NPAs should not be used on patients who have nasal fractures or an actively bleeding nose. In some cases, slight bleeding may occur when you insert the airway, which can be suctioned or wiped away. Be gentle when inserting either an oropharyngeal or nasopharyngeal airway.
What should I know about NPAs before using them?
NPAs should not be used on patients who have nasal fractures or an actively bleeding nose. In some cases, slight bleeding may occur when you insert the airway, which can be suctioned or wiped away. Be gentle when inserting either an oropharyngeal or nasopharyngeal airway.
What is an NPA used for in nursing?
Nasopharyngeal airways are also used to keep the airway open and can be used with patients who are conscious or semi-conscious. For example, semi-conscious patients may need an NPA because they are at risk for airway obstruction but cannot have an OPA placed due to an intact gag reflex.
When should you not use an OPA on a patient?
Patients that can cough still have a gag reflex and an OPA should not be used. If the patient has a foreign body obstructing the airway, an OPA should also not be used. NPAs should not be used on patients who have nasal fractures or an actively bleeding nose.
When should NPAs not be used on patients with nasal fractures?
NPAs should not be used on patients who have nasal fractures or an actively bleeding nose. In some cases, slight bleeding may occur when you insert the airway, which can be suctioned or wiped away.
When should a nasopharyngeal airway not be used?
Absolute contraindications for NPA and NT intubation include signs of basilar skull fractures, facial trauma, and disruption of the midface, nasopharynx or roof of the mouth.
Can you use NPA on unconscious patient?
Only use an OPA in unresponsive individuals with NO cough or gag reflex. Otherwise, an OPA may stimulate vomiting, laryngeal spasm, or aspiration. An NPA can be used in conscious individuals with intact cough and gag reflex. However, use carefully in individuals with facial trauma due to the risk of displacement.
When should you not consider the use of an oropharyngeal airway OPA?
Avoid using an oropharyngeal airway on a conscious patient with an intact gag reflex. If the patient can cough, they still have a gag reflex, and an oral airway is contraindicated. If the patient has a foreign body obstructing the airway, an oropharyngeal airway should not be used.
When should you insert a nasopharyngeal airway?
Nasopharyngeal airways can be used in some settings where oropharyngeal airways cannot, eg, oral trauma or trismus (restriction of mouth opening including spasm of muscles of mastication). Nasopharyngeal airways may also help facilitate bag-valve-mask ventilation.
Which of the following is a contraindication for the use of a nasopharyngeal airway quizlet?
Contraindications to a nasopharyngeal airway include (I)anticoagulation, (2)basilar skull fracture, (3)pathology, sepsis, or deformity of the nasal cavity or nasopharynx, and (4)a history of nosebleeds requiring medical treatment.
What is the most serious potential complication of a nasopharyngeal airway insertion into a patient with facial trauma?
Cribriform insertion is perhaps the most catastrophic complication of a nasopharyngeal airway, but it is also the least likely. Improper technique can cause the tube to enter the cribriform plate, causing soft tissue or skull damage, and potentially even penetrating the brain.
In which of the following patients would a nasopharyngeal airway be contraindicated?
Rationale: Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.
Which patient is appropriate to use an oropharyngeal airway?
Use an oropharyngeal airway only if the patient is unconscious or minimally responsive because it may stimulate gagging, which poses a risk of aspiration. Nasopharyngeal airways are preferred for obtunded patients with intact gag reflexes.
What is a potential complication of using a nasopharyngeal airway that is too long quizlet?
What happens if the nasopharyngeal airway is too long? -It would enter either the larynx and aggravate laryngeal reflexes or enter the space between the epiglottis and the vallecula leading to potential obstruction of the airway.
What would be a contraindication to inserting an oropharyngeal airway in a patient?
Contraindications. Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated. Patients that can cough still have a gag reflex and an OPA should not be used. If the patient has a foreign body obstructing the airway, an OPA should also not be used.
Which of the following is true concerning the procedure for inserting a nasopharyngeal airway NPA )?
