Nasopharyngeal and Oropharyngeal Airway Insertion

Summary

This video demonstrates the correct use of nasopharyngeal and oropharyngeal airways in airway management. It explains the steps for sizing and inserting a nasopharyngeal airway to bypass obstructions caused by the tongue in patients with sonorous breathing. The educator emphasizes proper lubrication and technique to ensure the airway is correctly placed. For the oropharyngeal airway, used in unconscious patients, it covers sizing, opening the mouth using the 'snap finger' technique, and proper insertion to avoid obstructing the airway further. The demonstration highlights critical considerations for successful ventilation.

Takeaways

• 🩺 The nasopharyngeal airway is used to manage airway obstruction caused by the tongue, especially in unconscious or semi-conscious patients.
• 🟢 Nasopharyngeal airways are made of rubber with a trumpet end and are available in different sizes, which must be chosen carefully for each patient.
• 📏 To determine the correct size, the length should match the distance from the patient's naries to their tragus.
• 💧 Lubrication is critical for smooth insertion, with jelly applied to the tube and inside the nose to avoid any blockages or resistance.
• 👃 The nasopharynx is a straight horizontal passage, so the airway should be inserted directly back, not angled upward.
• ✋ Proper insertion involves opening the nares by lifting the tip of the nose and advancing the tube in small increments without meeting resistance.
• 📦 The oropharyngeal airway is used only in unconscious patients and is stiffer, with a question mark shape designed for oral insertion.
• 🧠 Proper sizing of the oropharyngeal airway involves measuring from the corner of the mouth to the angle of the mandible to ensure effective airway management.
• ✊ The correct method to open an unconscious patient's mouth is using a 'snap finger' technique, applying flexion for more control and power.
• 🔄 When inserting an oropharyngeal airway, rotate it during insertion to avoid pushing the tongue further back, which could worsen the airway obstruction.

Q & A

What is a nasopharyngeal airway and why is it used?

A nasopharyngeal airway is a flexible rubber tube designed to maintain an open airway in patients by bypassing soft tissue obstructions, particularly the tongue. It is inserted through the nose and positioned behind the tongue to prevent airway obstruction.

How do you choose the correct size of a nasopharyngeal airway for a patient?

To select the correct size, place the trumpet end at the patient's nostril and ensure that the angulated end reaches the tragus of the ear. This ensures that the airway is long enough to bypass the tongue and open the airway.

What is the proper technique for inserting a nasopharyngeal airway?

After lubricating the airway and the patient's nostril, lift the tip of the nose to open the nasal passage. Insert the tube straight back into the nasopharynx, not upwards, advancing it a few centimeters at a time. The tube should slide in smoothly without resistance.

What should you do if you encounter resistance while inserting a nasopharyngeal airway?

If you encounter resistance, stop the insertion and reassess. The patient may have a deviated septum, in which case you can try the other nostril to successfully insert the airway.

Can a nasopharyngeal airway be used in conscious patients?

Yes, nasopharyngeal airways can be used in awake, semi-conscious, or unconscious patients. Most patients tolerate having the tube in their nose well, even in a conscious state.

What is the purpose of an oropharyngeal airway, and when should it be used?

An oropharyngeal airway is used to open the airway by displacing the tongue in unconscious patients. It is typically considered a prelude to intubation and should not be used in conscious patients due to the risk of gag reflex and vomiting.

How do you properly size an oropharyngeal airway?

To size an oropharyngeal airway, align the airway from the corner of the patient’s mouth to the angle of the mandible. This ensures that it is long enough to reach behind the tongue and maintain an open airway.

What is the correct method for opening the mouth of an unconscious patient before inserting an oropharyngeal airway?

Use the snap finger technique to open the patient’s mouth. Place the middle finger on the upper incisors and the thumb on the lower incisors, applying a flexing motion to open the mouth. This method is more powerful and causes less damage than pushing directly on the gums.

Why is it important to rotate the oropharyngeal airway during insertion?

The oropharyngeal airway must be rotated to avoid pushing the tongue further back, which could obstruct the airway. The tip should first be placed against the hard palate, and then the airway is rotated to ensure proper placement without interfering with the tongue or soft tissues.

What is the main difference between a nasopharyngeal airway and an oropharyngeal airway?

The nasopharyngeal airway is inserted through the nose and can be used in both conscious and unconscious patients, while the oropharyngeal airway is inserted through the mouth and is only suitable for unconscious patients due to the risk of gag reflex.