# Opa+npa



## medichopeful (Jan 1, 2010)

Alright, so for some reason this question came to my mind today as I was coming home from a friend's house.

Is it possible to have both an OPA and an NPA inserted in the same patient at the same time?  I don't mean insert both simultaneously; I mean have both in place.  My instructor said "no," but I am curious if there is a second opinion.  

Here is my thinking.  If you have a patient who is unconscious with no gag reflex, you could put both adjuncts in place.  If the patient spontaneously regained a gag reflex, removal of the OPA could leave the airway unprotected.  But if you had both an OPA and an NPA in, the patient would still have one adjunct in place after that removal.  Basically, the NPA would be an auxiliary or "back-up" airway.  Plus, if the patient regained consciousness but could not completely control their airway (as opposed to just a gag reflex), they would not have to go through the process of having an NPA put in.

My main concern would be that there would be pressure on the pharynx/trachea where the two adjuncts met.  But would the benefit outweigh the risk (potentially)?  Are there any articles on the subject?  A quick Google search didn't turn up anything.

Thanks!
Eric


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## MrBrown (Jan 1, 2010)

In theory yes it is possibe; an NPA sits in the nasopharynx while an OPA sits in the oropharynx and basic anatomy tells us that they are superior/inferior to each other.

An OPA is often used as a bite block on a patient with an LMA or who is intubated to keep them from biting the tube


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## nomofica (Jan 1, 2010)

^ What he said.

However it's not very common to see an OPA and an NPA in a pt at the same time as one airway adjunct will usually suffice, more often than not - at least in my experience.


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## wyoskibum (Jan 1, 2010)

You place the NPA when the pt wont tolerate an OPA but can't protect their own airway.


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## VentMedic (Jan 1, 2010)

Depending on the position of the OPA in the pharynx, it may render the NPA useless as it will block or pinch off the NPA. Thus, you may then have an obstruction in the form of the NPA to add resistance. If it improves ventilation noticeably then both might be useful. 

 I wouldn't put the NPA in just in case the patient wakes up. However, we have placed an NPA to facilitate nasotracheal suctioning with an OPA although the suction catheter may be difficult to pass because of the OPA.


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## rescue99 (Jan 1, 2010)

VentMedic said:


> Depending on the position of the OPA in the pharynx, it may render the NPA useless as it will block or pinch off the NPA. Thus, you may then have an obstruction in the form of the NPA to add resistance. If it improves ventilation noticeably then both might be useful.
> 
> I wouldn't put the NPA in just in case the patient wakes up. However, we have placed an NPA to facilitate nasotracheal suctioning with an OPA although the suction catheter may be difficult to pass because of the OPA.



Yep! ^_^


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## medichopeful (Jan 1, 2010)

nomofica said:


> ^ What he said.
> 
> However it's not very common to see an OPA and an NPA in a pt at the same time as one airway adjunct will usually suffice, more often than not - at least in my experience.



Right, I know that having two adjuncts in place is not "common," but if it will do more good who cares whether it's common or not?  Not trying to take a knock at you or anything, just saying.


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## medichopeful (Jan 1, 2010)

wyoskibum said:


> You place the NPA when the pt wont tolerate an OPA but can't protect their own airway.



Yes sir/ma'am, I understand that.  I was just thinking (a bad thing to do ) about ways to improve patient care by having, in a way, a "back-up" airway in case one has to be removed.


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## medichopeful (Jan 1, 2010)

VentMedic said:


> Depending on the position of the OPA in the pharynx, it may render the NPA useless as it will block or pinch off the NPA. Thus, you may then have an obstruction in the form of the NPA to add resistance. If it improves ventilation noticeably then both might be useful.
> 
> I wouldn't put the NPA in just in case the patient wakes up. However, we have placed an NPA to facilitate nasotracheal suctioning with an OPA although the suction catheter may be difficult to pass because of the OPA.



