Airway Management: ACLS Basic Airway Adjuncts Review Video

IN ACLS CERTIFICATION, you will learn about airway management. There are two categories of airway management, basic airway adjuncts and advanced airway adjuncts. Like the name implies, basic airway adjuncts are used to increase the success of simple airway maneuvers. Let’s go over the basic indications, precautions and steps for correcting using basic airway adjuncts in ACLS protocols.

ACLS Basic Airway Adjuncts:

Oropharyngeal Airway (OPA)

When a patient becomes unconscious, it is crucial to maintain an open airway. One of the most common causes of airway obstruction is due to blockage from the tongue, as the tongue can fall back into the throat. In this case, ACLS providers use OPA to ventilate the patient effectively. The OPA is used when an unconscious patient is at risk for developing airway obstruction. For example, if you attempt a head tilt-chin lift, but the airway cannot be opened, you will use an OPA. OPAs can only be used in unconscious patients.

There are a few contradictions for using an OPA. Do not use an OPA on conscious patients, as a gag reflex and coughing may occur. You should also not use an OPA if the patient has a foreign object lodged in the throat.

Inserting an OPA:

Step 1: Clear the mouth of blood or secretions with suction.

Step 2: Select the oral airway device that is the correct size for the patient.

Step 3: Place the device at the side of the patient’s face to determine if the size is correct. It should be measured to fit from the corner of the mouth to the edge of the mandible.

Step 4: Insert the device so that the point is to the roof of the mouth and parallel to the teeth.

Step 5: Once the device is almost fully inserted, turn it until the tongue is cupped by the interior curb of the OPA device.

Nasopharyngeal Airway (NPA)

NPA is also used with unconscious patients, but is also used with conscious patients. It is often used by ACLS providers when a patient is semi-conscious, as they require an airway device but cannot use an OPA due to a gag reflex. It is also used when patients maintain a clenched jaw or require frequent nasal-tracheal suctioning.

There are contradictions for using an NPA. Do not use if the patient has a nose bleed or fractured nose.

Inserting a NPA:

Step 1: Select the airway device that is the correct size for the patient

Step 2: Place the device at the side of the patient’s face to determine the correct size. The NPA should measure from the tip of the nose to the mandible.

Step 3: Lubricate the airway with a water-soluble lubricant or anaesthetic jelly.

Step 4: Insert the device slowly, straight towards the face, but not towards the brain.

Step 5: Ensure the device feels snug, but not forced. If the NPA feels stuck, try the other nostril or a smaller device.

There are contradictions for using an NPA. Do not use if the patient has a nose bleed or fractured nose.

Suctioning

Suctioning is used when patients are unable to control or mobilize their secretions, such as blood or saliva, and is often used on patients with neuromuscular disease. It is also used when patients are sedated or have an artificial airway. Clinical indications should be used to determine if a patient needs suctioning to avoid risk. Some of these include respiratory distress such as tachycardia, difficulty talking, and increase resistance, SPO2, PEEP, and FiO2. It is important to suction the airway immediately, only attempt for 10-second intervals, and follow with 100% oxygen administration.

There are two types of catheters, open and closed, so be sure to choose the correct size and type.

Tips on suctioning:

• Do not insert the catheter too deeply
• Sterile technique should be used near bronchi
• Keep in mind the patient will not receive oxygen while suctioning
• Monitor vital signs during suctioning and stop if the patient experiences hypoxia, new arrhythmia or becomes cyanotic

Check out the video below:

There you have it! Now you know the basics of OPA, NPA and suctioning. If you are interested in taking online ACLS certification or recertification, check out the other resources below.

Other helpful resources:

• Online ACLS certification and Renewal
• ACLS Algorithms you Need to Know
• ACLS Study Guide