ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (2025)

The nasopharyngeal airway (NPA) is a soft, flexible tube inserted through the nostril into the nasopharynx to maintain an open airway. Unlike the oropharyngeal airway (OPA), the NPA can be used in semi-conscious and conscious patients who still have a gag reflex.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (1) Why It’s Important:
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (2) Prevents airway obstruction caused by the tongue.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (3) Can be used in semi-conscious or conscious patients.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (4) More comfortable than an OPA for prolonged use.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (5) HOW THE NASOPHARYNGEAL AIRWAY WORKS

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (6) The NPA bypasses the soft tissues of the pharynx, preventing airway collapse and allowing for spontaneous breathing or assisted ventilation.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (7) It is particularly useful when an OPA is not tolerated due to a gag reflex.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (8) It should NOT be used in patients with suspected skull fractures!

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (9) INDICATIONS FOR NPA USE

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (10) Patients who require airway maintenance but cannot tolerate an OPA (e.g., intact gag reflex).
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (11) Semi-conscious or conscious patients with a partially obstructed airway.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (12) Patients needing frequent suctioning of airway secretions.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (13) Patients requiring airway support but unable to tolerate intubation.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (14) NPAs are commonly used in both pre-hospital and hospital settings for airway management.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (15) CONTRAINDICATIONS

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (16) DO NOT use an NPA if any of the following are present:

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (17) Suspected basilar skull fracture

  • Signs include:
    • CSF (cerebrospinal fluid) leakage from the nose or ears.
    • “Raccoon eyes” (periorbital bruising).
    • Battle’s sign (bruising behind the ears).

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (18) Significant nasal trauma or deformity

  • Fractured nasal bones can cause airway trauma or improper placement.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (19) If a skull fracture is suspected, use an OPA (if tolerated) or consider alternative airway management.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (20) SIZING THE NASOPHARYNGEAL AIRWAY

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (21) Proper sizing is crucial for effectiveness and patient safety.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (22) To determine the correct NPA size:
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (23) Diameter: Select an NPA slightly smaller than the patient’s nostril.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (24) Length: Measure from the tip of the nose to the earlobe or angle of the jaw.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (25) If the NPA is too short → It may not bypass the tongue, leading to obstruction.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (26) If the NPA is too long → It may enter the esophagus, leading to improper placement.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (27) INSERTION TECHNIQUE: HOW TO INSERT AN NPA

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (28) Step-by-Step Instructions:

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (29) Preparation:

  • Select the correct NPA size.
  • Lubricate generously with a water-soluble lubricant (do NOT use petroleum-based lubricants).

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (30) Positioning the Patient:

  • Keep the head in a neutral position (unless contraindicated due to cervical spine injury).

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (31) Insertion:

  • Insert the beveled end first, following the natural curve of the nasal passage.
  • Direct the tip posteriorly, not upward (to avoid nasal trauma).

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (32) Advancement:

  • Gently advance the NPA until the flange rests against the nostril.
  • If resistance is met, try the other nostril—one nostril may be more open than the other.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (33) Never force an NPA! If resistance is met, stop and attempt in the other nostril.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (34) CONFIRMATION OF PLACEMENT

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (35) Signs of Proper Placement:
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (36) Visible chest rise with ventilation.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (37) Clear, unimpeded airflow through the NPA.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (38) Presence of normal breath sounds when auscultating the lungs.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (39) Signs of Improper Placement:
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (40) Air entering the stomach instead of the lungs → NPA may be too long and in the esophagus.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (41) Persistent snoring-like sounds → NPA may not be deep enough.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (42) Gagging or coughing → Consider an OPA instead.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (43) COMPLICATIONS & HOW TO PREVENT THEM

ComplicationCausePrevention
Nosebleeds (Epistaxis)Trauma to the nasal mucosaLubricate well, insert gently
Placement in the Esophagus (Rare)Incorrect sizing or insertionMeasure correctly before insertion
Gagging or DiscomfortNPA too large or improper placementUse proper sizing, insert carefully
Airway ObstructionNPA too short or kinkedEnsure full insertion, reposition if needed

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (44) If complications occur, remove the NPA and reassess airway management options.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (45) WHY THE NASOPHARYNGEAL AIRWAY IS A CRITICAL TOOL

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (46) Easier to tolerate than an OPA in semi-conscious patients.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (47) Maintains airway patency when an OPA is contraindicated.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (48) Useful in patients requiring frequent suctioning.
ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (49) Allows for spontaneous breathing while providing an open airway.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (50) Takeaway: Mastering the NPA ensures effective airway management in patients who cannot tolerate an OPA, providing a crucial alternative in airway emergencies.

ACLS – NASOPHARYNGEAL AIRWAY (NPA) INSERTION – FirstAidWeb Certifications (2025)
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