Nasopharyngeal Airway Use Instructions

The nasopharyngeal airway (NPA) is an important tool in maintaining a patient's airway patency and ensuring adequate oxygen supply during medical emergencies and surgical procedures. Nasopharyngeal airway use instructions, intended to be informative and instructive, explain the purpose, size determination, and use instructions of nasopharyngeal airways.

Background Information: What Is the Human Airway

The human airway is a complex system that facilitates the intake and expulsion of air during respiration. It comprises several distinct sections, each with its unique anatomical features and functional roles.

Nasal Cavity

This is the starting point of the respiratory tract, located in the face. The nasal cavity filters, warms, and humidifies inhaled air, reducing the irritants that would otherwise reach the lower respiratory tract. Its intricate structure, including nasal hairs, mucous membranes, and sinuses, contributes to these functions.

Pharynx

Serving as a common passage for both the respiratory and digestive tracts, the pharynx is divided into three main regions: nasopharynx, oropharynx, and laryngopharynx. Each of these regions has specialized roles in swallowing, voice production, and protecting the airway from foreign bodies.

Larynx (Voice Box)

Located below the pharynx, the larynx contains the vocal folds (also known as vocal cords), which are crucial for sound production. Additionally, the larynx acts as a gatekeeper, preventing food and liquids from entering the lungs during swallowing.

Trachea (Windpipe)

The trachea is a rigid, cylindrical tube that connects the larynx to the lungs. It is composed of rings of cartilage reinforced by smooth muscle, which allows it to maintain its shape while also being flexible enough to accommodate changes in air pressure during breathing. The trachea's lining is covered with ciliated epithelium and mucus-secreting glands, which help clear debris and pathogens from the airway.

Bronchial Tree

The trachea branches into the right and left main bronchi upon entering the lungs. These bronchi further divide into smaller and smaller bronchioles, eventually terminating in tiny alveoli where gas exchange occurs. The bronchial tree's intricate branching pattern ensures that air is distributed evenly throughout the lungs. Like the trachea, the bronchi and bronchioles are lined with ciliated epithelium and mucus-producing glands, which are vital for maintaining airway health.

What Is a Nasopharyngeal Airway

A nasopharyngeal airway is designed to be inserted through the nose into the pharynx, effectively bypassing the glottis (vocal cords) to maintain a patent airway and ensure unobstructed breathing. This device is particularly useful in situations where there is an upper airway obstruction, such as from a tongue falling backwards (tongue base obstruction) or other anatomical factors that might compromise the patient's ability to breathe freely.

An illustrative image of a nasopharyngeal airway manufactured by Hangzhou Bever Medical Device Co. Ltd. (www.bevermedical.com)

What Is the Use of a Nasopharyngeal Airway

The primary use of a nasopharyngeal airway is to maintain airway patency and facilitate ventilation in patients with upper airway obstruction. It allows for efficient oxygen delivery and prevents asphyxiation by keeping the airway open.

How to Determine the Length and Size of a Nasopharyngeal Airway

1) Length Determination

One such method is to measure the distance from the tip of the patient's nose to the earlobe and then subtract 1-2 cm. This is a rough estimate and may not be accurate in all cases.

Another approach is to insert the NPA until resistance is felt, indicating that the tip has reached the posterior pharyngeal wall. However, this requires caution to avoid over-insertion, which could cause trauma or discomfort.

2) Diameter Determination

Age and Sex: The patient's age and sex can provide a rough estimate of the nasal and pharyngeal anatomy, which can influence the choice of diameter. For instance, adults tend to have larger airways than children, and males may have slightly larger airways than females on average.

Manufacturers typically provide sizing guidelines or charts that correlate patient age, weight, or other factors with recommended NPA diameters. These recommendations can serve as a starting point for selection.

Insert Different Sizes: Begin by inserting a smaller-diameter NPA and gradually increase the size until an optimal fit is achieved. This process should be done with caution to avoid causing discomfort or injury to the patient.

Nasopharyngeal Airway Use Instructions

I. Pre-Insertion Preparation

Patient Assessment: Prior to insertion, thoroughly assess the patient's level of consciousness, nasal cavity condition, respiratory function, and oxygen saturation. Ensure that there are no contraindications such as nasal fractures, bleeding, infections, or deviated nasal septum, which may complicate the procedure.

Equipment Preparation: Select an appropriately sized NPA based on the patient's age, body size, and nasal cavity dimensions. Gather necessary supplies including water-soluble lubricant, cotton swabs, gauze, adhesive tape, etc.

Environmental Setup: Ensure the insertion environment is clean, well-lit, and free from distractions, creating a comfortable and safe atmosphere for the patient.

II. Insertion Procedure

Nasal Cleaning: Gently clean the patient's nasal cavity with cotton swabs to remove any secretions or debris, ensuring a clear path for NPA insertion.

Lubrication: Apply a liberal amount of water-soluble lubricant to the tip and exterior of the NPA to reduce friction and minimize patient discomfort during insertion.

Positioning: Assist the patient into a supine position with the head slightly extended, enlarging the pharyngeal space to facilitate NPA placement.

Insertion Technique: With one hand, hold the NPA and, with the other, gently press down on the patient's nasal ala to widen the nostril. Insert the NPA along the floor of the nose, aiming for a straight path and avoiding upward insertion towards the nasal bridge to prevent mucosal injury.

Confirmation of Placement: Verify proper placement by observing the patient's respiratory pattern, auscultating lung sounds, and ensuring the NPA is centered within the nasal cavity.

Securing the NPA: Use adhesive tape or ties to secure the NPA to the patient's nasal sidewall, preventing dislodgement or accidental removal.

III. Precautions

Gentle Manipulation: Throughout the procedure, maintain a gentle touch to avoid causing nasal mucosa trauma or bleeding.

Patient Monitoring: Continuously monitor the patient's response, halting the procedure immediately if symptoms such as coughing, respiratory distress, or laryngospasm occur.

Periodic Checks: After insertion, regularly check the NPA's position and the patient's respiratory status, adjusting or replacing the NPA as necessary.

Aseptic Technique: Adhere strictly to aseptic principles to minimize the risk of infection.

IV. Post-Insertion Care

Vital Sign Monitoring: Continuously monitor the patient's vital signs, including respiratory rate and oxygen saturation, ensuring uninterrupted airway patency and oxygen delivery.

Maintaining Patency: Regularly clear any secretions or debris around the NPA to maintain airway patency.

Complication Surveillance: Be vigilant for potential complications such as nasal bleeding or infection, taking prompt action if identified.

Patient Education: Explain the purpose and importance of the NPA to the patient, addressing any concerns or anxieties to enhance treatment compliance.

Conclusion

Nasopharyngeal airway insertion should be handled with skill. A competent skill includes precise techniques, thorough patient assessment, and continuous monitoring. This article presents nasopharyngeal airway use instructions to ensure a safe and effective procedure that yields optimal care for patients.