Oropharyngeal Airway: How To Insert an Oropharyngeal Airway

October 17, 2024

Did you know that airway obstruction is one of the leading causes of accidental death? According to a study, 47.9% of oropharyngeal airways were properly sized, 23.4% were undersized, and 28.7% were oversized.

Interruption to the pulmonary processes in cases where the patient lacks conciseness is a major concern that can determine the patient’s outcome. Furthermore, In emergencies, ensuring there is no airway obstruction is crucial for effective breathing and ventilation. Hence, to help achieve better airway management, an oropharyngeal airway (OPA) is necessary.

An OPA is a simple yet important device used in emergencies to keep a patient’s airway open for patients who are unconscious or semi-conscious. Inserting an oropharyngeal airway is a must-know procedure for first responders, healthcare professionals, and even those pursuing basic first-aid training.

In this blog, we will explain the correct way to insert an oropharyngeal airway. We will also cover everything about OPA, from what it is to when to use it, to help you understand this medical device.

What Is An Oropharyngeal Airway?

An oropharyngeal airway (OPA) is a curved plastic or rubber device designed to keep the airway open by preventing the tongue from covering the epiglottis, which could block the airway. It is typically shaped like a curved tube with a flange at one end. The curve matches the natural curvature of the mouth and throat. The flange remains outside the mouth, preventing the OPA from slipping further into the airway.

Interestingly, the OPA was designed by Arthur Guedel and is also known as the Guedel pattern airway. Its main purpose is to maintain an open airway in patients who are not fully conscious or have trouble maintaining their airway due to an injury like brain trauma or stroke.

Understanding The Use Of An Oropharyngeal Airway

Once you know what an OPA is, you need to understand when it is used. An OPA can help prevent the tongue from blocking the airway, especially in patients who are unconscious or have a reduced level of consciousness. Here are the key situations where it is appropriate:

Unconscious Patients

An oropharyngeal airway (OPA) is most often used for people who are completely unconscious and don’t have a gag reflex. When someone is unconscious, their muscles relax, including the tongue. The tongue can fall back and block the airway, making it hard for them to breathe.

Inserting an OPA keeps the tongue in place and helps to keep the airway clear. This can stop the person from choking or facing other serious breathing problems.

Reduced Level of Consciousness

An OPA can also be useful in semi-conscious or heavily sedated patients. These patients might have some awareness, but their muscles, including the tongue, are not fully in control. However, there is a risk because they may still have a gag reflex, which can cause them to gag or even vomit if something touches the back of their throat.

So, while OPAs can help in these cases, healthcare providers need to be very cautious and watch carefully for any signs of discomfort or choking.

Assisted Ventilation

When using devices like a bag-valve-mask (BVM) to help someone breathe, an OPA becomes especially helpful. The OPA keeps the airway clear, allowing the oxygen to pass through more easily. Without an OPA, the tongue might block the airway, and the ventilation might not work as well. By holding the airway open, the OPA makes sure that the patient gets the oxygen they need during assisted breathing.

Before Intubation

Sometimes, an OPA is used as a temporary solution before a more secure airway is established, like with endotracheal intubation. This happens when a doctor or paramedic needs to make sure the airway stays open while they prepare for a more permanent way to keep the airway clear. The OPA acts as a short-term fix, giving healthcare providers time to set up the more advanced equipment.

When Not to Use an Oropharyngeal Airway

When using an oral airway, it’s equally important to know when to avoid using it. There are several situations where using an OPA could cause harm instead of helping. Let’s look at some of those:

Conscious Patients

Never use an OPA for a patient who is conscious and has an intact gag reflex. An intact gag reflex is the body’s natural reaction to something touching the back of the throat. If a person has an intact gag reflex, they will automatically gag or even vomit if something like an OPA is inserted into their mouth.

Inserting the device could trigger vomiting or choking, leading to aspiration (breathing in vomit) and further complications.

Facial or Oral Trauma

If the patient has significant trauma or bleeding on the face, mouth, or throat, an OPA might not be suitable. The insertion could cause additional injury or escalate the condition.

Obstructions

If a foreign body obstruction (such as food, a small object, or anything that can get stuck in the throat) is known or suspected, an OPA might push it further down, making the obstruction worse.

Choosing the Right Size Oropharyngeal Airway

Choosing the correct size OP airway is another key factor for effective airway management. If the OPA is too small, it won’t keep the tongue out of the way, and the airway might remain blocked. However, if it’s too large, it could cause trauma to the throat or even obstruct the airway itself.

To choose the right size, measure the OPA against the patient’s face. The length of the OPA should match the distance from the corner of the patient’s mouth to the angle of their jaw (just below the ear). This ensures that the device is long enough to keep the airway open but not so long that it causes harm.

Preparing for Insertion

Before inserting an oropharyngeal airway (OPA), you must prepare sufficiently to ensure the procedure goes smoothly. Proper preparation helps avoid complications and makes the process safer for the patient. Here’s what you need to do before inserting the OPA:

Assess the Patient: Check the patient’s level of consciousness and gag reflex. Remember, an OPA should only be used in unconscious patients with no gag reflex.

Select the Right Size: Based on the measurement technique discussed earlier, choose the correct size of the OPA airways for your patients.

Position the Patient: Ideally, the patient should be in a supine position (lying flat on their back) with their head in a neutral or slightly extended position. This helps open the airway and makes the OPA insertion easier.