Which of the following is true concerning the procedure for inserting a nasopharyngeal airway (NPA)? The bevel should be turned toward the nasal septum.
Can nurses insert nasopharyngeal airway?
2.1 The Registered Nurse (RN), Registered Psychiatric Nurse (RPN), Graduate Nurse (GN), Graduate Psychiatric Nurse (GPN) will insert, maintain, remove and suction a nasopharyngeal airway (NPA).
Which medicine is best for unconscious patient?
SubstancesAntidotes.Benzodiazepines. Flumazenil.
What is the first step to take if a patient is unconscious?
If a person is unconscious or has a change in mental status, follow these first aid steps: Call or tell someone to call 911 or the local emergency number. Check the person's airway, breathing, and pulse frequently. If necessary, begin CPR.
What is the treatment for an unconscious casualty?
If the person is unconscious but still breathing, put them into the recovery position with their head lower than their body and call an ambulance immediately. Continue watching the patient to ensure they don't stop breathing and continue to breathe normally.
What to do if a patient is unconscious nursing?
OverviewCheck the person's airway, breathing, and circulation.If you do not think there is a spinal injury, put the person in the recovery position: Position the person lying face up. Turn the person's face toward you. ... Keep the person warm until emergency medical help arrives.
Why use NPA?
Enhancing Healthcare Team Outcomes . There are many reasons why an NPA would be utilized and/or why nasal intubation can be beneficial and sometimes the only route for intubation. An NPA should be part of everyone healthcare provider’s arsenal for basic airway management.
What is a NPA?
A nasopharyngeal airway device (NPA) is a hollow plastic or soft rubber tubes that a healthcare provider can utilize to assist with patient oxygenation and ventilation in patients who are difficult to oxygenate or ventilate via bag mask ventilation, for example. NPAs are passed into the nose and through to the posterior pharynx.
What is a nasopharyngeal airway device?
While nasopharyngeal airway devices are airway adjuncts for patients that are difficult to ventilate and oxygenate, they only act as a bridge to either a stabilized patient that is breathing without aid or a patient that requires a secure airway via endotracheal or nasotracheal (NT) intubation.
What is an OPA device?
If there is continued difficulty at delivering breaths, then airway adjuncts like an oral pharyngeal airway (OPA) device or nasopharyngeal airway (NPA) can be useful for maintaining a patent airway to allow delivery of breaths in an unresponsive patient.
What are the advantages of NT intubation?
Other advantages include the patient’s inability to bite or manipulate the tube, better patient tolerance, decrease salivation, and better access to patient oral care. In addition, the NT tube is much more stable as it has the entire nasal tract holding it in place versus the endotracheal tube that flops out the mouth and can easily dislodge or become inserted into the right mainstem bronchus in the lungs.
How big is a NPA?
Adult sizes range from 6 to 9 cm. Sizes 6 to 7 cm should be considered in the small adult, 7 to 8 cm in the medium size adult, and 8 to 9 cm in the large adult. If the healthcare provider is unsure of which size to use, and there is time to assess which size to use, then the provider can place the NPA at the nasal opening and orient it down toward the angle of the mandible. If the NPA goes past the mandible, then it is too long, and if it does not reach the mandible, it is too short.
When should NT intubation be considered?
In an emergency setting, the healthcare provider should consider NT intubation when the patient presents with a strong gag reflex, limited mouth opening, macroglossia, cervical spine instability, severe cervical kyphosis, severe arthritis, intraoral masses, structural abnormalities, trismus, or angioedema. In the pre-operative setting, NT intubation should be considered in patients requiring maxillofacial surgery or dental procedures. [5][6]
How to teach NPA?
In teaching the use of the NPA, focus needs to shift from fear of contraindications to methods of safe placement to avoid intracranial placement. This needs to emphasise lifting the nares to reveal the nasal airway and the placement of the NPA parallel to the nasal floor, rather than upwards towards to the cribriform plate of the ethmoid bone. Lubrication, gentle rotation of the NPA and trying both nostrils are further methods that will ease insertion. These will reduce any risk of the often quoted but very infrequent complication of intracranial tube placement.
