Nasopharyngeal Airway (NPA) Guide

Introduction

Effective airway management is essential in emergency, anesthesia, and critical care. A Nasopharyngeal Airway (NPA) is a soft, flexible tube inserted through the nose to maintain a patent airway. Unlike oropharyngeal airways, NPAs are better tolerated by conscious or semi-conscious patients, making them ideal in pre-hospital and hospital settings. 

Indications and Contraindications

Indications

NPA is indicated when:

• Upper airway obstruction occurs due to tongue or soft palate collapse
• OPA is not tolerated due to gag reflex
• Mouth opening is limited (trauma, trismus, fixation)
• Temporary airway maintenance is needed before intubation
• Continuous suctioning or oxygen delivery via nasal passage is required
   

Contraindications

Avoid NPA in:

• Suspected basilar skull fracture or CSF leak
• Severe facial or nasal trauma
• Coagulopathy or bleeding disorders
• Nasal obstruction, polyps, or infection

Inserting an NPA in patients with skull fractures can risk intracranial placement.

Preparation and Equipment

Essential Equipment

• Sterile NPAs (various sizes)
• Water-based lubricant or lidocaine gel
• Suction apparatus and catheters
• PPE (gloves, mask, goggles)
• Monitoring equipment (pulse oximeter, ECG, capnography)
• Tape or fixation device 
  
  

Choosing the Correct Size

• Length: Nostril to earlobe or jaw angle
• Diameter: Slightly smaller than nostril opening
• If uncertain, start with a smaller size to avoid trauma 
  
  

Step-by-Step Insertion Technique

• Hand hygiene and protective gear
• Inspect nostrils, select the more patent side
• Lubricate the NPA generously
• Position patient (neutral or sniffing, avoid neck extension if spinal injury suspected)
• Insert gently along the nasal floor, bevel facing septum
• If resistance occurs, withdraw and try the opposite nostril
• Confirm placement: airflow, chest rise, breath sounds, oxygen saturation
• Secure with tape or fixation strap
• Document size, side, time, and patient tolerance 
  
  

Monitoring and Ongoing Care

• Assess airway patency, breathing pattern, and oxygenation
• Check for bleeding, blockage, or displacement
• Suction secretions as needed
• Maintain hygiene and replace NPAs if prolonged use

Potential Complications

• Epistaxis: prevent with lubrication and gentle insertion
• Nasal tissue injury: avoid force, alternate nostrils
• Tube blockage: regular suctioning
• Dislodgement: secure properly
• Sinus infection: replace periodically
• Vagal stimulation: monitor depth, adjust as needed
• Intracranial insertion: avoid in skull fracture patients

Most complications are minor and preventable with proper technique and monitoring. 

Removal and Follow-Up

Remove when:

• Patient regains airway reflexes
• Active bleeding, discomfort, or infection occurs
• NPA is damaged or no longer needed

Removal steps:

• Explain to patient if conscious
• Gently withdraw while supporting nostril
• Observe for bleeding or respiratory distress
• Document removal and patient status
  
  

BEVER Medical Nasopharyngeal Airways

• BEVER Medical NPAs are designed for safe, gentle, and reliable airway management.
• Made from medical-grade PVC or silicone
• Multiple sizes for adult, pediatric, and elderly patients
• ISO 13485, CE, FDA-certified
• OEM customization available

BEVER Medical NPAs support healthcare professionals in maintaining safe, effective airway access, ensuring every breath counts. 

Conclusion

The Nasopharyngeal Airway is a simple yet essential tool for maintaining airway patency in semi-conscious or compromised patients. Proper size selection, gentle insertion, and ongoing monitoring are key to safe and effective use.