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    Placing an oropharyngeal airway

    When a patient stops breathing, inserting an oropharyngeal device is the quickest way to provide a patent airway. Here's a review of this lifesaving measure.


    An oropharyngeal airway is an ideal way to restore the patency of an airway that's become obstructed by the tongue in an unconscious patient—or to aid in ventilation during a code. This device, which is easily inserted at the bedside, can also be used to facilitate suctioning in an unconscious or semi-conscious patient and can prevent him from biting his tongue and the inside of his lips and cheeks (though it's not indicated for someone who's actively seizing).

    Knowing how to properly insert an oropharyngeal airway is the best way to ensure an optimal and injury-free outcome. But before we review how it's done, let's take a look at the two most common types of devices.

    The Berman and Guedel airways Oropharyngeal airways are generally made of hard plastic, and have a semicircular design that conforms to the curvature of the palate. When properly inserted, an oropharyngeal airway will hold the tongue away from the posterior pharynx so air can pass through and around the device.

    For adult patients, the two most widely used oropharyngeal airways are the Berman and the Guedel, each named for its designer. The Berman has channels along each side that allow a suction catheter or endotracheal tube to slide into the pharyngeal space. The Guedel is a tubular device. While its central lumen can be used for suctioning, it can't support an ET tube.

    Each oropharyngeal airway has three parts: the flange, the body, and the tip. When properly inserted, the flange is the piece that protrudes from the mouth and rests against the lips, preventing the device from sinking into the pharynx. The body follows the contour of the roof of the mouth, and will curve over and rest on top of the tongue. The distal end, or tip, sits at the base of the tongue.

    Steps you'll take prior to insertion Before inserting an oral airway, make sure you select the appropriate size. Large adults require a size 5 - 6; medium adults require a size 4 - 5; and small adults need a size 3 - 4.

    To get the right size, use the device itself as a measure. When you place it on the patient's cheek with the flange parallel to his front teeth, the tip of the oropharyngeal airway should reach no further than the angle of the jaw. If the airway is too long, it could obstruct breathing by displacing the tongue against the oropharynx. If it's too short, it won't be able to hold the tongue away from the pharynx, and patency won't be restored.

    Before insertion, suction the patient's mouth and pharynx to remove any secretions. Place the patient in a supine or semi-Fowler's position, and tilt the head back, unless this is contraindicated. With gloved hands, remove dentures (if they're present), and prepare to insert the device.

    Now you're ready First, open the patient's mouth using the cross-finger method, placing your thumb on the patient's bottom teeth and your index finger on the upper teeth, then gently pushing them apart. With the patient's mouth open as wide as possible, begin inserting the airway upside down, with the curvature toward the tongue to prevent pushing the tongue back into the pharynx.

    Avoid dislodging teeth or damaging mouth tissue by gently sliding the airway over the tongue toward the back of the mouth. When the airway reaches the back of the tongue, rotate the device 180 degrees. The tip should point down as it approaches the posterior wall of the pharynx, and the curvature should follow the contour of the roof of the mouth.

    An alternative method is to hold the airway in its normal upright position and use a tongue blade to hold the tongue down. Slide the airway carefully over the tongue and into position.

    If the patient gags or appears to be gasping for air after insertion, remove the airway immediately. Recheck the size before attempting reinsertion.


    Sally Beattie, RN, MS, CNS, GNP
    Sally Beattie, is an RN editorial board member and an advanced practice nurse at the University of Missouri Hospital and Clinics, ...