What is the important factor in sizing a NPA?
Thus the important factor in sizing a NPA is not the width of the tube, but rather the length. In the study Stoneham clearly identified a relationship between nares—epiglottis (N-E) distance and subject height. 120 adult caucasian subjects, under general anaesthesia, had their N-E distance measured.
Why is the nasopharyngeal airway used?
This may be due to fears over intracranial placement in cases of possible basal skull fracture.
What is NPA equipment?
The NPA is a simple piece of equipment that is easy to use and cheap. It is effective and has advantages over the OPA but appears to be used less frequently.
How to size an NPA?
Widely taught 3,4 methods of sizing an NPA include comparing an NPA to the width of the patients little finger or nares. In paediatric practice it is also taught that an appropriate NPA will blanch the nares. 5
How many abstracts are there in the NPA?
The results identified 494 abstracts. Papers in English that reviewed indications and/or contraindications to NPA use and those that discussed methods of sizing NPAs were selected for review. The level of evidence for each paper referred to is presented where appropriate. (Level I, Strong evidence from at least one systematic review of multiple well-designed randomised controlled trials. Level II, Strong evidence from at least one properly designed randomised controlled trial of appropriate size. Level III, Evidence from well-designed trials such as non-randomised trials, cohort studies, time series, or matched case-controlled studies. Level IV, Evidence from well-designed non-experimental studies from more than one centre or research group. Level V, Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees.)
What is an OPA?
The nasopharyngeal airway (NPA) is a simple airway adjunct used in a number of healthcare disciplines, by staff trained to varying levels of competence in airway management. It has advantages over the oropharyngeal airway (OPA) as it can be used in patients with an intact gag reflex, trismus or oral trauma.
How to use OPA?
There are some general precautions to take when using an OPA or NPA: 1 Always check spontaneous respirations immediately after insertion of either an OPA or NPA 2 If respirations are inadequate or absent, start positive-pressure ventilations immediately using an appropriate device 3 If adjuncts are unavailable, use mouth-to-mask barrier device ventilation
Why do you rotate the NPA tube?
Slightly rotate the NPA tube to facilitate insertion at the angle of the nasal passage and nasopharynx.
What is a Nasopharyngeal Airway?
A nasopharyngeal airway, also referred to as an NPA, is a type of basic airway adjunct. The nasopharyngeal airway tube is designed to be inserted into the nasal passageway to help secure an open airway.
How to determine the correct size of nasopharyngeal airway?
The correct size of a nasopharyngeal airway is chosen by measuring the device on the patient. Healthcare providers will compare the outer circumference of the nasopharyngeal airway with the inner aperture of the nares. The device should reach from the patient’s nostril to the earlobe along the angle of the jaw.
How many steps are needed to insert a nasopharyngeal airway?
Inserting a nasopharyngeal airway once healthcare providers have selected the proper size entails just three steps:
How to maintain a patient's head tilt?
Healthcare providers will need to reevaluate the patient frequently and maintain head tilt by providing anterior displacement of the mandible using a chin lift or jaw thrust. Blood, vomit, mucus, or the soft tissues of the pharynx can obstruct the nasopharyngeal airway, which has a small internal diameter. Therefore, frequent evaluation and suctioning of the patient’s airway may be necessary to ensure patency.
When inserting a nasopharyngeal airway in patients with facial trauma, should you?
Use caution when inserting a nasopharyngeal airway in patients with facial trauma because of the risk of misplacement into the cranial cavity through a fractured cribriform plate.
Where should an NPA be inserted?
An NPA should be inserted with the bevel pointing towards the septum and following the natural curvature of the floor of the nasal cavity as it is advanced. Adequate application of a water-based lubricant to the outside of the NPA can facilitate a less traumatic insertion.
Why do you need an OPA?
