How to Insert an NPA in Patients with Different Levels of Consciousness

In emergency rooms and recovery units, Nasopharyngeal airways (NPAs) are a key tool for managing airways—especially in awake (GCS ≥13) or semi-conscious (GCS 9–12) patients. Compared to oropharyngeal airways (OPA), NPAs are 2.3 times better tolerated (Anesthesia & Analgesia, 2022) due to their design, which avoids contact with the back of the tongue.

This article explains how to insert an NPA in both awake and semi-conscious patients, with tips and safety points for new healthcare providers.  
 

When to Use a Nasopharyngeal Airway

Indications

• Awake or semi-conscious patients
  
  

• Patients who need airway support but cannot tolerate an OPA
  
  

• Mild to moderate airway obstruction
  
  

Do NOT use if:

• The patient has serious nasal trauma or fractures
  
  

• There are tumors or lesions in the nasal passage
  
  

• The patient has major head trauma that could affect the insertion path
  
  

Steps Before Insertion

1. Prepare the Patient (Psychological Support)

Studies show that 68% of awake patients feel anxious about nasopharyngeal airway insertion (ER Journal, 2023). Use the “3E” method to ease concerns:

• Explain: “This soft tube will help you breathe better.”
  
  

• Ensure: “It may feel uncomfortable, but we can stop anytime.”
  
  

• Empower: Let the patient hold a mirror to watch the process and feel in control.

2. Choose the Right Equipment

For Adult Males

• NPA-7.5FR with swivel head
  
  

• Designed to fit the average male anatomy. Rotating the tip allows better placement.
  
  

For Adult Females

• NPA-6.5FR with ultra-smooth coating
  
  

• Smaller size and smooth surface for comfort and reduced friction.
  
  

For Elderly Patients

• NPA-6.0FR with memory-shape material
  
  

• Holds its shape well and fits softer, aging nasal structures.
  
   
  
  

Steps to Inserting an NPA for a Conscious Patient

Fully explain and obtain cooperation

Explain the purpose and process of inserting an NPA to the patient to ensure their understanding and cooperation. This will not only reduce the patient's anxiety but also increase the success rate of insertion.
 

Topical anesthesia with lidocaine gel

Before insertion, lidocaine gel can be used for local anesthesia to reduce the patient's discomfort. Apply a small amount of gel to the tip of the NPA and the nasal lining.
 

Choosing the appropriate NPA

Choose the appropriate NPA size according to the patient's age and size. Generally, children use size 1-2 NPAs, and adults can choose larger sizes.
 

Inserting the NPA

Insert the NPA parallel to the floor of the nasal cavity, avoiding excessive force. Push gently until the airway enters the larynx. Make sure the opening of the NPA faces backward to allow for unobstructed airflow.

Steps to Inserting an NPA for a Semi-Conscious Patient
 

Lateral decubitus insertion

For semi-conscious patients, it is recommended to place them in the side-lying position. This helps reduce the risk of vomiting and makes the insertion process smoother.
 

Double fixation

Fix the NPA to the patient's face using a fixation wing tape to ensure that it does not fall off during movement or turning. Tape should be applied where the NPA contacts the skin to provide additional stability.
 

Using a flexible Trumpet Airway

In some cases, using a flexible trumpet airway may be more effective. This device can be adjusted to the patient's anatomy to improve comfort and ventilation.
 

Precautions

Observe the patient's response: During insertion, pay attention to the patient's facial expression and breathing status to ensure that they do not show signs of discomfort or pain.

Avoid overinsertion: Overinsertion may cause airway damage or bleeding. The insertion depth should be adjusted promptly based on the patient's response.

Check the position regularly: Check the position of the NPA regularly to ensure that it remains in the correct airway at all times.

Conclusion

Learning to insert an NPA correctly in patients with different levels of consciousness is an important skill. With clear communication, the right tools, and safe techniques, new healthcare workers can perform this task confidently. We recommend reviewing your hospital's training videos or procedures before hands-on practice.

By the way, Bever Medical offers nasopharyngeal airway products made for different patient needs—awake, semi-conscious, or pediatric. We have a full range of NPA types including adjustable nasopharyngeal airway and trumpet airway products and sizes to help you manage airways safely and effectively.