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Basic Airway Adjuncts

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The OPA is a J-shaped device fits over the tongue to hold it and the soft hypopharyngeal structures away from the posterior wall of the pharynx. It is used in patients who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle. A properly sized and inserted OPA results in proper alignment with the glottis opening.

The OPA is used in unconscious patients if efforts to open the airway fail to maintain a clear, unobstructed airway. An OPA should not be used in a conscious or semiconscious patient because it can stimulate gagging, vomiting and possibly aspiration. The key assessment to determine if an OPA can be placed is to check if the patient has an intact cough and gag reflex. If so, do NOT use an OPA.


The NPA is a soft rubber or plastic uncuffed tube that provides a conduit for airflow between the nares and the pharynx. It is used as an alternative to an OPA in patients who need a basic airway management adjunct.

Unlike the oral airway, NPAs may be used in conscious or semiconscious patients (patients with intact cough and gag reflex). The NPA is indicated when insertion of an OPA is technically difficult or dangerous. Placement can be facilitated by the use of a lubricant. Never force placement of the NPA as severe nose bleeds may occur. If it does not fit in one nare, try the other side. Use caution or avoid placing an NPA in a patient with obvious facial fractures.


Suctioning is an essential component of maintaining a patent airway. Providers should suction the airway immediately if there are copious secretions, blood, or vomit. Attempts at suctioning should not exceed 10 seconds. To avoid hypoxemia, follow suctioning attempts with a short period of 100% oxygen administration.

Monitor the patient’s heart rate, oxygen saturation, and clinical appearance during suctioning. If deterioration is seen, interrupt suctioning and administer oxygen until the clinical condition improves. Continue to assist ventilation as warranted.

  • Only use an OPA in unresponsive patients with NO cough or gag reflex. Otherwise, an OPA may stimulate vomiting, laryngeal spasm, or aspiration.
  • A NPA can be used in conscious patient with intact cough and gag reflex. However, use carefully in patient with facial trauma because of risk of displacement.
  • Remember, the patient is not receiving 100% oxygen while suctioning. Interrupt suctioning and administer oxygen if any deterioration in clinical picture is observed during suctioning.
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