critical care medicine
How To Insert a Nasopharyngeal Airway
Positioning for Nasopharyngeal Airway
The sniffing position—only in the absence of cervical spine injury: Position the patient supine on the stretcher. Align the upper airway for optimal air passage by placing the patient into a proper sniffing position. Proper sniffing position aligns the external auditory canal with the sternal notch. To achieve the sniffing position, folded towels or other materials may need to be placed under the head, neck, or shoulders, so that the neck is flexed on the body and the head is extended on the neck. In obese patients, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck. In children, padding is usually needed behind the shoulders to accommodate the enlarged occiput. A: The head is flat on the stretcher; the airway is constricted. B: The ear and sternal notch are aligned, with the face parallel to the ceiling (in the sniffing position), opening the airway. Adapted from Levitan RM, Kinkle WC: The Airway Cam Pocket Guide to Intubation, ed. 2. Wayne (PA), Airway Cam Technologies, 2007. If cervical spine injury is a possibility: Position the patient supine or at a slight incline on the stretcher. Avoid moving the neck and use only the jaw-thrust maneuver or chin lift without head tilt to manually facilitate opening of the upper airway. 