P R OC E D UR E 1 0

Nasopharyngeal Airway Insertion

Kirsten N. S killings and Bonnie L. Curtis

PURPOSE:
Nasopharyngeal airways are used to maintain a patent airway to the hypopharynx and to facilitate the removal of
tracheobronchial secretions by directing the catheter and by averting tissue trauma that is associated with
repeated suction attempts.4

PREREQUISITE NURSING KNOWLEDGE

• Nasopharyngeal airways are passed through the nose and follow the posterior nasal and oropharyngeal walls to the
base of the tongue (Fig. 10-1).3

FIGURE 10-1 Nasopharyngeal airw ay. A, Airw ay parts. B, Proper placement. (From Eubanks DH, Bone RC: Comprehensive respiratory care: a learning system, St Louis,
1990, Mosby, 518.)

• The nasopharyngeal airway has three parts: the flange, cannula, and bevel or tip. The flange is the wide trumpet-like
end that prevents further slippage into the airway. The hollow shaft of the cannula permits airflow into the
hypopharynx. The bevel or tip is the opening at the distal end of the tube. When properly inserted, and the correct
size, the tip can be seen resting posterior to the base of the tongue.
• The external diameter of the nasopharyngeal airway should be slightly smaller than the patient’s external nares
opening. The length of the nasopharyngeal airway is determined by measuring the distance between the naris and the
tragus of the ear (Fig. 10-2).2 Improperly sized nasopharyngeal airways may result in increased airway resistance,
limited airflow (if the airway is too small), kinking and mucosal trauma, gagging, vomiting, and gastric distention (if
the airway is too large). Some manufacturers provide nasopharyngeal airways shaped specifically for the right and left
nares.
 FIGURE 10-2 A, Estimating nasopharyngeal airw ay size. B, Nasopharyngeal position after insertion. (From Eubanks DH, Bone RC: Comprehensive respiratory care: a
learning system, St Louis, 1990, Mosby, 552.)

• The advantages of the nasopharyngeal airway include increased comfort and tolerance in a conscious patient, stable
airway positioning for long periods, decreased incidence of gag reflex stimulation, and minimal incidence of mucosal
trauma during frequent suctioning.
• Nasopharyngeal airways are especially useful for relieving airway obstruction associated with mandibular-type injuries
that result in jaw immobility or soft tissue obstruction. Examples of these injuries include jaw wiring, trismus, pain,
edema, jaw spasms, and mechanical impairment such as temporomandibular joint fractures and zygomatic fractures.
In selected patient situations, a nasopharyngeal airway may be used to facilitate the passage of a fiberoptic
bronchoscope and to tamponade small bleeding blood vessels in the nasal mucosa.
• Insertion of the nasopharyngeal airway in an alert patient may stimulate the gag reflex and cause retching and
vomiting.
• The nasopharyngeal airway is used most commonly in the postanesthesia recovery period to facilitate pulmonary
toilets and in situations in which the patient is semiconscious.
• Contraindications to use of a nasopharyngeal airway are as follows:
Patients undergoing anticoagulation or antiplatelet therapy
Patients prone to epistaxis
Patients with obstructed nasal passageways
Patients with facial or head trauma when basilar skull fracture or cranial vault communication is suspected

EQUIPMENT
• Appropriately sized nasal airway (Table 10-1)

TABLE 10-1
Nasopharyngeal Airway Sizing

Approximate Body Weight Size (mm)

Small adult 6 to 7
Medium adult 7 to 8
Large adult 8 to 9

(From Cummins RO, editor: Airway, airway adjuncts, oxygenation, and ventilation. In ACLS: principles and practice, Dallas, 2003, American Heart Association, 145-
146.)

• Nonsterile gloves
• Water-soluble lubricant
• Suction equipment
• Flashlight
• Tongue depressor
PATIENT AND FAMILY EDUCATION
• Explain the purpose of the airway and the necessity of the procedure to conscious patients or to the family of an
unconscious patient. Rationale: Communication and explanation regarding therapy are cited as important needs of
patients and families to relieve anxiety and encourage communication.
• Explain the patient’s role in assisting with insertion of the airway. Rationale: Patient cooperation is elicited, and tube
insertion is facilitated.
• Discuss the sensory experiences associated with nasal airway insertion, including the presence of an airway in the nose
and possible gagging. Rationale: Knowledge of anticipated sensory experiences reduces anxiety and distress.

PATIENT ASSESSMENT AND PREPARATION

Patient Assessment
• Verify correct patient with two identifiers. Rationale: Prior to performing a procedure, the nurse should ensure the
correct identification of the patient for the intended intervention.
• Assess cardiopulmonary status. Rationale: Evaluation of the patient’s cardiopulmonary status assists in determining
the need for an artificial airway.
• Assess pain according to institution standard. Rationale: This assessment identifies the need for discomfort
management.
• Assess patent nasal passageway. With finger pressure, occlude one nostril; feel for air movement under the open
nostril. Patency also can be assessed with inspection of each naris with a flashlight. Rationale: Assessment of
patency promotes smooth, quick, unobstructed airway insertion.
• If a difficult insertion is anticipated (e.g., with nasal polyps, septal deviation), contact the practitioner for an order to
apply a topical anesthetic to coat the nasal passageway. Rationale: Topical anesthetics with a vasoconstrictor help
shrink nasal mucosa and decrease the incidence of trauma and bleeding. Vasoconstrictor property acts on capillaries
to decrease bleeding.

Patient Preparation
• Ensure that the patient understands preprocedural teachings. Answer questions as they arise, and reinforce
information as needed. Rationale: This step evaluates and reinforces understanding of previously taught
information.
• Position the patient. Unless contraindicated, a supine or high Fowler’s position is acceptable. Rationale: This
positioning promotes patient and nurse comfort and provides easy access to the external nares.
Procedure for Nasopharyngeal Airway Insertion
References
 1. American Association of Respiratory Care and Clinical Practice Guidelines, Nasotracheal suctioning, revision
and update. 2004. American Association of Respiratory Care: Irving, TX.
2. Cummins, RO. Airway, airway adjuncts, oxygenation, and ventilation. In: In ACLS: principles and practice. Dallas:
American Heart Association; 2006:145–146.
3. Eubanks, DH, Bone, RC, Comprehensive respiratory care. a learning system. Mosby, St Louis, 1990:491–495.
4. Pierce, LNB. Management of the mechanically ventilated patient, ed 2. St Louis: Saunders; 2007.

Additional Readings
Roberts, K, Whalley, H, Bleetman, A, The nasopharyngeal airway. dispelling myths and establishing the fac ts. J Emerg Med 2005; 22:394–396.
S t. John RE, S ec kel, MA, Airway managementBurns S M, ed.. AACN protoc ols for prac tic e. c are of the mec hanic ally ventilated patient. ed 2. 2007. Jones and
Bartlett Publishers: S udbury, MA.