In medicine, a nasopharyngeal airway, also known as an NPA or a nasal trumpet because of its flared end, a type of airway adjunct, is a tube that is designed to be inserted into the nasal passageway to secure an open airway. When a patient becomes unconscious, the muscles in the jaw commonly relax and can allow the tongue to slide back and obstruct the airway. The purpose of the flared end is to prevent the device from becoming lost inside the patient's nose.
Indications and contraindications
Nasopharyngeal airways are sometimes used by people who have sleep apnea, however; these are only used in rare cases and are not a common form of treatment for sleep apnea.
These devices are also used by emergency care professionals such as EMTs and paramedics in situations where an artificial form of airway maintenance is necessary but it is impossible or inadvisable to use an oropharyngeal airway, the preferred type of airway adjunct, or intubate, considered the most certain way to secure a patent airway, but also the most medically invasive. In an unconscious patient, suction of the upper airways may also be applied via an NPA.
Insertion of an NPA is contraindicated in patients with severe head or facial injuries, or have evidence of a basilar skull fracture (Battle's sign, raccoon eyes, cerebrospinal fluid/blood from ears, etc.) due to the possibility of direct intrusion upon brain tissue. An oropharyngeal airway may be used instead, but these devices frequently trigger a patient's gag reflex, while nasopharyngeal airways usually do not.
The correct size airway is chosen by measuring the device on the patient: the device should reach from the patient's nostril to the earlobe or the angle of the jaw. The outside of the tube is lubricated with a water-based lubricant so that it enters the nose more easily. The device is inserted until the flared end rests against the nostril. Some tubes contain a safety pin to prevent inserting the tube too deeply. Care must be taken to ensure the pin does not stick into the nostril. In the event that a pin is not available, you may also stop insertion just short of the natural gag reflex and tape the remaining exposed portion of the NPA to the surrounding facial tissue.
- Daniel Limmer and Michael F. O'Keefe. 2005. Emergency Care 10th ed. Edward T. Dickinson, Ed. Pearson, Prentice Hall. Upper Saddle River, New Jersey. Page 147.