Why do you rotate one nasal airway but not the other?

[DragonClaw]

I've looked through tons of videos and google, but I have only seen them mention that the if using the left nostril, rotate the airway. I thought the airway/nasal cavity and such were symmetrical. Anatomically/medically, why the rotation on the left and not the right?

 

[DesertMedic66]

The NPAs are supposed to be inserted so that the bevel is towards the septum of the nose. The NPAs also have a curve designed in them so they face down to follow the nasopharynx. On the right nostril the NPA can be inserted with the bevel facing the septum with the curve of the NPA in the correct location.

With the left side in order to have the bevel towards the septum the NPA must be flipped which makes the curve face superiorly which is not the way we want it to face. The thought process is to insert the NPA in upside down on the left side so that the bevel is facing the septum and then rotate it so the curve is in line with our nasopharynx.

 

[Gurby]

 

[Gurby]

With the left side in order to have the bevel towards the septum the NPA must be flipped which makes the curve face superiorly which is not the way we want it to face. The thought process is to insert the NPA in upside down on the left side so that the bevel is facing the septum and then rotate it so the curve is in line with our nasopharynx.

I think I get it after watching this video 5 times. Do you find doing it this way makes it easier?

 

[Peak]

Sometimes I wiggle it a bit to advance it, but I've never flipped it upside down to put it in

 

[DragonClaw]

Why does the bevel have to face the septum. Why can't you just follow the curve?

 

[Gurby]

Why does the bevel have to face the septum. Why can't you just follow the curve?

It doesn't have to face the septum, I had never heard of this before your post... I always just lubed it up and shoved it in there... But I think I can see the wisdom of it now. Check out this really cool video that shows what the inside of the nasopharynx looks like. This video is of the right nasal cavity.

Look at all the structures the NPA encounters as you shove it in there. Especially in the first 10 seconds of the video, imagine what's happening as you push that plastic through there. Life will be easier if the plastic hugs the right wall, and goes along the bottom, as you push it in. If we were on the left side, in order to get the NPA to hug the wall better, maybe we would need to flip it so the bevel part lines up better with the wall as we advance it. I imagine this could change depending on what brand/style of NPA you're using - some don't have a bevel and for those I guess it wouldn't really matter / would make it more difficult.

 

[DragonClaw]

So did the camera do this? As a NPA should?

 

[Gurby]

So did the camera do this? As a NPA should?

The camera gives you more control and the ability to see where you're going, so you can avoid the turbinates - so the answer is no. By contrast, with an NPA we are just shoving a soft piece of plastic in there and hoping it makes it to the other side without getting caught up on things.

 

[DrParasite]

Life will be easier if the plastic hugs the right wall

Most NPAs i've used were rubbery and flexible, which made them easier to just shove in the nose (with lube of course), and twist and turn until they were all the way in.

Only the OPAs were hard plastic.

 

[Jim37F]

We had a TECC class at work a few weeks back where they talked about this. They had a skeleton model, and showed us on the skull in the nasal passages those ridges along the lateral sides of the nasal cavity, so if you keep the bevel towards the septum, you'll keep (in theory at least) the NPA from hitting those which can cause excess pain in a conscious/semi-conscious patient who might now be pulling away/fighting against you inserting the NPA if its painful for them.

The instructors also mentioned they've seen students try to insert NPAs with the tip pointed superiorly because that's what the direction of the nostrils seems to be... but that proper insertion is basically 90° perpendicular to the face (or straight down if the patient is supine) so as to properly follow the airway, otherwise you're hitting the roof so to speak which is also unnecessarily painful

I remember in past classes where we inserted NPAs in each other where it was indeed painful, but after that lecture we were able to insert them quickly and easily without really any pain (maybe uncomfortable but not fight/pull away from the pain uncomfortable).

I've heard it oft repeated that the right nare is typically a larger diameter, and if you'll notice the bevel cut on virtually every NPA is such that the curve of the NPA follows the body if you insert it into the right nare, so that might also have something to do with it.