Securing a Nasopharyngeal Airway (NPA)

ThadeusJ

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I was once taught (by a sage wise man...or was it a woman?) that upon placement of a NPA, one should secure it using a safety pin and a piece of tape to the bridge of the nose. I was asked about this and after a 30 minute search on Dr. Google, I was able to find a single reference in a Respiratory Therapy exam review textbook and one "study" published in 2008 (not able to access the actual document, only the abstract).

Two questions:
1) is this standard practice in your service, and
2) is the action of securing the NPA device part of your policies and procedures?
 

NPO

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I was once taught (by a sage wise man...or was it a woman?) that upon placement of a NPA, one should secure it using a safety pin and a piece of tape to the bridge of the nose. I was asked about this and after a 30 minute search on Dr. Google, I was able to find a single reference in a Respiratory Therapy exam review textbook and one "study" published in 2008 (not able to access the actual document, only the abstract).

Two questions:
1) is this standard practice in your service, and
2) is the action of securing the NPA device part of your policies and procedures?
I secure mine with the NRB over the face. If the patient coughs it may come out about an inch, but that's it.

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ThadeusJ

ThadeusJ

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Actually the questions stem from two separate incidents I have heard about where the NPA was pushed down into the airway and was deemed "lost" only to be discovered some time later when the patient was undergoing intubation (whoops).
 

NPO

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Actually the questions stem from two separate incidents I have heard about where the NPA was pushed down into the airway and was deemed "lost" only to be discovered some time later when the patient was undergoing intubation (whoops).
Well in that case, you're pushing way too hard. It should just glide in and there is a flange to prevent that.

But, I did see some med students lose an OPA in a oropharynx during a (failed) intubation attempt and they couldn't figure out why his sats were not improving with a BVM until the attending pulled it out of the back of the guys throat...

So I guess anything is possible.

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Carlos Danger

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I have heard of securing an NPA that way, but have never done it or seen it or heard of it being a standard anywhere.

There are various urban legends about NPA's being sucked into the nasopharynx and then aspirated, and I'm highly skeptical of them. Of course I can't say that it has never happened, but I'm pretty confident that it's an unlikely enough event to fit easily into the "not really a concern" category.

I would imagine that the risk of causing a problem messing with a safety pin near the eyes and airway is greater than the risk of simply keeping an eye on your NPA.
 

DrParasite

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http://www.oxfordmedicaleducation.com/clinical-skills/procedures/nasopharyngeal-airway/

https://clinicalgate.com/emergency-airway-management-2/ references the safety pin, when using an ET tube as an improvised NPA

here is a picture of an NPA
114363-10812344.jpg
00_Sunmed_1-5075-24_Nasopharyngeal_airway_Robertazzi.jpg


if the patient snorts the NPA in, then they have overcame the flange completely, and either you chose the wrong size NPA, or the manufacturer designed it poorly, and you should no longer be using it. Or you are pushing it down waaaaaaay further than you should be

In any case, I have never seen the safety pin used, nor will I be putting one on any NPA in the near future.
 
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DesertMedic66

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I didn’t even know securing them was a thing. I’ve used a decent amount and have never had any issues
 

VFlutter

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I have had NPAs slide back out slightly when a lot of lube is used. Most of the time they aren't left in long enough to be an issue but the times I want to keep them in for frequent NT suctioning I will secure them similar to how I secure NG tubes. Split tape half way up, place on bridge of nose, and twist 1/2 pieces around back up.

Tape-the-Nasogastric-Tube.jpg
 

StCEMT

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I've had issues with them coming out a bit, but never going too deep. NPA's have typically been a very temporary thing for me, they usually get pulled after a while.
 

E tank

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What indications for an NPA v. OPA do folks use? I'll say that I use them as a "reminder" to breathe in patients at risk for or diagnosed with obstructive sleep apnea that are just on the edge with narcotic and I don't want to give narcan to.

An OPA would be too much and nothing wouldn't be enough...Of note, I'd never put one in a patient taking blood thinners or without neosynepherine (or equivalent) nasal spray if I had it.
 

NomadicMedic

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I'm still in the field, and quite active. We just don't get patients requiring an npa as opposed to an opa.

Interesting. The only time I ever use an OPA is during an arrest. And even then, not for long, as I usually place an SGA. Anyone else that needs any type of airway management gets one (or 2) NPAs.
 

NomadicMedic

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What indications for an NPA v. OPA do folks use? I'll say that I use them as a "reminder" to breathe in patients at risk for or diagnosed with obstructive sleep apnea that are just on the edge with narcotic and I don't want to give narcan to.

An OPA would be too much and nothing wouldn't be enough...Of note, I'd never put one in a patient taking blood thinners or without neosynepherine (or equivalent) nasal spray if I had it.


OPAs go in dead people. Seems like just about everyone else has a semblance of a gag... an NPA is much easier. Anyone I have to bag, that's not a GCS of 3 or 4, ODs, stroke, DKA... all would get an NPA.

The guy I had today, GI bleed, GCS of 4, in the house was bagged with 2 NPAs, then quickly intubated.
 

ResQchick

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Interesting. The only time I ever use an OPA is during an arrest. And even then, not for long, as I usually place an SGA. Anyone else that needs any type of airway management gets one (or 2) NPAs.
From what I've noticed from many people in my County-npa's aren't used as often as many other places. I believe our npa pack expired before it was used. (We replaced it, but it sits, lonely and ignored. Lol)
In an arrest, an opa is only used until als arrives to intubate.

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ResQchick

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Oh, I might add that I'm 5 minutes from 2 hospitals, and our level 1 trauma Center is 15 minutes.

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