In this section
Definition of Terms
Indications for insertion of NPA (Medical Patients)
Indications for insertion of NPA (Surgical Patients)
Contraindications for insertion
Insertion / Re-insertion of a NPA (ward setting only)
Insertion and Securing of NPA
Securement of a NPA (all settings)
Ongoing Assessment and Management
Removal of NPA
Discharge Planning for patients requiring an NPA at home
Complications associated with NPA insertion
A nasopharyngeal airway (NPA) is a thin, clear, flexible tube that is inserted into a patient’s nostril. The purpose of the NPA is to bypass upper airway obstruction at the level of the nose, nasopharynx or base of the tongue. It also prevents the tongue falling backward on the pharyngeal wall to prevent
obstruction. NPA’s maintain airway patency in patients who are conscious or semi-conscious, they can be used in neonates to adults.
The aim of this Clinical Guideline (CG) is to provide a framework for the insertion and management of NPA’s to relieve airway obstruction, in a self-ventilating patient within a medical ward setting and/or for surgical patients postoperatively in the Post Anaesthetic Care Unit (PACU)
and surgical ward.
NPA: Nasopharyngeal airway; is a soft, anatomically designed airway adjunct inserted into the nasal passageway to provide airway patency.
Upper Airway Obstruction: Upper airway obstruction above the level of the larynx results in a failure of airflow into the lungs, despite adequate inspiratory effort. Increasing respiratory effort can worsen the obstruction, as increased intra-thoracic pressure collapses the soft tissue structures inwards.
OSA: Obstructive Sleep Apnoea
Post Anaesthetic Care Unit
OT: Operating Theatre
Electronic Medical Record
ENT: Ear, Nose, Throat
Micrognathia: is a condition in which the jaw is undersized. It is a symptom of a variety of craniofacial conditions. Sometimes called mandibular hypoplasia
Glossoptosis: An abnormal posterior placement of the tongue, which may occlude the airway
WOB: work of breathing
PPE: Personal Protective Equipment
Stertor: noisy, snoring-like breathing resulting from obstruction in the naso- or oropharynx
A patient’s bed card team should determine whether a NPA is required and order accordingly, ensuring the appropriate size and length are included.
Common indications for patient’s in a ward setting:
Nasopharyngeal Airway Insertion:
NPA’s are inserted at the end of surgery when the patient is anaesthetised. This enables the NPA to be inserted under direct vision to the correct length.
NPA’s are commonly inserted electively at the end of surgery to prevent problems with postoperative airway obstruction, including:
Children who have a NPA inserted intra/postoperatively, generally only require it for the first postoperative night. It is then removed the next day as directed by the bed card team.
postoperatively in PACU:
If an NPA is accidentally removed, reinsertion should only be done after consultation with surgical team, to avoid damaging the operative site.
(ward setting only, does not inc
lude NPA’s inserted in surgical patients in OT/Recovery)
The tube should pass to just below the level of the soft palate and should be checked with a light and tongue depressor - in case it is too long (causes gagging) or too short (may not bypass the obstruction). If you are unable to insert the NPA, STOP,
do not force, and escalate to medical/senior nursing team for assistance.
Initially after insertion of the NPA the child may need to be suctioned more than normal, as there will be mucus in the nose and pharynx. This should settle, if it does not seek medical review.
Suctioning of the NPA tube is necessary to remove excess mucous, secretions (and blood for postoperative patients) to maintain a patent airway and avoid tube blockage.
Additional Indications for
* follow local medical emergency response procedure, if clinically indicated (signs of respiratory distress).
For further assessment information please see the
Nursing Assessment guideline.
Prior to removing NPA assess and document vital signs including a full respiratory assessment
Respiratory Assessment in the Nursing Assessment Guideline.
A patient who has had an NPA inserted postoperatively will require a surgical team review prior to removal.
Table 1: Recommended suction catheter sizes:
May indicate need to alternate nostrils to enable skin to heal.
Pressure injury prevention and management
The evidence table for this guideline can be viewed here.
Please remember to
read the disclaimer.
The development of this nursing guideline was coordinated by Lauren Jorgensen, CNS, and Casey Clarke, CSN, Sugar Glider, and approved by the Nursing Clinical Effectiveness Committee. First published August 2022.