What Is the Difference Between the Oral And Nasal Airway?

Despite oral tracheal intubation being widely regarded as the preferred airway method, nasal tracheal intubation may be a better choice in specific cases, such as facial injuries or restricted airways. Therefore, healthcare providers must quickly choose right airway management according to the patient's situation. To help you know these two methods better, Bever Medical will share oral and nasal airway management and explain the differences between them.

Oral Airway

An Oral Airway, or Oropharyngeal Airway (OPA), helps keep the patient’s airway open by preventing the tongue from covering the epiglottis. When a patient loses consciousness, an OPA can be inserted to maintain an open airway. However, a conscious patient usually finds it uncomfortable and may attempt to push it out. When inserting an OPA, be cautious if the patient has a history of neck trauma to protect the cervical spine and avoid further injury. Maintaining an open airway is essential in emergency care, so proper use of the OPA is a critical step in ensuring patient safety.

Insertion Steps

1. Preparation

Equipment: Select an appropriately sized OPA, measured from the patient’s earlobe to the corner of the mouth.

Lubrication: Prepare lubricant to assist with insertion.

Personal Protection: Wear gloves and safety goggles. Additional protective gear, such as a mask and gown, may be required for personal safety.

2. Insertion Procedure

Open the Mouth: Use your fingers or a suitable tool to gently open the patient’s mouth, avoiding placing fingers between the teeth to prevent bites.

Insert the OPA: Insert the curved part of the OPA sideways with the tip pointing toward the cheek.

Push the OPA: Gently push the OPA into the patient’s mouth. When you cannot push it further, rotate the OPA 90 degrees so the tip points toward the throat, and continue inserting.

Full Insertion: Use the curve of the tongue, if necessary, to fully insert the OPA, ensuring the flange (the wide, flat end) rests against the patient’s lips for stability.

3. Check Position

Ensure the OPA tip does not push the tongue downward or obstruct the back of the throat. Confirm airway patency to allow effective ventilation.

Precautions

Continuously monitor the patient's breathing and reaction during insertion.

Take extra care if the patient has a history of neck trauma to prevent further injury.

When Are They Used?

Oral airways are typically used when someone is unconscious because their jaw muscles relax, causing the tongue to obstruct the airway. They can also be used during CPR to assist ventilation.

Green Nasopharyngeal Airway

Nasopharyngeal Airway (NPA)

A Nasopharyngeal Airway (NPA), particularly a PVC nasopharyngeal airway, is generally better tolerated in semi-conscious patients or those at risk of airway obstruction from an oropharyngeal airway. However, an NPA should not be used in patients with head and facial injuries.

Insertion Steps

1. Select the Appropriate Size

Measure from the bottom of the nostril to the earlobe to determine the correct NPA size. The NPA’s diameter should be smaller than the patient’s nasal passage.

2. Evaluate Nasal Passage

Check the nasal passage to ensure there is no visible airway obstruction.

3. Lubricate the NPA

Ensure the NPA is adequately lubricated before insertion.

4. Insert the NPA

Insert the NPA into the nostril, guiding it along the nasal floor towards the throat until the wide, flat part of the tube rests against the nostril.

5. Provide Oxygen

If possible, provide supplemental oxygen to improve the patient's oxygenation.

When to Use an NPA?

An NPA is useful for semi-conscious patients who retain reflexes, such as swallowing and coughing, or when an OPA may cause airway blockage. It’s also an effective alternative for patients at risk of airway obstruction from an OPA.

Advantages and Disadvantages

Oral Airway (OPA)

Advantages

Effective Airway Maintenance: The OPA effectively prevents the tongue from sliding backward, ensuring an open airway for unconscious patients.

Ease of Use: OPA insertion is relatively simple, allowing emergency responders to quickly apply it in critical situations.

Broad Applicability: The OPA is widely used in various emergency settings, including trauma, cardiac arrest, and respiratory failure, making it a staple in emergency kits.

Disadvantages

Not Suitable for Conscious Patients: OPAs are only for unconscious patients. Conscious patients often experience significant discomfort and may try to expel it, potentially causing a gag reflex and complicating airway management.

Risk of Vomiting: OPA insertion can stimulate the patient’s throat, potentially causing vomiting in semi-conscious or drowsy patients, which increases the risk of aspiration.

Risk of Facial or Oral Injury: OPA is unsuitable for patients with facial or oral injuries, as it may worsen the condition.

Nasopharyngeal Airway (NPA)

Advantages

Suitable for Patients with Reflexes: NPAs are better for semi-conscious patients who retain reflexes such as swallowing or coughing, effectively maintaining airway patency.

Better Tolerance: Since the NPA is inserted through the nose and doesn’t stimulate the throat directly, conscious patients often tolerate it better, reducing interference with airway management.

Safer for Certain Situations: NPA is safer for patients with facial or oral injuries as it enters through the nose, avoiding further trauma to the mouth or face.

Disadvantages

Not for Patients with Head or Facial Trauma: If a patient has head or facial trauma, especially with a risk of basilar skull fracture, using an NPA could potentially drive the tube into the cranial cavity, leading to serious complications.

Inserting Technique Requirements: Inserting an NPA requires skill and experience to avoid damaging nasal structures, especially in patients with narrow or obstructed nasal passages.

Possible Nasal Bleeding: Improper insertion or lack of experience can cause nasal bleeding, making airway management more challenging.

Conclusion

Both the Oral Airway (OPA) and Nasopharyngeal Airway (NPA) have unique advantages and suitable scenarios. Proper selection and technique can help healthcare providers rapidly maintain an open airway in emergencies, improving rescue success rates. Bever Medical offers a range of reliable and safe OPA and NPA tools, dedicated to supporting healthcare providers in achieving efficient, professional airway management in various emergency situations. To learn more or to order products, please visit the Bever Medical official website and ensure your emergency equipment meets the highest standards.