Nasopharyngeal airway
Overview
- Nasopharyngeal airways are tubular, soft, flexible airway devices
- NPA's provide an open airway through the nasopharynx rather than the oropharynx
- The widened opening which remains outside the nose gives the device its common moniker "Nasal trumpet"
- NPA's are supraglottic by definition and generally do not stimulate the gag reflex when placed
- NPA are not contraindicated in the conscious or semi-conscious patient whose gag reflex is intact
- Oxygen therapy and/or pressurized respiratory therapies by nasal cannula, simple masks, non-rebreather masks, CPAP, and BiPAP may be used with an NPA in place
- Presence of an NPA in the posterior pharynx may interfere with intubation; they generally should be removed prior to laryngoscopy
Indications
- Need to ensure an open airway
Contraindications
- Suspected or known maxillofacial fractures
- Suspected or known septal hematoma on the same side
Equipment Needed
- 1x NPA device, appropriately sized
- Lubricant
Procedure
- Gently insert the well-lubricated tip end of the NPA device with the bevel oriented toward the septum, pushing the tip directly backward (not upward) into the nasopharynx
- Depending on the orientation of the bevel, you may need to progressively rotate the device so that the natural curvature aligns with the caudal curvature of the device while in place
- Insert the device fully, until the "trumpet" end is in contact with, or very near, the nare
Complications
- Epistaxis
- Device intrusion through fracture lines if placed in patient with facial trauma