Nasopharyngeal Airway Use in Elderly Patients

A nasopharyngeal airway (NPA) can enhance breathing, but additional caution is required when using it in elderly patients. This guide offers healthcare experts and caregivers expert advice on the safe selection and insertion of NPAs for elderly patients, covering distinctive types such as trumpet-shaped and adjustable models.

Considerations for Using NPAs in Elderly Patients

Anatomical Changes in Aging Airways

With age, the nasal cavity and pharynx experience basic changes, including mucosal atrophy, nasal septum deviation, and expanded vascular delicacy, making elderly patients more inclined to bleeding. The legitimate method is significant to maintain a strategic distance from damage and complications.

 

Common Indications

1. Tongue Retraction: Reduced muscle tone in elderly patients may cause the tongue to fall back, partially blocking the airway. An NPA helps lift the tongue and maintain airflow.

2. Mild Airway Obstruction: During sleep or sedation, upper airway resistance may increase, leading to partial obstruction. An NPA can help keep the airway open and improve breathing.

3. Postoperative Recovery: After general anesthesia or sedation, patients are at risk of airway obstruction. An NPA ensures a clear airway during recovery, reducing complications. 
   
   

Contraindications

1. Severe Nasal Trauma: Using an NPA in patients with severe nasal trauma may worsen the injury or cause bleeding. These patients require careful evaluation.

2. Coagulation Disorders: Patients with bleeding disorders have a higher risk of nasal bleeding when using an NPA. Alternative airway management strategies should be considered.

3. Basilar Skull Fracture: Inserting an NPA in these patients risks intracranial placement, which can be life-threatening. NPAs should be strictly avoided in such cases. 
   
   

Advantages Of Oropharyngeal Airways (OPA)

Compared to OPAs, NPAs offer key benefits:

• Better Tolerance: NPAs are more comfortable for patients with an intact gag reflex.

• Allows Suctioning: NPAs facilitate effective suctioning to keep the airway clear. 
  
  

Choosing the Right NPA for Elderly Patients

Standard Nasopharyngeal Airway

• Material: Soft silicone NPAs are gentler on nasal mucosa than PVC ones, making them ideal for elderly patients with fragile nasal passages.

• Size: Choose the appropriate length by measuring from the nostril to the earlobe. Smaller sizes help reduce discomfort in elderly patients. 
  
  

Trumpet Airway

• Advantages of the Flared End: The trumpet airway reduces airway resistance, benefiting patients with chronic obstructive pulmonary disease (COPD).

• Insertion Considerations: Avoid excessive pressure on the nasal vestibule to prevent pressure sores or tissue damage.  
  
  
  

Adjustable Nasopharyngeal Airway

Adjustable nasopharyngeal airway allows customizable length that accommodates anatomical variations in elderly patients. And anti-slip mechanisms prevent dislodgement, making them suitable for agitated or uncooperative patients.

Key Techniques for Safe Insertion

Preparation

Apply a water-soluble lubricant or local anesthetic to reduce discomfort and bleeding risk.

Insertion Steps

• Patient Positioning: Place the patient in a supine position with a slight head tilt to align the nasal passage.

• Select the Nostril: Use the more open nostril for insertion.

• Insertion Technique: Insert the NPA vertically along the nasal floor, then rotate 90° and advance gently. Avoid forceful insertion to prevent damage to fragile nasal structures.

• Verify Placement: Confirm correct positioning by checking breath sounds, observing chest movement, or using capnography. 
  
  

Depth Adjustment for Adjustable NPAs

Adjust the length based on anatomical landmarks, ensuring the distal tip aligns with the thyroid cartilage for effective airway management. 

Preventing and Managing Complications

1. Nasal Bleeding: Use soft, narrow NPAs and assess coagulation status before insertion. Consider prophylactic hemostatic measures if needed.

2. Mucosal Injury or Ulcers: For long-term use, inspect nasal mucosa regularly and manage any tissue damage promptly.

3. Intracranial Placement Risk: Strictly avoid NPAs in patients with suspected basilar skull fractures.

4. Aspiration Prevention: Avoid inserting NPAs in patients with a full stomach. Combine with suctioning if necessary. 
   
   

Conclusion

Using an NPA in elderly patients requires cautious thought of their special anatomical and physiological changes to guarantee security and effectiveness. Whether selecting a standard, trumpet-shaped, or adjustable model, appropriate choice, insertion technique, and complication management are essential. By following these guidelines, healthcare suppliers can optimize airway management and minimize risks. Bever Medical offers high-quality NPAs in various models designed to meet the different clinical needs of elderly patients.