Complications of Nasopharyngeal Airway Too Long

A nasopharyngeal airway (NPA) is used in emergencies to help open the patient's airway, ensuring unobstructed breathing. It is particularly suitable for semi-conscious or drowsy patients at risk of airway obstruction. In emergency settings, NPAs also help healthcare professionals in ventilation procedures. However, an NPA that is too long can lead to complications or injury. Today, Bever Medical will share the potential complications caused by an NPA that is too long,  and guide on selecting the right size for airway management products.

What is the Complication of an NPA that is too Long? 

Airway Obstruction  

If the NPA extends too far, it may press against the epiglottis or the posterior pharyngeal wall, causing severe airway obstruction and worsening breathing difficulties. Additionally, foreign bodies or dried secretions can become lodged in the airway tube, leading to airway blockage. In semi-conscious patients, inserting an airway tube may trigger coughing or laryngospasm, potentially resulting in severe airway obstruction, especially if the airway's tip contacts the epiglottis or vocal cords.

Nasal Bleeding  

If the NPA is too long, it may exert excessive friction and pressure on the nasal cavity, causing nasal bleeding. Patients with coagulation issues or those on anticoagulants are at higher risk for severe nasal bleeding. If bleeding originates from the anterior nasal vessels, applying pressure to the nasal area may help; if the posterior nasal vessels are bleeding, it may be necessary to leave the NPA in place, suction the pharynx, and ensure adequate ventilation. In cases where bleeding persists, intubation may be considered.

Central Nervous System Injury  

In patients with basal skull fractures, an excessively long NPA could penetrate the nasal cavity and reach the cranial cavity, leading to central nervous system injury and serious complications.

Pharyngeal Ulcers and Necrosis  

Prolonged placement of an NPA, especially one that is too rigid or too large, may lead to ulcers in the nasal or pharyngeal area. Hard or oversized NPAs can cause sustained pressure on the nasal and pharyngeal mucosa, resulting in tissue compression and ischemia, leading to ulcers. Long-term placement also raises the risk of infection; caregivers should monitor for signs of pressure ulcers or sinusitis for prompt management.

Risk of Aspiration or Ingestion  

Using an NPA that is too long may increase the risk of aspiration into the pharynx or trachea, potentially leading to obstruction of the lower respiratory tract or even ingestion into the stomach, which can cause choking or gastrointestinal injury. Moreover, inserting the airway may trigger a gag reflex, raising intracranial pressure, which can complicate or create new injuries. Care providers should carefully monitor the patient's condition to reduce aspiration risks, quickly clearing any potential contaminants if the patient begins to vomit or experiences airway bleeding.

How to Prevent Complications When Using an NPA

Choose the Correct Airway Tube Size 

Selecting the appropriate size and softness of the NPA is crucial to preventing complications. Oversized tubes can unnecessarily press on the nasal and pharyngeal mucosa, leading to ulcers, bleeding, or other injuries; undersized tubes may not effectively maintain airway patency. Softer materials are preferable for extended use, as they reduce irritation to the nasal walls, lowering the risk of ulcers and infection.

Alternate Between Left and Right Nasal Passages  

For patients requiring long-term NPA use, alternating between the left and right nostrils daily can reduce the risk of tissue damage and ulcers from prolonged pressure on one side, allowing both nasal passages to rest and recover.

Regularly Humidify the Tube and Nasal Passage  

Regular humidification of the NPA and nasal cavity helps maintain mucosal moisture, preventing dryness and irritation. Because dry environments can cause the nasal and pharyngeal mucosa to crack, increasing the likelihood of ulcers and infection. So, using humidifiers, nasal sprays, or saline to alleviate discomfort in the nasal and pharyngeal area.

How to Select the Proper Size for an NPA?

Length: Measure the distance from the patient's nostril to the earlobe. This approximate length helps ensure the NPA's tip reaches the posterior pharyngeal wall without being too long or too short.

Diameter: The airway tube's diameter should match the patient's nostril size to avoid being too tight or too loose. Generally, the diameter should be close to the width of the patient's little finger.

Sizing for Children: Extra care should be taken when selecting an NPA size for children. Smaller-diameter tubes are typically recommended, and the length should be confirmed to avoid excessive length that could irritate.

Adjustment and Testing: It is wise to apply a lubricant before insertion, as it can reduce friction and discomfort. Observe the patient's reaction during insertion to ensure the appropriate fit and maintain an open airway.

Final Thoughts

To ensure the safety and comfort of patients using an NPA, healthcare providers should follow the proper insertion steps, select the correct tube size, and closely monitor the patient's condition. These precautions help reduce complications and improve emergency care outcomes. Selecting high-quality airway management products, like those offered by Bever Medical, provides reliable support for both medical personnel and patients. For more information, please contact our professional team to learn how to choose the right equipment for your emergency needs.