# Nasopharyngeal Airway Device Insertion

## Overview

This module describes how to insert a nasopharyngeal airway (NPA) in a patient who requires airway support.

## Indications

1. Impaired consciousness with loss of airway reflexes but still breathing independently

2. Difficulty in ventilating with a BVM resuscitator due to upper airway collapse, while the patient cannot tolerate an OPA or the mouth cannot be opened or is obstructed

3. Enlarged tonsils or angioedema causing upper airway obstruction and difficult breathing in an awake patient

## Contraindications

1. Suspected

   basal skull fracture
   basal skull fracture

   Suspect if a patient has bruising around the eyes or behind the ears, or is leaking CSF from the nose or ears.

2. Foreign bodies in the airway

3. Consider the risks and benefits in patients with coagulopathy

## Patient information and consent

### How do I explain this procedure?

“I need to put a short tube through your nose into your throat to keep your airway open for breathing.”

### What can my patient expect?

“This will be uncomfortable, but it won’t make you feel like throwing up, and you should be able to breathe more easily right away.”

### What is my patient’s role?

“Tell me if you have a bleeding tendency or use blood thinners. Please keep still while I place the tube, and let me know if you feel severe pain while I’m placing it.”

## Preparation

### Documentation

1. Patient notes

### Equipment

1. Non-sterile gloves

2. Water-soluble lubricant jelly

3. Different sizes of

   NPA
   NPA

## Site & Positioning

The patient may be lying on their back, or sitting upright. The patient’s head should be in a “sniffing the air” position.

## Procedure

Follow medical asepsis with non-sterile gloves.

1. Perform hand hygiene. Don non-sterile gloves.

2. Measure for the correct size, while keeping the device as clean as possible. Place one end at the nostril entrance and the other end at the angle of the jaw, maintaining the bend of the NPA to follow the curve of the airway. Ensure NPA is not too long.

3. Generously lubricate the device inside the sterile packaging.

4. Gently insert the airway device into the larger nostril (normally right side) with the bevel against the septum. Direct towards the back of the patient’s head, following the curve of the upper airway.

5. Advance until the flange is just outside the nostril.

## Troubleshooting

I can’t advance the NPA.

Don’t advance with force. Make sure the NPA is properly lubricated. Pull back slightly, and with a slight twisting action, advance again. If unsuccessful, try the other nostril. If still unsuccessful, consider another airway device.

## Risks

1. Stomach inflation, worsening obstruction, and vomiting caused by too long NPA

2. Damage to the structures of the nose and throat

3. Nosebleeds

4. Sinusitis

## References

1. Atanelov Z, Aina T, Amin B, et al. Nasopharyngeal Airway. [Updated 2021 Sep 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513220/