Nasopharyngeal airway

Reviewed and revised 7 February 2017


  • Nasopharyngeal airway (NPA) or nasal trumpet


  • Can provide an airway in patients with an intact gag reflex, trismus or oral trauma
  • Facilitate suctioning in patients with a weak cough


  • Soft, flexible anatomically designed airway adjunct
  • Sized by measuring from the tip of the patient’s nose to the earlobe
  • described by internal diameter in mm (range from 2–9 mm in half sizes)
  • commonly 6–7 mm in an adult female and 7–8 mm for an adult male


  • smooth angled tip
  • curved body
  • flanged end


Internal diameter
External diameter


  • pre-prepare nose with topical local anaesthetic/vasoconstrictor spray
  • Apply lubricant then insert tube with bevel facing the nasal septum
  • advance along the septum horizontally, following the natural curvature of the floor of the nasopharyngeal cavity and rotated 90 degrees to lie in the nasopharynx
  • a safety pin can be placed just behind the flange to prevent it advancing too far
  • The tip should lie behind the uvula


  • epistaxis and aspiration
  • ulceration
  • insertion through the cribriform plate into the brain
  • may still stimulate gag reflex and vomiting
  • sinusitis



  •  base of skull or nasal fractures
  • coagulopathy

References and Links

  • Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: dispelling myths and establishing the facts. Emerg Med J. 2005 Jun;22(6):394-6. PMC1726817.

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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