A nasopharyngeal airway (NPA) is a medical device that helps maintain an open passage for air to reach the lungs. This flexible tube is inserted through a patient’s nostril, creating a clear pathway in the upper airway. Its primary role is to prevent obstructions, especially when the tongue or soft tissues block the throat in unconscious or semi-conscious individuals.
Understanding the Nasopharyngeal Airway
A nasopharyngeal airway, often called a “nasal trumpet” due to its flared end, is a soft, hollow tube made from plastic or rubber. It is shaped to navigate the nasal passage and extend into the posterior pharynx, the part of the throat behind the nasal cavity. The flared end remains outside the nostril, preventing the device from being lost inside the patient’s nose.
The main function of an NPA is to bypass upper airway obstructions, such as the tongue falling backward in patients with reduced consciousness. By creating an open channel, the NPA ensures continuous airflow to the lungs. This device is useful because it does not trigger the gag reflex, making it better tolerated by conscious or semi-conscious patients compared to other airway adjuncts.
Indications and Contraindications
Nasopharyngeal airways are used when maintaining a clear airway is necessary, especially for patients breathing on their own with reduced consciousness. They are considered when an oropharyngeal airway (inserted through the mouth) might cause gagging due to an intact gag reflex. NPAs are also beneficial when a patient’s mouth is difficult to open, such as with jaw clenching or certain facial injuries.
There are specific situations where NPA insertion is not recommended. It is contraindicated in cases of suspected basilar skull fractures or severe facial trauma. Inserting an NPA in such circumstances could worsen injuries, cause significant bleeding, or lead to the tube entering the cranial cavity. Patients with bleeding disorders or those on anticoagulant medications also face a higher risk of complications, including severe nasal bleeding. Severe nasal obstructions, deformities, or recent nasal surgery can also make NPA insertion unsafe or ineffective.
Step-by-Step Insertion
Proper NPA insertion requires specific steps:
Equipment and Patient Positioning
Gather the correct size NPA, a water-soluble lubricant, and gloves. Ensure adequate lighting and position the patient appropriately, lying flat with the head in a neutral or “sniffing” position to align the airway. This positioning facilitates smooth passage of the device.
Sizing the NPA
Selecting the correct size NPA is important for effective airway management. Measure the airway from the tip of the patient’s nose to the tragus of their ear. This ensures the tube’s tip rests just above the epiglottis, providing optimal airway patency. The NPA’s diameter should also be appropriate for the patient’s nostril, often approximated by the width of their little finger.
Lubrication and Nostril Selection
Before insertion, lubricate the entire length of the NPA with a water-soluble lubricant. This significantly reduces friction and potential trauma to the nasal passages. Identify the wider nostril for insertion, as this can make the process easier.
Insertion Technique
Gently insert the NPA into the chosen nostril with the bevel, or angled tip, facing towards the nasal septum. Direct the tube straight back, parallel to the floor of the nasal cavity, not upwards. Apply gentle, consistent pressure, using a slight twisting motion if mild resistance is encountered. If significant resistance persists, withdraw the NPA and attempt insertion into the other nostril. Advance the airway until the flared end rests against the patient’s nostril.
Confirming Placement
After insertion, confirm proper placement by observing the patient’s breathing, looking for chest rise, and listening for air movement through the NPA. This ensures the airway is clear and functioning as intended. Continuous assessment verifies effective ventilation and allows for adjustments if needed.
Post-Insertion Care and Potential Issues
Once the nasopharyngeal airway is correctly positioned, ongoing care involves continuous monitoring of the patient’s airway and overall condition. The NPA should be secured to prevent accidental dislodgement, often by gently taping the flared end to the patient’s face. Regular assessment of the patient’s respiratory rate and oxygen saturation is important to confirm the NPA is effectively maintaining an open airway.
It is important to keep the NPA clear of secretions or debris, which may require gentle suctioning. While safe, potential issues can arise, such as nasal bleeding (epistaxis) due to the rich blood supply in the nasal passages. Dislodgement or blockage of the NPA can also occur, necessitating prompt attention to restore airway patency. Rarely, a tube that is too long might trigger a gag reflex or lead to gastric distension. Any complications require immediate evaluation and appropriate management to ensure patient safety.
When to Seek Professional Assistance
Inserting a nasopharyngeal airway is a medical procedure. This intervention should be performed by trained healthcare professionals, such as paramedics, nurses, or doctors, who have received certified training in airway management. Attempting to insert an NPA without proper instruction and practice can lead to serious complications, including injury to the nasal passages, bleeding, or improper placement that could worsen airway obstruction.
For individuals not medically trained who encounter a situation requiring airway support, the safest course of action is to immediately contact emergency medical services. Emergency responders are equipped and trained to assess the situation and provide necessary interventions, including proper airway management, ensuring the best possible outcome for the patient. Relying on professional assistance in such scenarios is the recommended approach.