The nasopharyngeal airway: dispelling myths and establishing the facts

https://emj.bmj.com/content/22/6/394

CONCLUSIONS

• 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.
• Traditional methods of sizing NPAs place emphasis upon the width of the patient’s nares or little finger, these are inaccurate and must be abandoned; tube length is more important. Evidence clearly demonstrates a relationship between NPA length to subject height, which is independent of sex. Average height females require a size 6 Portex^TM NPA and males a size 7. Optimal and rapid sizing of the NPA can be modified from these average sizes to take account of the subject’s height.
• The widely taught contraindication to NPA placement of a suspected basal skull fracture may be the reason that NPA use is less than that of the OPA. This extremely rare complication must be considered in relation to the potential benefit of simple and effective airway management. Fear of this complication will provide high false positive prediction of the fracture and may dissuade prehospital carers from using a very effective airway adjunct. Selecting an OPA in preference to an NPA in patients with an intact gag reflex risks vomiting and aspiration pneumonia. This maybe as equally grave as intracranial placement of a NPA and is certainly a more commonly encountered problem. Therefore methods of teaching must move from fear of complications to methods of safe placement of simple airway adjuncts and appropriate patient selection.