How to Use a Nasopharyngeal Airway: Step-by-Step Guide

By LOYAL TO THE MISSION | Published: 2026-10-28

Category: How-to Guides

Learn the correct steps for inserting a nasopharyngeal airway (NPA), including sizing, lubrication, and placement. This guide covers common mistakes and safety checks for field and clinical use.

Quick answer

Insert a nasopharyngeal airway by selecting the correct size based on the patient's nostril diameter, lubricating the tube, and gently advancing it along the floor of the nasal cavity until the flange rests against the nostril.

Why size and lubrication matter

Using the wrong NPA size can cause discomfort, inadequate airway opening, or tissue damage. The 28FR Pre-Lubricated Nasopharyngeal Airway from North American Rescue is designed for adult patients with average nasal passages. Pre-lubrication reduces friction during insertion, making the process smoother and less traumatic.

When to avoid NPA use

Do not insert an NPA if you suspect a skull base fracture (look for clear fluid from the nose or ears, raccoon eyes, or Battle's sign). In such cases, an oropharyngeal airway is contraindicated as well. Also avoid use if the patient has a known nasal obstruction or recent nasal surgery.

Step-by-step NPA insertion

Step 1: Measure the correct size: Hold the NPA next to the patient's face with the flange at the nostril. The tube should reach from the nostril to the earlobe or the angle of the jaw. For an adult, a 28FR is a common starting size. If the tube is too long, it may enter the esophagus; too short, it won't maintain the airway. Check length against the patient's face before insertion.
Step 2: Lubricate the tube: Apply a water-based lubricant to the outside of the NPA. If using a pre-lubricated NPA like the 28FR, you can skip this step but still verify that the lubricant is evenly coated. Avoid petroleum-based lubricants as they can damage the material. Do not add extra lubricant if the NPA is already pre-lubricated.
Step 3: Insert into the right nostril (usually): Tilt the patient's head slightly back. Insert the NPA into the right nostril with the bevel facing toward the septum (medial). Gently advance the tube along the floor of the nasal cavity—not upward—until the flange rests against the nostril. If you meet resistance, do not force; try the other nostril or a smaller size. If resistance is met, stop and switch nostrils or downsize.
Step 4: Confirm placement and secure: Check that the flange sits flush against the nostril and that the tube does not protrude into the mouth. Listen for breath sounds at the tube opening. Tape the flange to the patient's cheek or use a commercial holder to prevent dislodgement during transport. Always verify airflow through the tube after placement.

Product facts

Pre-Lubcricated Nasopharyngeal Airway - 28FR: The Pre-Lubricated Nasopharyngeal Airway - 28FR is pre-lubricated and designed to remain steady during transport without being easily dislodged. Pre-lubrication saves time in an emergency and reduces the risk of nasal trauma, while the secure fit helps maintain the airway during movement.
Pre-Lubcricated Nasopharyngeal Airway - 28FR