Insertion Of A Nasopharyngeal Airway (Npa)

Front 1

Check indications, and contraindications

Back 1

Utilise standard infection control precautions

Indications:

• Unconscious with trismus

Contraindications

• Middle third facial fractures (1)
• Significant nasal trauma
• TBI and neurological event where airway is patent and Vt is adequate despite trismus (2)

(1) High possibility of intrusion into brain tissue

(2) May induce undesirable gag, increasing ICP so use must be essential.

Front 2

Check precautions

Back 2

Precautions

• Basal skull fractures (3)
• CSF from nares or ears (3)
• Removal may be required if NPA interferes with intubation attempts (4)

(3) Increased possibility of intrusion into brain tissue

(4) Interrupts view of glottis.

Front 3

Prepare patient

Back 3

• Attempt manual airway clearance
• Attempt triple airway manoeuvre and insertion of OP airway.

Front 4

Prepare equipment

Back 4

• Select appropriate sized airway. Confirm correct size by measuring from the corner of the nose to the earlobe. The diameter should be slightly smaller than nostril opening. (1)
  
• Lubricate distal end with KY jelly (2)

(1) Correct size affords optimum airway support. Too large can put the airway into the oesophagus.

(2) Reduces risk of mucosal injury on insertion.

Front 5

Insert NPA

Back 5

• Inspect nostril for obstruction
• Select widest nostril
• Push tip of nose gently upwards towards eyes (1)
• Insert gently with NP airway pointing posteriorly along the floor of nose (90 degrees to pts face)
• If resistance is felt, stop, do not force
• Gently rotate clockwise and anticlockwise 45 degrees whilst continuing to insert. If further resistance felt, re-lubricate and try the other nostril or smaller airway device.
• Insert to measured length. (2)

(1) to prevent trauma ensure airway is in correct position

(2) to allow NPA to adequately support tongue forward.

Front 6

Check Pt

Back 6

• check for gag reflex
• Maintain triple airway manoeuvre
• Maintain position of NPA
• Look, listen and feel for air movement
• If required, suction pharynx by passing an appropriate sized suction catheter down the airway
• If NPA becomes obstructed and obstruction remains after attempted suction, remove and insert new NPA (1)

(1) NPA are an adjunct to manual techniques