Absolute contraindications for NPA and NT intubation include
signs of basilar skull fractures, facial trauma
, and disruption of the midface, nasopharynx or roof of the mouth.
When should you not use an NPA?
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.
When would you not use a nasal airway?
An NPA is often used in conscious patients where an oropharyngeal airway would trigger the gag reflex. They are
contraindicated in patients with severe facial trauma
, as they may have an altered facial anatomy (particularly concerning the nasal passageways) and inserting an NPA may cause additional harm to the patient.
What would cause a nasopharyngeal airway to be contraindicated?
Like other nasal tubes, use of nasal airways increases the risk of sinusitis; therefore, contraindications to their use include
severe coagulopathy, cerebrospinal fluid (CSF) leaks, and basilar skull fractures
.
When should you use a nasopharyngeal airway?
Nasopharyngeal airways can be used in some settings where oropharyngeal airways cannot, eg,
oral trauma or trismus
(restriction of mouth opening including spasm of muscles of mastication). Nasopharyngeal airways may also help facilitate bag-valve-mask ventilation.
Can you intubate someone with a gag reflex?
A weak gag reflex is an important risk factor for aspiration pneumonia, so
its absence may trigger intubation in at-risk patients
. The absence of a gag reflex may also suggest brain death in comatose patients.
What are the contraindications of using an NPA?
Absolute contraindications for NPA and NT intubation include
signs of basilar skull fractures, facial trauma, and disruption of the midface, nasopharynx or roof of the mouth
.
Can you sleep with a nasopharyngeal airway?
Nasopharyngeal airway stents are an
effective and well tolerated treatment for individuals with obstructive sleep apnea
, according to findings presented at SLEEP 2018, the Annual Meeting of the Associated Sleep Societies.
How often should a nasopharyngeal airway be changed?
More frequent occlusions may occur during this time from the trauma of initial insertion. After this period it should be routinely changed
every 5-7 days
, with alternating nostrils utilised. If the NPT is required over long-term, size and length may need adjusting according to patient’s growth.
Which type of airway adjunct may stimulate a patient’s gag reflex?
Use
an oropharyngeal airway
only if the patient is unconscious or minimally responsive because it may stimulate gagging, which poses a risk of aspiration. Nasopharyngeal airways are preferred for obtunded patients with intact gag reflexes.
When inserting a nasopharyngeal airway what should you do if resistance is felt?
Be gentle when inserting any type of airway device. Use a water soluble lubricant when inserting a nasopharyngeal airway. If resistance is felt during insertion of a nasopharyngeal airway,
stop and try the other nostril
.
What is the recommended ventilation rate with advanced airway?
When an advanced airway (ie, endotracheal tube, Combitube, or LMA) is in place during 2-person CPR, ventilate at a rate of
8 to 10 breaths per minute
without attempting to synchronize breaths between compressions. There should be no pause in chest compressions for delivery of ventilations (Class IIa).
What is the most serious potential complication of nasopharyngeal airway insertion into a patient with facial trauma?
Cribriform insertion
is perhaps the most catastrophic complication of a nasopharyngeal airway, but it is also the least likely. Improper technique can cause the tube to enter the cribriform plate, causing soft tissue or skull damage, and potentially even penetrating the brain.
What occurs when a patient is breathing very rapidly and shallowly?
49. What occurs when a patient is breathing very rapidly and shallowly?
rapid respirations
.
How often do you ventilate a patient with a perfusing rhythm?
For ventilation of patients with a perfusing rhythm (ie, better pulmonary blood flow than is present during CPR), deliver
approximately 10 to 12 breaths per minute
(1 breath every 6 to 7 seconds). Deliver these breaths over 1 second when using a mask or an advanced airway.
