Healthcare and Medicine Reference
to the patient. Most NP airways require a safety pin inserted
through the fl ange to prevent the airway slipping into the
Step-by-step guide: nasopharyngeal airway
Choose an appropriately sized NP airway.
If necessary, place a safety pin through the fl ange of the NP (this
ensures it does not fully enter the nasal cavity).
Apply a water-based lubricant (Figure 13.9a).
Maintaining an airway opened by a head-tilt/chin-lift or jaw
Insert the NP airway into the right nostril fi rst (unless blocked,
nasogastric tube in situ etc.) (Figure 13.9b). The bevel should be
on the medial side of the NP airway.
The NP airway should be inserted at 90° to the patient's fore-
As an alternative method of opening an obstructed airway when
airway manoeuvres have failed.
Better tolerated than OP airways in semi-conscious patients.
head, and should pass with minimal resistance towards the
Rolling the NP from side to side in your fi ngers as
Excellent for use in patients unable to open their mouths
(e.g. trismus or seizures).
As a means of facilitating bronchial suction.
you exert downwards pressure may make insertion easier
If resistance is met try the other nostril.
Known or potential base of skull fracture
Reassess the patient's airway for patency.
Commonly causes nose bleeds so should be avoided in
Bag-valve-mask (with reservoir)
those patients known to have bleeding tendencies (e.g. on
In many patients a simple airway manoeuvre or use of an adjunct
to open the airway will allow them to breathe spontaneously. If this
is the case high-fl ow oxygen (15L/min) should be administered via
a mask with non-rebreathe reservoir.
If they are not breathing suffi ciently it is necessary to venti-
late the patient. The most convenient method of achieving this is
with a bag-valve-mask with reservoir. This device consists of the
A tight fi tting face mask
NP airways were traditionally sized choosing a diameter which
closest matched that of the patient's little fi nger (Figure 13.8).
A better 'fi t' is achieved using the chart in Table 13.1.
. This facemask must be appropriately
sized to the patient and allow an airtight seal between the mask
and the patient's face.
A self-fi lling chamber
. Usually 2 litres in size, this chamber is self-
fi lling. The chamber will preferentially fi ll from the oxygen reser-
voir, but in the absence of an oxygen supply still allows the patient
to be ventilated on room air (21% O 2 ).
A one-way valve
. This allows oxygen (or air) to be entrained into
the self-fi lling chamber and then applied as a positive pressure to
ventilate the patient.
An oxygen reservoir
. This oxygen reservoir fi lls when the valve is
closed and is used to fi ll the bag when the valve is open.
. To connect the reservoir and chamber to an oxygen
Step-by-step guide: bag-valve-mask
Assemble the bag-valve-mask with an appropriately sized face
Figure 13.8 Traditionally NP airways are sized using the patient's little
mask for the patient.
Connect the tubing to a high-fl ow oxygen supply (15L).
Ensure the reservoir fully infl ates with oxygen.
Check the valve is closed and opens when the chamber is
Table 13.1 Appropriate-sized NP airways.
Place the face mask on the patient ensuring a tight seal (do not
Size of NP (diameter)
remove any airway adjuncts).
Apply a head-tilt/chin-lift or jaw thrust to the patient.
Squeeze the chamber at a rate of 10-12 breaths a minute.
Ensure adequate ventilation by bilateral chest movement and
fogging of the face mask on expiration.