PALS: Basic Airway Adjuncts

Oropharyngeal Airway

The oropharyngeal airway (OPA) is a J-shaped device that fits over the tongue to hold the soft hypopharyngeal structures and the tongue away from the posterior wall of the pharynx. OPA is used in persons who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle. If efforts to open the airway fail to provide and maintain a clear, unobstructed airway, then use the OPA in unconscious persons. An OPA should not be used in a conscious or semiconscious person because it can stimulate gagging and vomiting. The key assessment is to check whether the person has an intact cough and gag reflex. If so, do not use an OPA.

Nasopharyngeal Airway

The nasopharyngeal airway (NPA) is a soft rubber or plastic un-cuffed tube that provides a conduit for airflow between the nares and the pharynx. It is used as an alternative to an OPA in persons who need a basic airway management adjunct. Unlike the oral airway, NPAs may be used in conscious or semiconscious persons (persons 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 person 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 person’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 until clinical condition improves. Assist ventilation as warranted.

Only use an OPA in unresponsive persons with no cough or gag reflex. Otherwise, OPA can stimulate vomiting, aspiration, and laryngeal spasm.

An NPA can be used in conscious persons with intact cough and gag reflex. However, use carefully in persons with facial trauma because of risk of displacement.

Keep in mind that the person is not receiving 100% oxygen while suctioning. Interrupt suctioning and administer oxygen if any change in monitoring parameters is observed during suctioning.