Nasopharyngeal Airway -

Nasopharyngeal Airway (NPA)

1. Definition

A nasopharyngeal airway is a soft rubber or plastic tube inserted through the nasal cavity to the posterior pharynx to maintain airway patency by bypassing obstruction at the tongue and soft palate.

2. Anatomy Relevant to NPA

Structure	Relevance
Inferior turbinate	Main structure to avoid trauma
Nasal septum	Deviation may obstruct insertion
Adenoids	May cause bleeding in children
Skull base	Risk in basal skull fracture

3. Design and Components

Structure

Part	Description
Tube	Soft rubber/PVC airway
Flange	Prevents over-insertion
Beveled tip	Facilitates atraumatic insertion
Internal lumen	Allows airflow and suction

4. Sizes of Nasopharyngeal Airway

Sizes are usually measured in internal diameter (mm).

Size	Internal Diameter
6 mm	Small adults / adolescents
7 mm	Average adult female
8 mm	Average adult male
9 mm	Large adult male

Pediatric sizes:
3–5 mm.

5. Determining Correct Length

Nostril → Earlobe (tragus)

Nostril → Angle of mandible

6. Mechanism of Action

Upper airway obstruction often occurs due to:

Loss of muscle tone
Posterior tongue displacement
Soft palate collapse

7. Indications in Critical Care

Primary Indications

Indication	Explanation
Decreased consciousness	Prevent tongue obstruction
Partial airway obstruction	Maintain patency
Need for airway adjunct with gag reflex	OPA not tolerated
Bag-mask ventilation	Improves airway patency
Seizures	Maintains airway
Sedation procedures	Maintains airway

8. Contraindications

Absolute Contraindications

Contraindication	Reason
Basilar skull fracture	Risk of intracranial insertion
Severe facial trauma	Disrupted anatomy

Signs suggesting skull base fracture:

CSF rhinorrhea
Battle sign
Raccoon eyes

Relative Contraindications

Condition	Risk
Coagulopathy	Epistaxis
Nasal polyps	Obstruction
Nasal fractures	Trauma
Recent nasal surgery	Bleeding

9. Procedure for Insertion

Equipment Required

Nasopharyngeal airway
Lubricant (water-soluble)
Gloves
Suction

Step-by-Step Technique

Assess airway

Check contraindications

Choose size

Measure nose → earlobe

Lubricate airway
Position patient

Sniffing position if possible

Insert into nostril

Preferred nostril:
Right nostril (usually larger)

Advance gently along nasal floor

Direction:Posterior (towards ear), not upward

During insertion of a nasopharyngeal airway, the bevel should face the nasal septum (medially).The turbinates present laterally are highly vascular and fragile, especially the inferior turbinate, which is commonly injured during airway insertion.

Stop when flange reaches nostril
Assess airflow

10. Advantages of Nasopharyngeal Airway

Advantage	Explanation
Can be used in conscious patients	Tolerated better than OPA
Maintains airway with gag reflex	Major advantage
Improves bag-mask ventilation	Reduces obstruction
Easy to insert	Minimal training required
Useful in seizures	No need to open mouth

11. Disadvantages

Disadvantage	Explanation
Epistaxis	Most common complication
Nasal trauma	Incorrect insertion
Limited airway control	Not definitive airway
Possible intracranial insertion	Rare but serious

12. NPA vs OPA

Feature	NPA	OPA
Route	Nose	Mouth
Gag reflex	Tolerated	Not tolerated
Conscious patients	Yes	No
Facial trauma	Avoid	Preferred
Seizures	Preferred	Difficult

13. Role in Bag Mask Ventilation

In ICU airway management:

NPA improves BMV by:

Reducing upper airway obstruction
Preventing tongue collapse
Increasing airflow

Often used with:

OPA + NPA combination

This is called:

Dual airway technique

14. Use in Difficult Airway Management

Important use:

Awake fiberoptic intubation

NPA acts as:

Conduit for oxygen
Conduit for fiberoptic scope