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  • • Nasopharyngeal airways provide a conduit for airflow between the nares and the pharynx.

    • Nasopharyngeal airways prevent mandibular tissue from obstructing the posterior pharynx.

    • Nasopharyngeal airways may be used in conscious patients (unlike oropharyngeal airways).

    • Nasopharyngeal airways may be used in children with impaired consciousness or in neurologically impaired patients with poor pharyngeal tone leading to upper airway obstruction.

    • Nasopharyngeal airways can be used to suction secretions.

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Absolute

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  • • Nasal airway occlusions.

    • Nasal fractures.

    • Coagulopathy (because of the risk of epistaxis).

    • Cerebrospinal fluid leak.

    • Basilar skull fracture.

    • Adenoidal hypertrophy.

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  • • A nasopharyngeal airway is a soft rubber or plastic tube.

    • Nasopharyngeal airways come in various sizes ranging from 12F to 36F.

    • A shortened tracheal tube may be used as a nasopharyngeal airway.

    • Lubrication jelly.

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  • • Nasal bleeding.

    • When using a shortened tracheal tube instead of a soft nasopharyngeal airway, injury to the soft tissues of the nasal passages may occur because of the rigid stiff plastic.

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  • • Nasopharyngeal airways do not prevent aspiration.

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  • • Measure the distance from the nares to the tragus of the ear to approximate the appropriate size and length of tube.

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  • • Head and airway must be positioned properly to maintain a patent airway even after insertion of a nasopharyngeal airway.

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  • • The upper airway consists of the oropharynx, the nasopharynx, and supraglottic structures.

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  • • The tube is lubricated and inserted into the nostril and positioned into the posterior pharynx.

    • Advance the tube gently, following the natural curvature of the nasal passage to direct the tube in a posterior inferior position.

    • After measuring as above, use the largest diameter tube that can fit into the nose without causing blanching of the nares.

    • If passage does not occur easily, attempt the other nostril because patients may have different size nasal passages.

    Figure 3–1 shows a nasopharyngeal airway in place (sagittal view).

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Figure 3–1.
Graphic Jump Location

Sagittal view of nasopharyngeal airway in place.

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  • • Because the nasopharyngeal airway has a small internal diameter, it can be obstructed with mucus, blood, vomit, or the soft tissues of the pharynx.

    • When necessary, suction the airway frequently to ensure patency.

    • Use pulse oximetry to measure oxygen saturation levels.

    • Measure heart rate.

    • Check blood pressure using a noninvasive device.

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  • • If the nasopharyngeal airway is too long, it may cause bradycardia through vagal stimulation or it may injure the epiglottis or vocal cords.

    • Physical irritation of the larynx or lower pharynx may stimulate coughing, vomiting, or laryngospasm (if the tube is too long).

    • Nasopharyngeal airways can cause a pressor response with increased blood pressure.

    • Failure of insertion.

    • Epistaxis (due to mucosal tears or avulsion of turbinates).

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