Skill Assessment - Oropharyngeal and Nasopharyngeal Airway (OPA, NPA) Insertion

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Laboratory Simulation

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Shared interskill preparation structure retained from the existing library; clinical and procedure-specific content is supported by peer-reviewed literature.
Shared interskill follow-up structure retained from the existing library; follow facility policy, scope of practice, provider orders, and device instructions for use.

Step	Pass	Unsatisfactory
Knowledge
States Contraindications and Relative Contraindications of procedure.
Preparation
Clinical Standards for Procedures and Interventions.
Assessment
Assesses airway patency, level of consciousness, gag reflex, mouth opening, nasal patency, facial or skull-base trauma, bleeding, and the need for assisted ventilation.
Preparation
Prepares multiple airway sizes, bag-mask device, oxygen, suction, water-soluble lubricant for an NPA, and monitoring.
Selects an adult OPA using the distance from the maxillary incisors to the angle of the mandible as a starting estimate and confirms that the chosen size produces effective ventilation without distal obstruction.
For a child, uses age-appropriate equipment and a validated facial measurement only as an estimate, then clinically verifies position and airway effectiveness.
Selects an NPA long enough to reach the pharynx without passing excessively deep and with the largest diameter that can pass atraumatically; follows device and local sizing guidance.
Implementation
Uses an OPA only in a deeply unresponsive patient without an intact gag reflex; opens the mouth, controls the tongue, and inserts using the approved adult or pediatric technique without forcing.
Lubricates the NPA with water-soluble lubricant, directs the bevel toward the septum, and advances gently along the floor of the selected nostril rather than cephalad.
Monitoring & Modifications
Stops for resistance, significant bleeding, gagging, vomiting, laryngospasm, worsening obstruction, or patient distress; removes or resizes the adjunct as indicated.
Confirms improved air movement, chest rise, bag-mask ventilation, oxygenation, and airway patency and reassesses frequently because adjuncts can migrate or become obstructed.
Post-Intervention
Maintains the adjunct only while indicated, removes it promptly when protective reflexes return or it causes harm, and documents type, size, route, response, and complications.
Post-Intervention Management Steps.

References

Summary Performance Evaluation

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