Airway adjuncts are medical devices designed to maintain an open airway in individuals who cannot do so on their own. The oropharyngeal airway (OPA) is a J-shaped device inserted into the mouth, primarily functioning to prevent the tongue from obstructing the back of the throat. The nasopharyngeal airway (NPA), often called a “nasal trumpet,” is a soft, flexible tube inserted through the nasal passage into the posterior pharynx. Both devices serve as temporary solutions to ensure continuous airflow, playing a role in emergency and pre-hospital care.
When to Consider Airway Adjuncts
Airway adjuncts are considered when a patient’s natural airway is compromised, often due to altered mental status causing the tongue to relax and obstruct breathing. An oropharyngeal airway is typically used for unconscious patients who lack a gag reflex, as its presence can stimulate gagging and potentially lead to vomiting or aspiration in conscious or semi-conscious individuals. In contrast, a nasopharyngeal airway can be utilized in patients who are conscious or have an altered level of consciousness but retain an intact gag reflex, as it is less likely to trigger this response.
Contraindications for these devices exist to prevent further harm. An OPA should not be used in patients with an intact gag reflex due to the risk of vomiting and aspiration. For NPAs, caution is advised or use is avoided in cases of facial trauma, particularly involving the nose, or if a basilar skull fracture is suspected, to prevent potential complications like severe nosebleeds or intracranial insertion. Adhering to these guidelines ensures safe application.
Measuring an Oropharyngeal Airway
Correctly measuring an oropharyngeal airway ensures it effectively clears the airway without causing harm and prevents complications like oral trauma or further airway compromise. An OPA that is too small may not adequately displace the tongue, failing to resolve the obstruction. Conversely, an OPA that is too large can push the epiglottis down, potentially obstructing the airway, or cause trauma to the larynx.
To measure an OPA, position the device with its flange at the corner of the patient’s mouth. The tip of the OPA should then extend to the angle of the patient’s jaw or the earlobe. This landmark provides an accurate length estimate. Another method involves aligning the OPA from the corner of the mouth to the earlobe.
After selecting a size, ensure the OPA is clean. If uncertain about the correct size, start with a slightly smaller OPA and adjust as needed. This minimizes the risk of trauma or obstruction from an oversized airway.
Measuring a Nasopharyngeal Airway
Accurate measurement of a nasopharyngeal airway is important for effective management and to avoid complications like nasal trauma, discomfort, or inadequate airflow. An NPA that is too short may not extend beyond the tongue’s base, failing to relieve the obstruction. If the NPA is too long, it can potentially enter the esophagus or irritate the larynx, leading to gagging, vomiting, or laryngospasm.
To determine the appropriate size for an NPA, measure the device from the tip of the patient’s nose to their earlobe. Another common method involves measuring from the tip of the nose to the angle of the jaw. The chosen NPA should match this length, with its flared end resting against the nostril once inserted.
When preparing for insertion, consider which nostril to use; the larger or less obstructed nostril is generally preferred. The outside of the tube should be lubricated with a water-soluble lubricant to facilitate easier passage and reduce the chance of nasal trauma. NPAs are commonly quoted in millimeters, with typical adult sizes ranging from 6.5 mm to 8.5 mm.
Post-Measurement and Airway Maintenance
After an airway adjunct is measured and potentially inserted, continuous patient assessment and monitoring ensure airway patency. Healthcare providers should regularly check for adequate chest rise and fall, indicating effective ventilation. Listening for clear breath sounds confirms that air is moving freely through the airway.
Maintaining an open airway extends beyond the initial placement of the adjunct. Proper head positioning, such as the head tilt-chin lift or jaw-thrust maneuver, can further optimize airflow, especially in patients with a relaxed tongue. If secretions, blood, or vomit are present, suctioning may be necessary to prevent obstruction and maintain a clear passage.