EMT · Primary Assessment · 7 min read
Suctioning and Basic Airway Adjuncts: OPA and NPA
- Identify indications, contraindications, equipment selection, and proper techniques for emergency airway suctioning in adult, pediatric, and infant patients.
- Explain the sizing, insertion methods, anatomic hazards, and removal steps for the oropharyngeal airway (OPA).
- Describe the indications, contraindications, sizing, lubrication, and insertion techniques for the nasopharyngeal airway (NPA).
Airway Assessment, Suction Equipment, and Preparation
An open and clear airway is the first priority of emergency airway management. Without a patent path for airflow, adequate oxygenation and ventilation are impossible. During the primary assessment, an EMT must evaluate the airway immediately. Gurgling respirations indicate the presence of fluid, blood, or secretions in the upper airway. Gurgling respirations require immediate suctioning of the airway to clear these liquids before they compromise breathing or enter the lungs.
Emergency suction equipment must always be operational and ready for use. Suction equipment must be assembled and tested at the beginning of every EMS shift. A fixed suction unit should generate a vacuum of at least 300 millimeters of mercury when the tubing is clamped. Testing the device at the start of every shift ensures that the vacuum pressure meets this performance threshold and that all canisters, tubing, and fittings form a tight, dependable seal before an emergency occurs.
Selecting the proper catheter is essential for effective clearance. A rigid catheter, also known as a Yankauer or tonsil-tip catheter, is used to suction the oropharynx. Rigid catheters are best suited for suctioning thick secretions, blood, and vomitus because their wide design and firm structure allow the rescuer to control the tip and clear heavy material efficiently. In contrast, soft suction catheters, also known as French catheters, are flexible tubes used to suction the nasopharynx and stomas where a rigid device could cause trauma or cannot physically pass.
Whenever a patient requires airway support, you must suction blood, vomit, or secretions that obstruct the airway before ventilating, without delaying needed ventilation longer than necessary. Pushing positive-pressure air past fluid can force contaminants deeper into the respiratory system. Therefore, prompt suctioning must immediately precede ventilations whenever fluids obstruct the passage, while always balancing the patient's critical need for air exchange.
Common mistakes
- Ventilating a patient before suctioning away pooled fluid, blood, or vomit that obstructs the airway.
- Exceeding age-appropriate suction time limits increases the risk of hypoxemia; suctioning can also trigger vagal bradycardia, particularly in children.
- Rotating an OPA 180 degrees in an infant or young child instead of using a tongue depressor to insert it right-side up, which can damage the soft palate.
- Using petroleum-based lubricant on an NPA, which can cause lung injury if aspirated, rather than a water-soluble lubricant.
- Forcing an NPA when meeting resistance instead of withdrawing the device and attempting insertion in the other nostril.
Key points
- An open and clear airway is the first priority; gurgling respirations indicate fluid in the airway requiring immediate suctioning before ventilating.
- Fixed suction units should generate at least 300 mmHg when clamped and should be assembled and tested at the beginning of every shift.
- Suction time limits are strictly capped at 15 seconds for adults, 10 seconds for pediatric patients, and 5 seconds for infants to prevent hypoxemia and bradycardia.
- OPAs are indicated only for unresponsive patients without a gag reflex; measure from the corner of the mouth to the angle of the jaw or earlobe.
- In pediatric patients, insert the OPA right-side up with a tongue depressor to avoid damaging the soft palate.
- NPAs are indicated for semi-conscious or unresponsive patients with a gag reflex or clenched teeth, but are strictly contraindicated in severe facial trauma, suspected basilar skull fractures, or CSF leakage.
- Neither the OPA nor the NPA isolates the trachea or protects against aspiration, and manual airway maneuvers and ongoing monitoring are still required.
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