A nasopharyngeal airway (NPA), also known as a “nasal trumpet,” is a soft, flexible tube inserted through a nostril into the back of the throat. This medical device helps keep a person’s airway open, maintaining an unobstructed pathway for air to reach the lungs. It is used in emergency and medical settings for preliminary upper airway management, especially for patients experiencing breathing difficulties.
What is a Nasopharyngeal Airway and When is it Used?
A nasopharyngeal airway is a hollow plastic or soft rubber tube with a flared end to prevent it from becoming lost inside the nose and a beveled tip for insertion. Its design allows it to pass through the nasal passage and rest in the posterior pharynx, effectively displacing the tongue and soft palate to clear the airway. This device is particularly useful in situations where the tongue might fall back and obstruct the airway, such as in unconscious patients.
NPAs are indicated for individuals who are spontaneously breathing but have an upper airway obstruction, especially those with altered consciousness who retain an intact gag reflex. They are often chosen over oropharyngeal airways when a patient’s mouth is difficult to open due to conditions like trismus or angioedema, or if oral trauma is present. The NPA can also facilitate bag-valve-mask ventilation and may be used as a temporary measure before more definitive airway management like intubation.
Getting Ready to Insert an NPA
Preparation for NPA insertion involves gathering necessary equipment, including nasopharyngeal airways of various sizes, water-soluble lubricant, and gloves. Having a range of NPA sizes ensures the best fit for the patient.
Determining the correct NPA size is important. One common method involves measuring from the patient’s nose tip to the tragus of their ear. This ensures the tube’s tip sits just above the epiglottis, preventing it from being too long (causing gagging) or too short (ineffective). For adults, another method is to place the NPA at the nasal opening and orient it toward the mandibular angle. The tube’s diameter should not be wider than the patient’s little finger.
Once the appropriate size is selected, apply water-soluble lubricant to the NPA’s tip and exterior to reduce friction and discomfort. Position the patient supine with their head in a sniffing position. This helps align the upper airway for optimal air passage.
The Step-by-Step Insertion Process
Before insertion, inspect both nostrils to determine the preferred insertion site. Hold the lubricated NPA with the bevel facing toward the nasal septum. This orientation guides the airway along the natural curve of the nasal passage and reduces trauma risk.
With gentle, steady pressure, insert the NPA into the chosen nostril. Direct the tube posteriorly, parallel to the floor of the nasal cavity, rather than upwards toward the eye. This follows the natural anatomical path and helps prevent mucosal injury. Advance the airway through the nasal cavity.
If resistance is encountered, do not force the NPA. Try rotating it slightly and re-advancing with gentle pressure. If it still does not pass easily, remove it and attempt insertion into the other nostril. Continue to advance the NPA until the flared end rests against the nostril opening, indicating proper depth.
After Insertion and Key Safety Points
After insertion, confirm proper placement to ensure effective ventilation. Observe for signs of improved breathing, such as adequate airflow, chest rise, and breath sounds. If the patient’s gag reflex is activated, the NPA may be too long, requiring removal and a smaller size.
Certain conditions make NPA insertion hazardous. Contraindications include suspected basilar skull fractures or severe facial trauma, as insertion could lead to intracranial placement. Significant nasal trauma, recent nasal surgery, severe nasal obstruction, bleeding disorders, or anticoagulant therapy are also contraindications.
Potential complications include epistaxis (nosebleeds). Gagging, vomiting, and aspiration can occur, especially if the NPA is too long. Other complications include pressure necrosis from prolonged placement and, rarely, intracranial placement with a basilar skull fracture. The NPA should be removed once a more secure airway is established or the patient can maintain their own airway independently.