NASOPHARYNGEAL AIRWAY (NPA) INSERTION

 

The nasopharyngeal airway (NPA) is a soft, flexible tube inserted through the nostril into the nasopharynx to maintain an open airway. Unlike the oropharyngeal airway (OPA), the NPA can be used in semi-conscious and conscious patients who still have a gag reflex.

🚨 Why It’s Important:
✅ Prevents airway obstruction caused by the tongue.
✅ Can be used in semi-conscious or conscious patients.
✅ More comfortable than an OPA for prolonged use.

 

1️⃣ HOW THE NASOPHARYNGEAL AIRWAY WORKS

🫁 The NPA bypasses the soft tissues of the pharynx, preventing airway collapse and allowing for spontaneous breathing or assisted ventilation.

🔹 It is particularly useful when an OPA is not tolerated due to a gag reflex.

🚨 It should NOT be used in patients with suspected skull fractures!

 

2️⃣ INDICATIONS FOR NPA USE

✅ Patients who require airway maintenance but cannot tolerate an OPA (e.g., intact gag reflex).
✅ Semi-conscious or conscious patients with a partially obstructed airway.
✅ Patients needing frequent suctioning of airway secretions.
✅ Patients requiring airway support but unable to tolerate intubation.

🚑 NPAs are commonly used in both pre-hospital and hospital settings for airway management.

 

3️⃣ CONTRAINDICATIONS

🚨 DO NOT use an NPA if any of the following are present:

❌ Suspected basilar skull fracture

  • Signs include:
    • CSF (cerebrospinal fluid) leakage from the nose or ears.
    • “Raccoon eyes” (periorbital bruising).
    • Battle’s sign (bruising behind the ears).

❌ Significant nasal trauma or deformity

  • Fractured nasal bones can cause airway trauma or improper placement.

🚨 If a skull fracture is suspected, use an OPA (if tolerated) or consider alternative airway management.

 

4️⃣ SIZING THE NASOPHARYNGEAL AIRWAY

✅ Proper sizing is crucial for effectiveness and patient safety.

🔹 To determine the correct NPA size:
1️⃣ Diameter: Select an NPA slightly smaller than the patient’s nostril.
2️⃣ Length: Measure from the tip of the nose to the earlobe or angle of the jaw.

🚨 If the NPA is too short → It may not bypass the tongue, leading to obstruction.
🚨 If the NPA is too long → It may enter the esophagus, leading to improper placement.

 

5️⃣ INSERTION TECHNIQUE: HOW TO INSERT AN NPA

✅ Step-by-Step Instructions:

1️⃣ Preparation:

  • Select the correct NPA size.
  • Lubricate generously with a water-soluble lubricant (do NOT use petroleum-based lubricants).

2️⃣ Positioning the Patient:

  • Keep the head in a neutral position (unless contraindicated due to cervical spine injury).

3️⃣ Insertion:

  • Insert the beveled end first, following the natural curve of the nasal passage.
  • Direct the tip posteriorly, not upward (to avoid nasal trauma).

4️⃣ Advancement:

  • Gently advance the NPA until the flange rests against the nostril.
  • If resistance is met, try the other nostril—one nostril may be more open than the other.

🚨 Never force an NPA! If resistance is met, stop and attempt in the other nostril.

 

6️⃣ CONFIRMATION OF PLACEMENT

✅ Signs of Proper Placement:
🔹 Visible chest rise with ventilation.
🔹 Clear, unimpeded airflow through the NPA.
🔹 Presence of normal breath sounds when auscultating the lungs.

🚨 Signs of Improper Placement:
❌ Air entering the stomach instead of the lungs → NPA may be too long and in the esophagus.
❌ Persistent snoring-like sounds → NPA may not be deep enough.
❌ Gagging or coughing → Consider an OPA instead.

 

7️⃣ COMPLICATIONS & HOW TO PREVENT THEM

 
ComplicationCausePrevention
Nosebleeds (Epistaxis)Trauma to the nasal mucosaLubricate well, insert gently
Placement in the Esophagus (Rare)Incorrect sizing or insertionMeasure correctly before insertion
Gagging or DiscomfortNPA too large or improper placementUse proper sizing, insert carefully
Airway ObstructionNPA too short or kinkedEnsure full insertion, reposition if needed

🚨 If complications occur, remove the NPA and reassess airway management options.

 

8️⃣ WHY THE NASOPHARYNGEAL AIRWAY IS A CRITICAL TOOL

✅ Easier to tolerate than an OPA in semi-conscious patients.
✅ Maintains airway patency when an OPA is contraindicated.
✅ Useful in patients requiring frequent suctioning.
✅ Allows for spontaneous breathing while providing an open airway.

🚑 Takeaway: Mastering the NPA ensures effective airway management in patients who cannot tolerate an OPA, providing a crucial alternative in airway emergencies.