Nasopharyngeal Airway Insertion

Question 1

What is the indication for an NPA?

Answer 1

1. Unconscious pt presenting with trismus, where an OPA can not be inserted.

Question 2

What are the 3 contraindications for an NPA?

Answer 2

1. Middle third facial fractures (brain intrusion)
2. Significant nasal trauma (ICP)
3. Neurological injury/TBI where the airway is patent and tidal volume adequate despite trismus (ICP)

Question 3

What are the 2 precautions for NPA insertion?

Answer 3

1. Basal skull fractures and any CSF from nares/ears (possible brain tissue intrusion)
2. Remove during intubation; can obscure view of glottis

Question 4

How is an NPA measured?

Answer 4

From corner of the nose to the tip of the earlobe, with diameter slightly smaller than nostril.

Question 5

If resistance felt during NPA insertion, what is the troubleshooting?

Answer 5

Rotate clockwise and anticlockwise 45 degrees.

If still resistant, remove and try other nostril.