Improving ventilations was one of the big things I was wondering about.  I was really just curious as to whether it could do any major harm or if there was anything that said "NEVER do this!" If there are no ways it could cause harm (besides one blocking the other, which should be caught rather quickly by evaluating the quality of the ventilations), would there be any harm in trying it if it could potentially help?  I know each patient is also different, so what works for one may not work for another.


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## VentMedic (Jan 1, 2010)

medichopeful said:


> Improving ventilations was one of the big things I was wondering about. I was really just curious as to whether it could do any major harm or if there was anything that said "NEVER do this!" If there are no ways it could cause harm (besides one blocking the other, which should be caught rather quickly by evaluating the quality of the ventilations), would there be any harm in trying it if it could potentially help? I know each patient is also different, so what works for one may not work for another.


 

If the OPA is working, why use an NPA?  

If the person is requiring an OPA, an NGT will have to be inserted in the hospital ED.   Thus, the NPA will be removed upon arrival to the hospital. The patient will be bagged with the OPA in place until ETI is done. 

If you are having problems ventilating the patient with the OPA, you should confirm size and placement of the device as well as checking your technique.  If those are off, it doesn't matter much what else you try.  

If it is only in place "in case the patient wakes up" then you may have done something considered invasive and not entirely without harm needlessly.


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## nomofica (Jan 1, 2010)

medichopeful said:


> Right, I know that having two adjuncts in place is not "common," but if it will do more good who cares whether it's common or not?  Not trying to take a knock at you or anything, just saying.



It was just a simple statement - it was no knock at you either.


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## medichopeful (Jan 1, 2010)

nomofica said:


> It was just a simple statement - it was no knock at you either.



lol I know.  Don't worry.


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## nomofica (Jan 1, 2010)

medichopeful said:


> lol I know.  Don't worry.



You'd better know. h34r:


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## medichopeful (Jan 1, 2010)

nomofica said:


> You'd better know. h34r:



Ha! 

Happy new year man.


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## nomofica (Jan 1, 2010)

medichopeful said:


> Ha!
> 
> Happy new year man.



You too, buddy.


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## LondonMedic (Jan 2, 2010)

The medically led pre-hospital trauma service in London will typically stick two NPAs and an OPA into a punter, reasoning that it provides a larger bore airway - therefore maximal air movement.

I remain unconvinced.


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## VentMedic (Jan 2, 2010)

LondonMedic said:


> The medically led pre-hospital trauma service in London will typically stick two NPAs and an OPA into a punter, reasoning that it provides a larger bore airway - therefore maximal air movement.
> 
> I remain unconvinced.


 
If one was actually to exam the nares and the septum, putting two NPAs may give you less than half an airway.  If more Paramedics could do NT suctioning with a catheter they would quickly see some of these things.


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## 18G (Jan 2, 2010)

I remember from back in the day when AED's were first brought to EMS services in my region, there was a specific AED protocol that had a special airway procedure with it. 

Anytime we used the AED, we were to use two NPA's and an OPA. The rationale was to maximize airflow. I never understood this protocol than and still don't. It has since gone to the way side and is no longer used.


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## eveningsky339 (Jan 3, 2010)

I personally would stick with either one or the other, depending on the circumstances...  Using both airways strikes me as unnecessary and potentially harmful, especially after reading a few posts in this here thread.


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## medichopeful (Jan 3, 2010)

eveningsky339 said:


> I personally would stick with either one or the other, depending on the circumstances...  Using both airways strikes me as unnecessary and potentially harmful, especially after reading a few posts in this here thread.



That's what I'll be doing.  Thanks for the responses everybody!


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## redcrossemt (Jan 4, 2010)

18G said:


> I remember from back in the day when AED's were first brought to EMS services in my region, there was a specific AED protocol that had a special airway procedure with it.
> 
> Anytime we used the AED, we were to use two NPA's and an OPA. The rationale was to maximize airflow. I never understood this protocol than and still don't. It has since gone to the way side and is no longer used.



Are you serious? Is this a West Virginia joke or something?


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