Nasopharyngeal Airway

Aka: Nasopharyngeal Airway, Nasal Pharangeal Airway, Nasal Airway, Nasal Trumpet

1. Indications
   1. Airway maintenance
      1. Oral Airway placement difficult
      2. Semiconscious patient not tolerating Oral Airway
   2. Nasotracheal Intubation guide in Maxillofacial Trauma
2. Contraindications
   1. Facial injury
   2. Basilar Skull Fracture
   3. Coagulopathy
3. Complications
   1. Esophageal intubation (if too long)
   2. Laryngospasm
   3. Vomiting (less likely than with Oral Airway)
   4. Nasal mucosa injury and secondary blood aspiration
4. Sizing
   1. General
      1. Airway diameter should not be too large
         1. Should not blanche the nasal ala
      2. Length: Tip of the nose to the tragus of the ear
   2. Adult
      1. Large: 8-9 mm Internal Diameter (I.D.)
      2. Medium 7-8 mm Internal Diameter (I.D.)
      3. Small 6-7 mm Internal Diameter (I.D.)
   3. Child
      1. Diameters: 12F (~3mm ET Tube) to 36F
      2. Alternatively may use a shortened ET Tube
         1. ET Tube 3 mm will fit a term newborn's NP airway
   4. Images
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5. Technique
   1. Lubricate with water soluble lubricant (or Anesthetic jelly)
   2. Gently insert into nostril
      1. Leading edge of bevel should be away from septum (away from Kiesselbach's Plexus)
         1. If results in upside-down Nasal Trumpet, rotate 180 degrees after passing the anterior nare
      2. Insert along floor of nostril, perpendicular to face
      3. If resistance occurs
         1. Try slight tube rotation
         2. Try other nostril
   3. Check for respirations following placement
6. Maintenance
   1. Check patency frequently
   2. Tube may be blocked by mucus, blood, secretions