Open the Mouth: To open your patient’s mouth, you can use the “cross-finger technique.” Place your thumb on the patient’s lower teeth and your index finger on the upper teeth. Then, gently push the teeth apart to insert the OPA.

Steps to Insert an Oropharyngeal Airway

Once you’ve prepared everything, it’s time to insert the oropharyngeal airway (OPA). The insertion process needs to be done carefully to ensure the airway is opened effectively without causing harm to the patient. Here are the steps you should follow to insert the OPA:

Hold the OPA Correctly: Hold the OPA by the flange (the flat part that stays outside the mouth) with the curved end pointing upward and toward the roof of the mouth.
Insert the OPA: Gently insert the OPA into the patient’s mouth, ensuring the curve of the OPA follows the curve of the mouth and throat.
Rotate the OPA: As you insert the OPA, rotate it 180 degrees so that the curved end is now pointing down, following the natural curvature of the tongue and throat. This helps guide the OPA into the correct position without pushing the tongue backward.
Advance the OPA: Continue to advance the OPA until the flange rests against the patient’s lips. The curved end should now be resting behind the tongue, keeping it from obstructing the airway.
Check Placement: Ensure that the OPA is correctly positioned. The patient’s airway should now be open, and you should be able to see or feel air movement if the patient is breathing.
Monitor the Patient: After insertion, constantly monitor the patient’s airway and breathing. If necessary, use a bag-valve-mask (BVM) or another appropriate method.

Common Issues Faced

Sometimes, inserting an OP airway can be challenging, especially in emergencies. Here are some common issues and how to address them:

Resistance During Insertion

If you feel resistance while inserting the OPA, it’s important to stop immediately and reassess the situation. Resistance might mean the OPA is hitting something, or the patient’s head might not be in the right position.

You need to check if you’re using the correct size of the OPA because using one that’s too large or too small can cause issues. Also, make sure the patient’s head is properly tilted back to open the airway. Never try to force the OPA into place because this can hurt the patient or damage their throat.

Gagging or Vomiting

If the patient starts to gag or vomit during the insertion of the OPA, it means they likely still have a gag reflex. In this case, you should stop immediately and remove the OPA. The presence of a gag reflex means an OPA is not suitable for this patient.

Gagging or vomiting could lead to choking or other complications, so it’s important to switch to a different method of airway management, such as a nasopharyngeal airway (NPA).

Improper Placement

Sometimes, after inserting the OPA, it may not be working as expected. This could mean the placement is incorrect. If the airway isn’t staying open or the OPA seems to be in the wrong position, it’s important to take it out and try again.

Double-check the steps you are following, and make sure you are using the correct size for the patient. Proper placement is crucial to keeping the airway open and ensuring the patient can breathe easily.

Airway Obstruction

If the airway is still blocked even after inserting the OPA, there could be another reason for the obstruction. It’s important to check if something else, like a foreign object or injury, is blocking the airway.

In this case, you might need to use other tools, such as an NPA or an endotracheal tube (ETT). If the OPA causes choking or makes the blockage worse, perform the Heimlich maneuver to clear the airway. Always be prepared to switch to a different method if needed to keep the airway clear and safe.

Safety Considerations

Using an oropharyngeal airway (OPA) demands proper care in handling, monitoring, and documentation of the device and patient. Here are some important safety considerations to keep in mind:

Infection Control

When using an OPA, it’s very important to follow infection control guidelines. This means always wearing gloves and any other necessary personal protective equipment (PPE) like masks or gowns to prevent spreading germs.

The OPA itself should either be sterile or thoroughly clean before you use it. Keeping things as clean as possible reduces the risk of infection for both the patient and the healthcare provider.

Patient Monitoring

After inserting the OPA, you need to monitor the patient’s airway and breathing closely. This means watching to make sure the airway stays open, and the patient can breathe properly.

Sometimes, conditions can change, and the airway might become blocked again, so it’s important to check regularly and be ready to act if the patient’s breathing gets worse or if there are any other signs of complications.

Proper Disposal

After using the OPA, it’s important to follow your facility’s guidelines for proper disposal. If the OPA is a single-use device, it should be thrown away right after use. If it’s reusable, make sure to clean and sterilize it according to the manufacturer’s instructions. Proper cleaning and disposal help prevent infections and ensure safety for future use.

Documentation

Healthcare providers should document the use of the OPA in the patient’s medical record. This includes writing down the size of the OPA that was used, the time it was inserted, and any complications or problems that happened during its use.

Good documentation ensures that other healthcare providers are aware of what has been done. It can help in making informed decisions about the patient’s care going forward.

Ensure Proper Oropharyngeal Airway Insertion

Inserting an oropharyngeal airway (OPA) is a vital skill in emergency care. This life-saving device prevents patients from undergoing any respiratory complications. It is useful in cases where patients can not regulate their own airway.

Additionally, while OPAs are simple tools, they must be used with care and attention. Always choose the right size of the OPA, follow proper insertion techniques, and monitor the patient closely. In situations where an OPA isn’t suitable, be ready to use alternative methods to maintain the airway.

To learn more about proper airway management and dealing with other emergencies, you can join the BLS Course today and gain the essential skills to respond during emergencies. Enroll Now and become a certified lifesaver!