NPA (nasopharyngeal airway) Placement 

Purpose

open patients airway

is considered a “basic” or “simple” adjunct.

Equipment Needed

NPA (correct size discussed later)

Water based lubricant (i.e.; KY)

NOTE!

The NPA is measured in French and comes naturally curved for the right nostril. One end will have a flange, and the other a bevel, that again is designed for insertion in the right nostril first. It is usually made of rubber or silicone.

Indications/Contraindications

Indicated for a patient that needs a basic airway (unconscious, compromised, etc)

Contraindicated for patients who have facial fractures or any S/S there of as the NPA my cause damage upon placement.

How to

Step 1

Measure patient for placement. Measuring can be done multiple ways:

The book way is to measure your NPA that you picked out (Note: NPAs come in French sizes) and hold one end against the outer edge of the nostril and the tip should touch the bottom of the patient’s ear lobe. If it’s to long, go down a size and re-measure or go up a size if  it’s to short.

The way I prefer and have found to be successful more often is to simply take your pinky and hold it up to their nostril. Gauge the size difference between the two and the select the appropriate NPA. It seems that diameter has more of an effect then length does in placement.

Step 2

Prep equipment/patient. Apply lubrication, and if patient is conscious (as this airway can be placed in a conscious patient) let them now what is about to happen.

NOTE!

NPA’s are preferably placed down the right nostril. This is due most people having a slightly larger right nostril, further NPA’s are designed with a natural curve for the right nostril. This does not mean that it can not be placed in the left nostril. Simply rotate the NPA around so that the bevel faces the septum. This is important in either case; THE BEVEL FACES THE SEPTUM. This is to allow a better pathway for air.

Step 3

Inserting the NPA-

Start by pushing up on the tip of the patients nose (give them the “piggy” nose). This will allow for easier placement.

Ease the NPA into the right nostril with a twisting motion at a near perpendicular angle to the patient. If you meet resistance, simply pull back and try again, a different angle, or a greater range of twisting. Remember there are little ridges inside your nose called “nares” to get past. These are the resistance you are feeling. DO NOT FORCE YOUR WAY PAST RESISTANCE. If you encounter too much, just try the other nostril.

Step 4

Continue to insert the NPA until the flange meets the nostril or until resistance is meet and the majority of the NPA is in.

Follow on

Take note of the insertion depth and make sure it is not coming back out. Remember this airway can be used on conscious and unconscious patients. So if your patient starts to wake up you don’t have to worry about pulling your airway.
 

Notes
NPAs are great airways. Personally this is my favorite simple airway. Can be used on nearly every one, and even a monkey could be taught how to put it in. Further if your patient does come around they don’t start gagging and retching. And you don’t have to keep pulling it in and out before/after attempting an intubation. Only drawback is they may take a little longer then an OPA, but with enough practice and knowledge I think they are preferable