Chapter 3. Placement of Nasopharyngeal Airway

• • 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.

Absolute

• • Nasal airway occlusions.

  • Nasal fractures.

  • Coagulopathy (because of the risk of epistaxis).

  • Cerebrospinal fluid leak.

  • Basilar skull fracture.

  • Adenoidal hypertrophy.

• • 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.

• • 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.

• • Nasopharyngeal airways do not prevent aspiration.

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

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

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

• • 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).

• • 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.

• • 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).

  • Submucosal tunneling ...