Basic Intubation Adjuncts
OROPHARYNGEAL AIRWAY (OPA)
Fitting over the tongue, the J-shaped device known as the OPA holds the soft hypopharyngeal structures, along with the tongue, to keep them from the pharynx’s posterior wall. Individuals who risk airway obstruction due to the tongue or an upper airway muscle are benefited by the OPA. If properly sized and inserted, the OPA will properly align with the glottis opening.
The OPA can stimulate aspiration, vomiting, and gagging, which is why you should not use it in individuals who are semiconscious or conscious. Check if the patient has a gag reflex; if so, avoid using the OPA.
NASOPHARYNGEAL AIRWAY (NPA)
Allowing for airflow that travels between the patient’s pharynx and nares, the NPA is a plastic or soft rubber uncuffed tube. This is used instead of the OPA when you are dealing with a patient who needs only basic airway management.
NPAs can be used on conscious and semiconscious individuals, unlike the OPA, and is called for whenever the provider finds it dangerous or difficult to insert the OPA. You can help the placement of the NPA by using a lubricant, but never force NPA placement as this can result in a severe nosebleed. Patients with facial fractures should be kept away from NPAs.
To maintain a patent airway, suctioning is a must. If there is vomit, blood, or copious secretions, the airway should be suctioned as soon as possible, but these attempts should not last longer than 10 seconds. Short periods of 100% oxygen administration is required after suctioning attempts to prevent hypoxemia.
Keep track of the patient’s vitals during suctioning: clinical appearance, oxygen saturation, and heart rate. If changes are observed, pause the suctioning attempt and deliver 100% oxygen until these vitals return to their previous states. Ventilation should be assisted as required.
- An OPA should only be used with unresponsive individuals who have no gag reflex or cough. If not, this can lead to laryngeal spasm, aspiration, or vomiting.
- For conscious individuals with a cough and gag reflex, an NPA is required. When dealing with patients with facial trauma, use carefully, as you risk displacement.
- Remember: the patient does not receive 100% oxygen during the act of suctioning; oxygen is only administered if deterioration in the patient are observed during suctioning.