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Nasopharyngeal / Oropharyngeal Airways

Nasopharyngeal and oropharyngeal airways can be very useful tools in certain situations, in both the field and hospital setting. But before reaching for one of these airway devices, it is essential to understand the indications, contraindications and appropriate use of these devices.

Function and Indications

When a patient becomes unconscious, regardless of the cause, maintaining a patent airway is critical. One of the most common causes of airway obstruction in an unconscious patient is the tongue. Once a person loses consciousness, the tongue may fall to the back of the throat and block the patient’s airway. Using an oropharyngeal or nasopharyngeal airway is an effective way to maintain an open airway, which allows you to ventilate the patient effectively if needed.

The main indication for use of an oropharyngeal airway is if your patient is at risk for airway obstruction due to relaxed upper airway muscles or blockage of the airway by the tongue. For example, if you perform a head tilt-chin lift maneuver on a patient to open their airway and are not able to ventilate the patient successfully, placement of an oropharyngeal airway is indicated. In addition, if you are manually ventilating a patient you may inadvertently push down on the patient’s chin, obstructing their airway. Using an oropharyngeal airway can prevent this from occurring. Oral airways can only be used in the unconscious patient.

A nasopharyngeal airway is a second type of device that can be used for patients who are either conscious or unconscious. It is also used to keep the airway open and is especially helpful in semi-conscious patients. Semi-conscious patients may still be at risk for airway obstruction, but cannot have an oropharyngeal airway placed due to an intact gag reflex. 

Nasopharyngeal airways may work well for patients who are clenching their jaw, which makes inserting an oral airway difficult.  A nasopharyngeal airway can also be helpful in patients who are semi-conscious and need frequent nasal-tracheal suctioning.

Insertion Procedure

The first step in inserting either type of adjunct airway device is selecting the correct size. If you select an inappropriate size, the device will not serve its purpose and could cause more harm than good.

The oropharyngeal airway should be measured from the corner of the patient’s mouth to the angle of the mandible. A device that is too big may cause injury or block the airway.

Before inserting the airway, clear the mouth of secretions such as vomit, blood or sputum using a suction catheter. Place the oral airway in the mouth with the curved end towards the hard palate or the roof of the mouth. As you are inserting the device and it approaches the posterior pharynx, rotate the device 180 degrees into the correct position.

After the oral airway is inserted, the flange of the device should rest on the patient’s lip. There is no need to secure the device with tape. Be sure to suction the airway as needed.

Similar to the oropharyngeal airway, if you choose to use a nasopharyngeal airway, selecting the proper size is also important. To determine the correct size, measure from the tip of your patient’s nose to the tip of their earlobe. In addition, choose a nasopharyngeal airway which has a diameter a little smaller than the patient’s nares.

A nasopharyngeal airway should be inserted with the bevel pointing towards the septum and following the natural curvature of the floor of the nasal cavity as it is advanced. Once the device is inserted the flange should rest on the nostril opening.

Contraindications

Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated. If your patient has the ability to cough they still have a gag reflex and you should not use an oral airway. If the patient has a foreign body obstructing the airway, an oropharyngeal airway should also not be used. 

There are few contraindications for using a nasopharyngeal airway. The device should not be used on patients who have nasal fractures or an actively bleeding nose. In some cases, slight bleeding may occur when you insert the airway, which can be suctioned or wiped away.

Tips

  • Be gentle when inserting either type of airway device.
  • Use a water soluble lubricant when inserting a nasopharyngeal airway.
  • Avoid forcing an oral airway, which can lead to trauma to the lips and tongue.
  • If resistance is felt during insertion of a nasopharyngeal airway, stop and try the other nostril.
  • Research has shown that the right nare is larger in most people- try the right nare first.

Article Sources

The American Red Cross. Airways Adjuncts. http://www.redcross.org/images/MEDIA_CustomProductCatalog/m4240191_AirwayAdjunctsFactandSkill.pdf Accessed August 2014.

Farzan, Sattar, MD, FACP, FCCP A Concise Handbook of Respiratory Diseases. Prentice Hall 1997. Accessed August 2014