Respiratory Cloud Clinical Skills Library

Clinical knowledge review

Contraindications

Use these educational prompts with current orders, protocols, patient assessment, facility policy, and supervising-clinician direction.

Skill

Oropharyngeal and Nasopharyngeal Airway (OPA, NPA) Insertion

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Contraindications Conditions identified as reasons to avoid or defer the procedure pending authorized clinical review. View list Relative contraindications Factors requiring individualized risk-benefit assessment, added precautions, or a modified approach. View list

Contraindications

Review these conditions before proceeding and follow current orders, protocols, facility policy, and supervising-clinician direction.

  • An intact gag reflex or conscious response is a contraindication to OPA placement.
  • Avoid NPA insertion with severe nasal obstruction or trauma, recent nasal surgery, or suspected basilar skull or severe midface fracture unless specifically directed by an experienced airway clinician.

Relative contraindications

Use individualized risk-benefit assessment, added precautions, or a modified approach as authorized for the patient and setting.

  • Coagulopathy, recurrent epistaxis, nasal deformity, and anticoagulation increase bleeding risk.

Sources

Supporting sources include peer-reviewed research, evidence-based clinical practice guidelines, professional standards, and foundational respiratory care references, as applicable to the skill.

  1. Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. doi:10.1161/CIR.0000000000001369. PMID:41122888.
  2. Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: dispelling myths and establishing the facts. Emerg Med J. 2005;22(6):394-396. doi:10.1136/emj.2004.021402. PMID:15911941.