What is the Nasopharyngeal Airway?
The
nasopharyngeal airway (NPA) is a type of airway adjunct used to maintain an open airway in patients. It is a flexible tube that is inserted into the nostril and extends to the nasopharynx, bypassing any obstructions in the nasal passage. This device is especially useful in patients who are semi-conscious or have facial trauma that precludes the use of an oropharyngeal airway.
Indications for Use
The primary
indications for using an NPA include situations where the patient has a reduced level of consciousness, but retains some ability to protect their airway. It is also indicated for patients who have a gag reflex, making an oropharyngeal airway unsuitable. Additionally, NPAs are used in trauma patients with facial or oral injuries, where other airway adjuncts might exacerbate the condition.
Contraindications
There are several
contraindications to consider before inserting an NPA. These include recent nasal surgery, severe facial trauma, and the presence of nasal polyps or other obstructions. Patients with a known or suspected skull fracture should not receive an NPA due to the risk of intracranial insertion.
Insertion Technique
Proper
insertion technique is crucial for the effective use of an NPA. The nurse should first select the appropriate size of the airway adjunct by measuring from the patient’s nostril to the earlobe. Lubrication is essential to minimize discomfort and reduce the risk of nasal trauma. The NPA should be inserted gently, with the bevel facing the septum, and advanced along the floor of the nasal cavity until the flange rests against the nostril.
Complications
While generally safe, the use of an NPA can be associated with several
complications. These include nasal trauma or bleeding, sinusitis, and potential misplacement into the esophagus. In rare cases, the tube can cause airway obstruction if it is too long or improperly positioned.
Patient Monitoring
Continuous
patient monitoring is essential when an NPA is in place. Nurses should regularly assess the patient's respiratory status, including rate, depth, and effort of breathing. Observing for signs of discomfort or nasal bleeding is also important. The NPA should be secured properly and checked frequently to ensure it remains in the correct position.
Removal and Care
The
removal of an NPA should be performed with care to avoid causing trauma to the nasal passages. Gentle traction is applied while the tube is rotated to minimize resistance. After removal, the patient’s nasal passages should be inspected for any signs of bleeding or injury. Proper documentation of the procedure and any complications is also essential.
Conclusion
In summary, the nasopharyngeal airway is a valuable tool in the nursing toolkit for maintaining airway patency in certain patient populations. Understanding the indications, contraindications, insertion techniques, and potential complications are paramount for effective and safe use. Continuous monitoring and proper care during and after the procedure ensure optimal patient outcomes.