As described, the main indication for use of an OPA is if a patient is at risk of airway obstruction due to relaxed upper airway muscles or blockage of the airway by the tongue. For example, if you perform a head tilt-chin lift maneuver or jaw thrust on a patient to open their airway and are not able to ventilate the patient successfully, ...
What is the OPA in medical terms?
An oropharyngeal airway (OPA) is also known as an oral airway or Guedel pattern airway or simply Guedel airway (named after the original designer Arthur Guedel). 2 The nasopharyngeal airway (NPA) is also called a nasal airway, NPAT (nasopharyngeal airway tube), or nasal trumpet. Either device can be used depending on the indications for use and patient circumstances.
Why do we need nasopharyngeal airways?
Nasopharyngeal airways are also used to keep the airway open and can be used with patients who are conscious or semi-conscious. For example, semi-conscious patients may need an NPA because they are at risk for airway obstruction but cannot have an OPA placed due to an intact gag reflex. Polyvinyl chloride nasopharyngeal airway tubes (NPATs) are readily available and are commonly used by anesthesia providers for patients either during induction or in the immediate postoperative period to help prevent obstruction of the airway. 8 NPAs may also work well for patients who are clenching their jaw, which makes inserting an oral airway difficult, and for those who are semi-conscious and need frequent nasal-tracheal suctioning.
What happens if an OPA is too small?
Although airways are simple to use, it is important to select an appropriate size. If the airway is too small, its distal end will be obstructed by the tongue, resulting in inadequate ventilation. 3 Radiographic assessment of the position of OPAs also demonstrated that the distal end of the airway may lodge in the vallecula or can be obstructed by the epiglottis. 5 If the OPA is too large, there is a risk of traumatic injury to the surrounding laryngeal structures 3, and possibly laryngospasm. 5
How to avoid trauma to the tongue?
Avoid forcing an oropharyngeal airway, which can lead to trauma to the lips and tongue. Use caution when twisting the oropharyngeal 180 degrees to avoid trauma along the hard palate. Use a water-soluble lubricant when inserting a nasopharyngeal airway.
How to determine OPA?
There are two common facial measurements recommended for determining the proper sized OPA: the distances between the maxillary incisors to the angle of the mandible, and the distance from the corner of the mouth to the angle of the mandible.
When to use NPA?
It is used as an alternative to an OPA in individuals who need a basic airway management adjunct. Unlike the oral airway, NPAs may be used in conscious or semiconscious individuals (individuals with intact cough and gag reflex). The NPA is indicated when insertion of an OPA is technically difficult or dangerous.
Why should OPA not be used in a conscious or semiconscious individual?
An OPA should not be used in a conscious or semiconscious individual, because it can stimulate gagging, vomiting, and possible aspiration.
What is an OPA device?
The OPA is a J-shaped device that fits over the tongue to hold the soft hypopharyngeal structures and the tongue away from the posterior wall of the pharynx. OPA is used in individuals who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle. A properly sized and inserted OPA results in proper alignment with the glottis opening. If efforts to open the airway fail to provide and maintain a clear, unobstructed airway, then use the OPA in unconscious victims. An OPA should not be used in a conscious or semiconscious individual, because it can stimulate gagging, vomiting, and possible aspiration. The key assessment to determine if an OPA can be placed is to check if the individual has an intact cough and gag reflex. If so, do not use an OPA.
How long should you suction a patent airway?
Providers should suction the airway immediately if there are copious secretions, blood, or vomit. Attempts at suctioning should not exceed 10 seconds.
Can you give 100% oxygen while suctioning?
Keep in mind that the individual is not receiving 100% oxygen while suctioning. Interrupt suctioning and administer oxygen if any deterioration in clinical picture is observed during suctioning.
Can OPA be used for cough?
Only use an OPA in unresponsive individuals with NO cough or gag reflex. Otherwise, an OPA may stimulate vomiting, laryngeal spasm, or aspiration. An NPA can be used in conscious individuals with intact cough and gag reflex. However, use carefully in individuals with facial trauma due to the risk of displacement.
