Nasal airway

The nasopharyngeal airway(NPA) is placed in either nasal passage and allow unobstructed routes for ventilation through the nose to the hypopharyngeal area. They tend to be less stimulating than oral airways but can cause epistaxis (nosebleed).

  1. Determine the correct size by measuring from the tip of your patient's nose to the tip of their earlobe. In addition, choose an NPA which has a diameter a little smaller than the patient's nares. The NPA's length is a more important factor than its diameter in selecting the appropriate size of NPA.
  2. Lubricate with water-based lubricant or the patient's saliva
  3. Inspect the nares for blood or deviated septum and choose the most open passage (commonly the right nostril).
  4. Place the NPA with the bevel pointing towards the septum
  5. Insert gently, following the natural curvature of the floor of the nasal cavity as it is advanced. The base of the nasal passage is relatively flat and parallel to the roof of the mouth. This limits contact with the turbinates and hopefully avoids the resultant nosebleed.
  6. Lift slightly on the tip of the nose with the free hand and when inserting the airway
  7. If resistance is felt during insertion, stop and try the other naris.
  8. Seat the flange against the nostril opening.

The distal tip of the NPA is properly placed beyond the tongue base but should not be in contact with the epiglottis.


NPAs should not be used on patients who have nasal fractures or an actively bleeding nose. In some cases, slight bleeding may occur when you insert the airway, which can be suctioned or wiped away.

Tips and Tricks

  1. NPAs are curved and beveled for a right-nostril approach. If the right nostril is unusable, insert the NPA against the curvature initially so that the beveled edge is still medial. Do not cut the NPA to make a left bevel medial, this can cause increased bleeding from a jagged cut. Once the NPA has passed the turbinates, it may be rotated so that the curvature matches the curvature of the patient's airway.

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