An oropharyngeal airway (OPA) also known as a Guedel airway is a curved, rigid device used to maintain an open airway in unconscious patients by preventing the tongue from obstructing the pharynx. It’s a staple in emergency and perioperative care.
Introduction
Airway obstruction caused by the tongue, foreign body, or body fluids (blood and stomach content) can be cleared or prevented by effective airway management through oral and nasopharyngeal airway, laryngeal mask, endotracheal intubation, etc.
Definition
Insertion of oropharyngeal airway is defined as the process of inserting a semicircular curved piece of hard plastic into the mouth.
Purposes
- Keeps the airway open during bag-mask ventilation.
- Helps deliver positive pressure ventilation effectively.
- Ensures proper oxygenation in apneic or critically ill patients.
- Used in patients with neurological impairment or loss of muscle tone.
- Helps avoid upper airway obstruction due to tongue displacement.
- Allows easy access for suctioning secretions from the airway.
- Reduces the risk of aspiration in unconscious patients.
- Used in cardiac arrest and trauma scenarios.
- Helps stabilize the airway before intubation.
Indications
- Patients who are at risk for airway obstruction.
- Upper airway gurgling with breathing.
- Absent cough or gag reflex.
- Excess oral secretions.
- Drooling.
- Teeth grinding.
- Biting of nasogastric or endotracheal tubes.
- Labored respirations.
Contraindications
Patient
- With an active gag reflex.
- Who had recent oral trauma.
- Who underwent oral surgery.
- With loose teeth
| Oral Airway Guidelines | |
| Size | Age |
| 000 | Preterm neonate |
| 00 | Newborn |
| 0 | Newborn to 1 year |
| 1 | 1-2 years |
| 2 | 2-6 years |
| 3 | 6-18 years |
| 4 | Adult medium |
| 5 | Adult large |
| 6 | Adult extra large |
Articles
| Articles | Purpose |
| Clean gloves | To prevent cross-infection. |
| Appropriate-sized oral airway | For insertion. |
| Suction equipment | To remove excessive secretions postinsertion. |
| Nonallergic adhesive tape | To secure the airway. |
| Tongue blade | To assess gag reflex and to open the patient’s mouth. |
| Stethoscope | For auscultation. |
| Tissue or washcloth | For cleaning face. |
Procedure
| Nursing Action | Rationale | |
| 1. | Perform hand washing. | Reduces transmission of microorganisms. |
| 2. | Arrange articles at bedside. | To perform the procedure smoothly. |
| 3. | Explain the procedure to the relative. | Reduces anxiety and enhances cooperation. |
| 4. | Place the patient in semi-Fowler’s position, if possible. | Aids in getting an easy access to the oral cavity. |
| 5. | Apply clean gloves. | Reduces transmission of microorganisms. |
| 6. | Use padded tongue blade; if difficult, use thumb and forefinger of the nondominant hand to aid in opening the mouth. | To open airway and be cautious when opening the airway with fingers as the patient can bite. |
| 7. | Insert oropharyngeal airway: Hold the oropharyngeal airway with the curved side facing upward and insert the distal part until it reaches the back of the throat, and then slowly turn the airway 180°, thereby following the natural curvature of the tongue. Hold airway sideways and insert into the oral cavity half-way and then rotate 90° tracing the natural curvature of the tongue.Make sure that the outer flange is just outside the patient’s lips after insertion. | Appropriate insertion prevents tongue to fall back and prevents airway obstruction. |
| 8. | Perform suctioning if necessary. | Removes secretions and helps in maintaining a patent airway. |
| 9. | Reassess the patient’s respiratory rate; auscultate lungs. | Helps in ensuring that the airway is patent. |
| 10. | Wipe face with tissue or washcloth. | Aids in maintaining hygiene. |
| 11. | Discard disposable articles into appropriate receptacle and replace articles. | For next use. |
| 12. | Document the date, time, size of airway used, and patient’s response. | Aids in providing continuity of care. |
Special Consideration
When inserting an oropharyngeal airway (OPA), several special considerations must be taken into account to ensure patient safety and effectiveness:
1. Patient Selection
- Only for unconscious patients – OPAs should not be used in conscious or semi-conscious individuals due to the risk of gagging and aspiration.
- Assess for contraindications – Avoid insertion in patients with oral trauma, trismus (jaw muscle spasm), or obstruction that may worsen with an OPA.
2. Correct Sizing
- Measure the OPA from the corner of the mouth to the angle of the jaw to ensure proper fit.
- Using an incorrect size can lead to airway obstruction rather than relief.
3. Proper Insertion Technique
- Upside-down method – Insert the OPA with the concave side facing upward, then rotate 180 degrees once past the hard palate.
- Avoid pushing the tongue backward – Improper insertion can worsen airway obstruction.
4. Monitoring After Placement
- Continuously assess for effective ventilation and signs of airway obstruction.
- If the patient gags or coughs, remove the OPA immediately to prevent aspiration.
5. Infection Control
- Use aseptic technique when handling the airway device.
- Regularly clean and replace OPAs to prevent contamination.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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