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NASOPHARYNGEAL AIRWAY
Clinical Indications
• Depressed mental status with need for airway augmentation to ensure patency/access
Relative Contraindications
• Patient at high-risk of aspiration and/or unable to protect airway
• Massive facial trauma, facial/inhalation burns, burns >40% TBSA, or suspicion of basilar skull
fracture (e.g., CSF otorrhea, Battle’s sign, raccoon eyes, mechanism)
Procedure
• Position the patient in the sniffing position
• Select appropriately sized NP tube and lubricate with water-soluble jelly [can measure tube by
placing exterior (lipped) end next to nare and tip should reach to the angle of the mandible]
• Select the most patent nare, orient open angle medially, and pass tube in a posterior—not
superior—direction. If resistance is met, attempt to corkscrew slightly or remove and attempt
in the other nare. If unsuccessful, try the next smallest-sized tube.
• Pass the tube until the lip of the NP tube rests against the nare
• Bag the patient with BVM/mask as needed
**Document procedure, results, and vital signs**

BLIND INSERTION AIRWAY DEVICE (BIAD)
Clinical Indications
• Patient with inadequate respiratory drive or respiratory failure due to any reason (e.g., altered
mental status, trauma, infection) other than airway burns, anaphylaxis, or other causes of
airway swelling/obstruction.
Contraindications
• Massive upper airway trauma distorting anatomy
• Penetrating neck trauma
• Anaphylaxis
• Airway burns or >40% TBSA
Procedure
Prior to attempting any Blind Insertion Airway Device (BIAD), follow the requirements of the
Rapid Sequence Intubation Protocol.
• Select the appropriate size BIAD and ensure proper cuff inflation/deflation.
• Lubricate with water-soluble jelly
• Insert according to the manufacturer’s guidance
• Confirm correct placement through EtCO waveform and secure tube
2
WARNING:
BIADs may not prevent or block aspiration of gastric contents.

200 • PROCEDURES