Airway Adjunct Insertion

Key Points

• Airway adjuncts maintain patency when upper airway obstruction or difficult mask ventilation is present.
• Correct sizing before insertion is essential to reduce ineffective placement and tissue injury.
• OPA and NPA insertion uses different landmarks and patient selection criteria.

Equipment

• Oropharyngeal airway (OPA) set in multiple sizes
• Nasopharyngeal airway (NPA) set in multiple sizes
• Water-soluble lubricant gel
• Personal protective equipment and suction setup per local policy

Procedure Steps

1. Assess indication for adjunct use (upper airway obstruction or difficult mask ventilation) and identify likely device choice.
2. Prepare equipment and place the patient in a position that supports airway access.
3. For OPA sizing, measure from the corner of the lip to the angle of the jaw.
4. Open the mouth and insert the OPA with the tip toward the roof of the mouth.
5. Advance past the uvula and rotate the OPA 180 degrees to final position, confirming flange rests appropriately.
6. For NPA sizing, measure from the tip of the nose to the earlobe and choose external diameter that matches internal naris diameter.
7. Lubricate NPA with water-soluble gel before insertion.
8. Insert NPA gently through the nostril until the flanged end rests against the nose, with distal tip positioned behind the uvula.
9. Reassess airway patency, ventilation effectiveness, and tolerance after insertion.
10. If airway remains unstable, prepare escalation to laryngeal-mask-airway or advanced-airways-and-intubation per team direction.

Common Errors

• Selecting incorrect airway size → inadequate patency, trauma risk, or poor ventilation support.
• Forcing insertion without lubrication or alignment → nasal or pharyngeal tissue injury.
• Using OPA in patients who require a better-tolerated route → gagging, poor tolerance, or failed placement.
• Failing to reassess after insertion → delayed recognition of persistent obstruction.

Related

• bag-valve-mask-manual-ventilation - Adjuncts are often paired with BVM to improve mask ventilation quality.
• manual-resuscitators-and-manual-ventilation - Conceptual framework for ventilatory support decisions.