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Basic Airway Adjuncts

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Oropharyngeal Airway (OPA)

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.

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

Nasopharynegeal Airway (NPA)

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. Use caution or avoid placing NPAs 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, pulse oxygen saturation, and clinical appearance during suctioning. If a change in monitoring parameters is seen, interrupt suctioning and administer oxygen until the heart rate returns to normal and clinical condition improves. Assist ventilation as warranted.

  • Only use an OPA in unresponsive patients with NO cough or gag reflex. Otherwise, OPA can stimulate vomiting, aspiration, and laryngeal spasm.
  • An NPA can be used in conscious patient with intact cough and gag reflex. However, use carefully in patients 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 change in monitoring parameters is observed during suctioning.
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