Nasopharyngeal airway
Reviewed and revised 7 February 2017
OVERVIEW
- Nasopharyngeal airway (NPA) or nasal trumpet
USE
- Can provide an airway in patients with an intact gag reflex, trismus or oral trauma
- Facilitate suctioning in patients with a weak cough
DESCRIPTION
- 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
Parts
- smooth angled tip
- curved body
- flanged end
Sizes
Size (Fr) | Internal diameter (mm) | External diameter (mm) |
24 | 6 | 8.1 |
28 | 7 | 9.4 |
32 | 8 | 10.8 |
METHOD OF INSERTION/ USE
- 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
COMPLICATIONS
- epistaxis and aspiration
- ulceration
- insertion through the cribriform plate into the brain
- may still stimulate gag reflex and vomiting
- sinusitis
OTHER INFORMATION
Contraindications:
- base of skull or nasal fractures
- coagulopathy
References and Links
Introduction to ICU Series
Introduction to ICU Series Landing Page
DAY TO DAY ICU: FASTHUG, ICU Ward Round, Clinical Examination, Communication in a Crisis, Documenting the ward round in ICU, Human Factors
AIRWAY: Bag Valve Mask Ventilation, Oropharyngeal Airway, Nasopharyngeal Airway, Endotracheal Tube (ETT), Tracheostomy Tubes
BREATHING: Positive End Expiratory Pressure (PEEP), High Flow Nasal Prongs (HFNP), Intubation and Mechanical Ventilation, Mechanical Ventilation Overview, Non-invasive Ventilation (NIV)
CIRCULATION: Arrhythmias, Atrial Fibrillation, ICU after Cardiac Surgery, Pacing Modes, ECMO, Shock
CNS: Brain Death, Delirium in the ICU, Examination of the Unconscious Patient, External-ventricular Drain (EVD), Sedation in the ICU
GASTROINTESTINAL: Enteral Nutrition vs Parenteral Nutrition, Intolerance to EN, Prokinetics, Stress Ulcer Prophylaxis (SUP), Ileus
GENITOURINARY: Acute Kidney Injury (AKI), CRRT Indications
HAEMATOLOGICAL: Anaemia, Blood Products, Massive Transfusion Protocol (MTP)
INFECTIOUS DISEASE: Antimicrobial Stewardship, Antimicrobial Quick Reference, Central Line Associated Bacterial Infection (CLABSI), Handwashing in ICU, Neutropenic Sepsis, Nosocomial Infections, Sepsis Overview
SPECIAL GROUPS IN ICU: Early Management of the Critically Ill Child, Paediatric Formulas, Paediatric Vital Signs, Pregnancy and ICU, Obesity, Elderly
FLUIDS AND ELECTROLYTES: Albumin vs 0.9% Saline, Assessing Fluid Status, Electrolyte Abnormalities, Hypertonic Saline
PHARMACOLOGY: Drug Infusion Doses, Summary of Vasopressors, Prokinetics, Steroid Conversion, GI Drug Absorption in Critical Illness
PROCEDURES: Arterial line, CVC, Intercostal Catheter (ICC), Intraosseous Needle, Underwater seal drain, Naso- and Orogastric Tubes (NGT/OGT), Rapid Infusion Catheter (RIC)
INVESTIGATIONS: ABG Interpretation, Echo in ICU, CXR in ICU, Routine daily CXR, FBC, TEG/ROTEM, US in Critical Care
ICU MONITORING: NIBP vs Arterial line, Arterial Line Pressure Transduction, Cardiac Output, Central Venous Pressure (CVP), CO2 / Capnography, Pulmonary Artery Catheter (PAC / Swan-Ganz), Pulse Oximeter
- 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.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC