Oropharyngeal Airway Insertion

P R OC E D UR E 11
Oropharyngeal Airway Insertion

Kirsten N. S killings and Bonnie L. Curtis
PURPOSE:
Oropharyngeal airways are inserted to relieve airway obstruction, provide short-term maintenance of an airway,
and facilitate removal of tracheobronchial secretions.
PREREQUISITE NURSING KNOWLEDGE

• Oropharyngeal airways are usually disposable and made of hard curved plastic.
• Oral airways are inserted through the open mouth with the posterior tip resting in the patient’s pharynx.
• The oral airway is placed over the tongue. The curvature or body of the airway displaces the tongue forward from the
posterior pharyngeal wall, a common site of airway obstruction.
• An oral airway has four parts: the flange, body, tip, and channel (Fig. 11-1). The flange, or flat surface, protruding
from the mouth rests against the lips. This design protects against aspiration into the airway. The body of the airway
curves over the tongue. The tip is the distal-most part of the airway toward the base of the tongue. The channel
enables passage of a suction catheter.
FIGURE 11-1 Oropharyngeal airw ays. A, Guedel airw ay. B, Berman airw ay. C, Properly inserted oropharyngeal tube. (From Eubanks DH, Bone RC:
Comprehensive respiratory care: a learning system, St Louis, 1990, Mosby, 518.)
• The Guedel airway is tubular with a flattened-oval inner diameter. A suction catheter passes through the central lumen
or channel.
• The Berman airway has a channel on either side that guides the catheter along the edge of the airway into the
pharyngeal space.
• Oral airways are manufactured in a variety of lengths and widths for adults, children, and infants. Sizing depends on
the age and size of the patient (Table 11-1). An alternative method used to select the size of an oral airway is to
measure the airway by placing the flange alongside the patient’s lips and the oral airway tip alongside the angle of the
jaw (Fig. 11-2). Improperly sized airways can cause airway obstruction (if they are too small) and tongue displacement
against the oropharynx (if they are too large).
TABLE 11-1
Oral Airway Sizes
Size of Patient Diameter of Oral Airw ay (mm) Size of Oral Airw ay (Guedel)
Large adult 100 5

Medium adult 90 4
Small adult 80 3
From Cummins RO, editor: Airway, airway adjuncts, oxygenation, and ventilation. In ACLS: principles and practice, Dallas, 2003, American Heart Association, 145.
FIGURE 11-2 Alternative method for selecting size of an oropharyngeal airw ay. (From Eubanks DH, Bone RC: Comprehensive respiratory care: a learning system, St
Louis, 1990, Mosby, 552.)
• Oropharyngeal airways are used most commonly in unconscious patients because they may stimulate vomiting in a
conscious or semiconscious patient.2
• Oral airways facilitate suctioning of the pharynx and prevent patients from biting their tongues, grinding their teeth,
or occluding their endotracheal or oral gastric tubes. In addition, an oropharyngeal airway may be used in
conjunction with an oral endotracheal tube to facilitate artificial ventilation, acting as a bite-block and preventing
damage to the endotracheal tube, tongue, and soft tissues of the mouth.
• Improper or rough insertion techniques can result in tooth damage or loss and lacerations to the roof of the mouth.
Improper lip, oral, and airway care can result in pressure sores, cracked lips, and stomatitis.
• Oropharyngeal airway placement should never be attempted in a patient who is actively seizing.
EQUIPMENT
• Appropriately sized oral airway
• Nonsterile gloves
• Tongue depressor
• Tape
Additional equipment, to have available as needed, includes the following:
• Goggles, glasses, or face mask
• Suction equipment
PATIENT AND FAMILY EDUCATION

• Explain the procedure to the family (if the patient’s condition and time allow) and the reason for the airway insertion.
Rationale: This process identifies family knowledge deficits about the patient’s condition, the procedure, its
expected benefits, and its potential risks and allows time for questions to clarify information and voice concerns.
Explanations decrease family anxiety.
• Discuss the sensory experiences associated with oral airway insertion, including the inability to clench teeth together,
the presence of a hard plastic airway in the mouth, the inability to move the tongue freely, and the possibility of
gagging. Rationale: Knowledge of anticipated sensory experiences reduces anxiety and distress.
PATIENT ASSESSMENT AND PREPARATION
Patient Assessment
• Assess the patient’s need for long-term airway maintenance. Rationale: Oropharyngeal airways are generally used
for temporary airway maintenance.1-3
• Assess condition of oral mucosa, dentition, and gums. Rationale: Pre-procedural assessment provides baseline
information for later comparison.
• Remove loose-fitting dentures and any foreign objects (including partial plates, tongue studs, lip rings) from the
mouth. Rationale: Removal ensures that objects do not advance farther into the airway during insertion.
Patient Preparation
• Verify correct patient with two identifiers. Rationale: Prior to performing a procedure, the nurse should ensure the
correct identification of the patient for the intended intervention.
• Ensure that patient and family understand preprocedural teachings. Answer questions as they arise, and reinforce
information as needed. Rationale: This step evaluates and reinforces understanding of previously taught
information.
• Position the patient. A semi-Fowler’s or supine position is preferred for a conscious patient. Rationale: This
positioning promotes patient and nurse comfort and provides easy access to the oral cavity.
• Hyperextend the patient’s neck with the head-tilt chin-lift technique or the jaw-thrust technique for opening the
airway of the unconscious patient. Maintain cervical stabilization in a trauma patient, using the jaw-thrust technique
only. Rationale: Opening the airway can prevent obstructions that result from posterior displacement of the tongue
and epiglottis.
Procedure for Oropharyngeal Airway Insertion
FIGURE 11-3 Crossed-finger technique for opening the mouth. (From Eubanks DH, Bone RC: Comprehensive respiratory care: a learning system, St Louis, 1990, Mosby,
631.)
FIGURE 11-4 Insertion of an oropharyngeal airw ay. A, Advance airw ay w ith curved end up. B, Rotate airw ay 180 degrees. (From Eubanks DH, Bone RC:
Comprehensive respiratory care: a learning system, St Louis, 1990, Mosby, 551.)
References
1. Cummins RO, ed.. Airway, airway adjuncts, oxygenation, and ventilation. In ACLS: principles and practice,.
American Heart Association: Dallas, 2006:145–146.
2. Dulak, S. Placing an oropharyngeal airway. RN. 2005; 68(2):20.
3. Pierce, L. Management of the mechanically ventilated -patient,. St Louis: Saunders; 2007.
Additional Reading
S t John, R, S ec kel MBurns S M, ed.. Airway management. Care of mec hanic ally ventilated patients. 2ed. Jones and Bartlett, S udbury, MA, 2007.

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P R OC E D UR E 11

Oropharyngeal Airway Insertion

PREREQUISITE NURSING KNOWLEDGE

Large adult 100 5

PATIENT AND FAMILY EDUCATION

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