# Oropharyngeal Airway Device Insertion

## Overview

This module describes how to insert an oropharyngeal airway device (OPA or Guedel airway) to maintain an open airway in a patient with impaired consciousness.

## Indications

1. Impaired consciousness with absent gag reflex (still breathing independently)

2. Ventilation with a bag valve mask resuscitator

## Contraindications

1. Intact gag reflex

2. Foreign bodies in the airway — remove foreign body first if possible

## Patient information and consent

This procedure is usually done as an emergency measure with an unconscious patient. However, it may be explained to family members afterwards.

### How do I explain this procedure?

“I had to put a short tube in the patient’s mouth, into their throat, to keep it open for breathing. This is not uncomfortable for them while they are not awake.”

## Preparation

### Documentation

1. Patient notes

### Equipment

1. Non-sterile gloves

2. A tongue spatula

3. Oropharyngeal airway devices — keep multiple sizes ready

## Site & Positioning

The patient should be lying on their back.

## Procedure

Follow medical asepsis with non-sterile gloves.

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

2. Choose the

   correct size
   correct size

   Selecting the correct size is crucial to avoid complications — see Risks.

   airway device by placing the tip of the OPA at the angle of the jaw, and pointing the rim towards the central incisors. Choose the size that just reaches the incisors.

3. Open the mouth and use a tongue spatula to depress the tongue. Insert the airway device and slide the tip over the tongue, following the curve of the tongue and oral cavity, until the rim of the OPA sits just outside the teeth. Be careful not to catch the patient's lip between the rim and the teeth.

## Troubleshooting

I think the patient is choking.

Remove the airway device. If the patient is conscious enough to have a gag reflex, the airway device is contraindicated. Consider using an NPA.

The patient is biting down.

Don’t use an OPA as a bite block — provide more sedation and analgesia.

## Risks

1. Vomiting and aspiration

2. Damage to teeth

3. Worsening obstruction caused by too short OPA pushing back against the tongue

4. Laryngospasm caused by too long airway

## References

1. Castro D, Freeman LA. Oropharyngeal Airway. [Updated 2021 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from:https://www.ncbi.nlm.nih.gov/books/NBK470198/