) INSERTION
The nasopharyngeal airway (NPA) is a flexible tube inserted through the nostril into the nasopharynx. It helps maintain an open airway by separating the tongue from the posterior pharyngeal wall. Unlike the OPA, the NPA can be used in some conscious or semi-conscious patients.
INDICATIONS
- Patients who require airway maintenance but cannot tolerate an OPA (e.g., due to a gag reflex).
- May be used in some conscious or semi-conscious patients.
CONTRAINDICATIONS
- Suspected basilar skull fracture (fracture at the base of the skull). Signs of basilar skull fracture may include:
- Cerebrospinal fluid (CSF) drainage from the nose or ears
- “Raccoon eyes” (bruising around the eyes)
- Battle’s sign (bruising behind the ears)
- Significant nasal trauma or deformity.
SIZING THE NPA
- Select an NPA with a diameter slightly smaller than the patient’s nostril.
- The length of the NPA should be approximately the distance from the patient’s nostril to the earlobe or angle of the jaw.
INSERTION TECHNIQUE
Preparation: Select the correctly sized NPA and lubricate it generously with a water-soluble lubricant.
Positioning: Position the patient’s head in a neutral position (unless contraindicated by suspected cervical spine injury).
Insertion: Gently insert the NPA into the nostril, following the natural curve of the nasal passage. Avoid forcing the NPA. If you encounter resistance, try the other nostril.
Advancement: Advance the NPA gently until the flange rests against the nostril.
CONFIRMATION OF PLACEMENT
- Observe for chest rise with ventilation.
- Listen for breath sounds.
COMPLICATIONS
- Nosebleeds (epistaxis)
- Trauma to the nasal mucosa
- Placement in the esophagus (rare)
IMPORTANT CONSIDERATIONS
- The NPA is generally better tolerated than the OPA in conscious or semi-conscious patients.
- If the patient develops significant bleeding or other complications during insertion, stop the procedure and consider alternative airway management techniques.