Page 163 - Clinical Application of Mechanical Ventilation

Special Airways for Ventilation 129

TABLE 5-2 Size Chart for Nasopharyngeal Airways

Patient Average Size

Short female 6 (pin 1 cm from flange)

Average female/short male 6
Tall female/average male 7

Tall male 8
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as this nasal airway can be used in patients with an intact gag reflex. Other indica-
An nasopharyngeal airway tions include patients with unstable fractures of the mandible, trimus (lockjaw), or
can be used in patients with an
intact gag reflex, unstable frac- oral trauma (Roberts et al., 2005).
tures of the mandible, trimus
(lockjaw), or oral trauma
Selection of Nasopharyngeal Airway

The appropriate size of nasopharyngeal airway for average females is a size 6. For
average males, the size should be a size 7. The final selection should be based on
the patient’s height and clinical condition. The methods of using the width of the
patient’s nares or size of the little finger are based on anecdotal teaching rather than
clinical evidence (Roberts et al., 2003).
Proper sizing for the patient is important. If the nasopharyngeal airway is too
short, the airway would not separate the soft palate from the posterior wall of
the pharynx. If the airway is too long, it would enter either the larynx and ag-
gravate laryngeal reflexes or enter the space between the epiglottis and the val-
lecula leading to potential obstruction of the airway. The ideal length of the na-
sopharyngeal airway should have the distal end of the airway within 1 cm of the
epiglottis (Stoneham, 1993). Table 5-2 shows the size chart for nasopharyngeal
airways.

Insertion of Nasopharyngeal Airway

Prior to insertion of a nasopharyngeal airway, the nares should be inspected for
obstruction. A local anesthetic spray may be applied to the posterior nares for
patient comfort. Prior to insertion, the patient should be in a sitting or semi-
Fowler position and the nares are lifted to reveal the nasal airway. Placement
of the airway should be parallel to the nasal floor, rather than upwards toward
the cribriform plate of the ethmoid bone. Lubrication with a water-soluble lu-
bricant and gentle rotation should facilitate the insertion (Roberts et al., 2005).
Body fluid or isolation precautions must be observed throughout the procedure.
A nasopharyngeal airway and its correct placement are shown in Figures 5-3
and 5-4.

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