A nasopharyngeal airway (NPA) is a flexible, hollow tube designed to secure an open air passage in the upper airway. This device is commonly used in emergency medicine and pre-hospital settings to bypass obstructions caused by the tongue or soft tissues. By creating a direct channel from the nostril to the back of the throat, the NPA ensures a clear path for air movement. It is a temporary measure employed by trained medical professionals to support breathing until the patient can maintain their own airway.
Indications for Use
The nasopharyngeal airway is designed for patients needing airway support who retain a semi-conscious state or an active gag reflex. Unlike an oropharyngeal airway (OPA), the NPA is better tolerated because it runs through the nasal passage, avoiding gagging and vomiting. This makes it useful for individuals who are obtunded due to intoxication or sedation but are not fully unconscious.
The NPA is important when a patient cannot protect their airway due to reduced consciousness, often indicated by an inability to cough or swallow effectively. It is also the preferred choice when access to the mouth is limited, such as in cases of trismus or significant trauma to the face. The device works by displacing the tongue and soft palate, preventing them from blocking the pharynx.
Sizing and Initial Setup
Accurate sizing is necessary to ensure the NPA functions correctly and avoids complications. The appropriate length is determined by measuring the distance from the tip of the patient’s nose to the tragus of the ear. If the tube is too short, it fails to clear the obstruction; if too long, it may irritate the larynx or enter the esophagus.
The tube’s diameter should be no wider than the patient’s little finger or fit comfortably within the nostril without blanching the skin. Before insertion, the NPA must be lubricated with water-soluble jelly to reduce friction. Lubrication minimizes the risk of trauma and bleeding from the delicate nasal mucosa.
The healthcare provider must visually inspect both nostrils for obstructions, such as a deviated septum or nasal trauma. Insertion must be avoided in patients with suspected basilar skull fractures due to the risk of the tube entering the cranial vault. Selecting the most open and unobstructed nostril facilitates a smoother procedure.
Step-by-Step Insertion
The patient is typically positioned on their back. If no spinal injury is suspected, a slight head-tilt/chin-lift maneuver helps align the airway passages. This “sniffing position” straightens the airway’s natural curve and optimizes the path for the tube. Insertion must be performed gently and methodically by a trained professional.
The lubricated tip of the NPA is introduced into the selected nostril. The bevel, the slanted opening, should be oriented toward the nasal septum. The tube is advanced along the floor of the nasal cavity, following the natural anatomy of the nasopharynx. This direction ensures the tube navigates the passage correctly and avoids damaging the turbinates.
A slight, gentle twisting motion can help guide the tube around the anatomical curves of the nose. Insertion must stop immediately if significant resistance is met, as forcing the tube risks serious trauma or severe nosebleeds. If resistance occurs, the tube should be removed, and insertion attempted in the opposite nostril or with a smaller size. The tube is properly seated when the flared end (the flange) rests flush against the nostril opening.
Post-Insertion Assessment and Removal
Once the NPA is in place, the priority is confirming the airway is patent and air is moving freely. This is done by listening for breath sounds and observing the patient’s chest for symmetrical movement. Effectiveness is confirmed if the patient’s breathing improves and signs of upper airway obstruction, such as snoring, are reduced.
The NPA’s flange should be secured to the patient’s face, often with medical tape, to prevent accidental displacement. Continuous monitoring is necessary, as an improperly sized tube can cause gagging, requiring immediate removal and replacement. A common complication is epistaxis (nosebleed), which usually resolves with gentle pressure.
The NPA is temporary and should be removed once the patient’s consciousness improves and they can maintain an open airway independently. Removal involves simply pulling the tube out by the flange. After removal, the patient’s respiratory status is closely watched to ensure the airway remains clear.