Chart — Respiratory · Emergency Nursing
Airway Adjunct Comparison Chart
NPA, OPA, BVM, LMA, ETT, and surgical cricothyrotomy compared side-by-side — indications, contraindications, sizing, aspiration protection, and nursing considerations for emergency airway management.
Educational use only. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Nasopharyngeal Airway (NPA)
Nasal Trumpet
| Indication | Semi-conscious patient WITH gag reflex; trismus/jaw clenching; cannot tolerate OPA |
| Contraindication | Suspected basilar skull fracture; severe nasal trauma; coagulopathy (relative) |
| Sizing | Measure: nostril → earlobe. Adult 28–34 Fr (~6.5–8 mm) |
| Insertion | Lubricate; insert perpendicular to face; bevel toward septum; gentle rotation if resistance |
| Aspiration protection | No — does not protect airway |
| Definitive airway | No |
| Nursing notes | Inspect for epistaxis after insertion (nares are vascular). Well-tolerated in awake patients. Can leave longer than OPA. Tape to secure. |
| NCLEX Pearl | Can use WITH gag reflex — key distinction from OPA. Lubricate well. |
Oropharyngeal Airway (OPA)
Guedel / Oral Airway
| Indication | Unconscious patient WITHOUT gag reflex; during BVM ventilation to lift tongue |
| Contraindication | Patient with intact gag reflex (triggers vomiting → aspiration) |
| Sizing | Measure: corner of mouth → earlobe. Too small = pushes tongue back; too large = laryngospasm. |
| Insertion | Adult: insert upside down (toward palate), rotate 180° past tongue. OR use tongue depressor and insert oriented correctly. |
| Aspiration protection | No — does not protect airway |
| Definitive airway | No |
| Nursing notes | NEVER tape in place — patient must be able to expel if gag reflex returns. Remove immediately if patient gags. Check positioning with capnography if BVM ventilating. |
| NCLEX Pearl | Unconscious/no gag reflex ONLY. If patient gags → remove immediately. Do NOT tape. |
Bag-Valve-Mask (BVM)
Ambu Bag
| Indication | Ventilation support for apneic or severely hypoventilating patient prior to/during intubation |
| Contraindication | Massive facial trauma preventing seal; excessive secretions without suction available (relative) |
| Sizing | Adult mask — use correct size for face. Pediatric sizes available. Reservoir bag must remain inflated (10–15 L/min O₂). |
| Insertion | EC-clamp technique for mask seal. 2-person technique preferred for better seal and tidal volume delivery. |
| Aspiration protection | No — aspiration risk with BVM (especially if not positioned correctly) |
| Definitive airway | No |
| Nursing notes | 1 breath every 5–6 sec (10–12/min) for adult. Avoid hyperventilation. With CPR: asynchronous ventilation — do NOT pause compressions for breaths once advanced airway is placed. Insert OPA to facilitate mask ventilation in unconscious patient. |
| NCLEX Pearl | 2-person BVM is superior technique. Rate 10–12/min adult. Avoid hyperventilation (increases intrathoracic pressure, impairs venous return). |
Laryngeal Mask Airway (LMA)
Supraglottic Airway
| Indication | Anesthesia maintenance; failed intubation rescue; blind insertion when visualization impossible; EMS use by trained providers |
| Contraindication | Full stomach / aspiration risk; intact gag reflex; morbid obesity or excessive secretions (relative); cannot open mouth > 1.5 cm |
| Sizing | Size by weight. Deflate cuff before insertion; inflate after correct positioning. |
| Insertion | Blind insertion — advance against hard palate; resistance indicates correct seating over glottis. Do NOT force. Check airway with positive-pressure breath (chest rise). |
| Aspiration protection | Minimal to none — sits above glottis; does NOT protect against aspiration |
| Definitive airway | No — supraglottic; not definitive |
| Nursing notes | Verify placement with capnography and auscultation. LMA Supreme/ProSeal variants have gastric drainage channel (reduces but does NOT eliminate aspiration risk). Cannot tolerate high airway pressures (leak above cuff inflation point). |
| NCLEX Pearl | Supraglottic = does NOT protect against aspiration. Rescue airway when intubation fails. Blind insertion. |
Endotracheal Tube (ETT)
Intubation / ET Tube
| Indication | Definitive airway control; prolonged mechanical ventilation; airway protection (unconscious/GCS ≤ 8); respiratory failure unresponsive to non-invasive support; RSI for procedural indications |
| Contraindication | No absolute contraindication in emergency — consider surgical airway if cannot intubate |
| Sizing | Adult female: 7.0–7.5 mm ID. Adult male: 7.5–8.0 mm ID. Depth: ~21 cm at lip for females; ~23 cm for males. Confirm with CXR (tip 3–5 cm above carina). |
| Insertion | RSI: pre-oxygenate → sedation → NMBA → direct or video laryngoscopy → intubate → cuff inflate → confirm → secure tube. |
| Aspiration protection | YES — cuffed ETT protects against aspiration when cuff adequately inflated |
| Definitive airway | YES — definitive airway |
| Nursing notes | Confirm: waveform capnography (gold standard) + bilateral breath sounds + chest rise. No gurgling over epigastrium. Secure tube with commercial holder or tape. Monitor cuff pressure 20–30 cmH₂O. Head-of-bed 30–45°. Suction as needed. VAP prevention bundle. |
| NCLEX Pearl | Gold standard confirmation = waveform capnography. ETT = definitive airway. Cuff pressure target 20–30 cmH₂O (avoid overinflation → tracheal necrosis; underinflation → aspiration). |
Surgical Cricothyrotomy
Cric / Surgical Airway
| Indication | CICO — Cannot Intubate, Cannot Oxygenate. Last resort when all other airway methods fail and patient cannot be oxygenated. |
| Contraindication | Children under 12 (use needle cric instead — ring structure too fragile). Laryngeal fracture or hematoma involving cricothyroid membrane. |
| Sizing | Cricothyrotomy tube 6.0–7.0 mm cuffed OR dedicated surgical airway device |
| Insertion | Palpate cricothyroid membrane (between thyroid cartilage and cricoid ring). Vertical skin incision → horizontal membrane incision → curved hemostat → insert tube → cuff inflate → ventilate → confirm with capnography. |
| Aspiration protection | YES — definitive cuffed airway |
| Definitive airway | YES — definitive airway (temporary pending tracheostomy) |
| Nursing notes | Prepare equipment immediately when called for CICO situation. Nurse role: remain calm, hand instruments, maintain SpO₂ monitoring, document time of procedure, assist with confirmation. This procedure is time-critical — seconds matter. |
| NCLEX Pearl | CICO scenario = last resort surgical airway. Cricothyrotomy performed BELOW thyroid cartilage on cricothyroid membrane. Needle cricothyrotomy is temporizing only (transient oxygenation, buildup of CO₂). |
Airway Escalation Quick Summary
| Situation | First Choice | If First Fails |
|---|---|---|
| Conscious patient, partial obstruction | NPA | Suctioning, positioning |
| Unconscious, no gag, needs brief support | OPA + BVM | Intubation if prolonged |
| Respiratory failure, failed non-invasive | ETT via RSI | Video laryngoscopy |
| Cannot intubate — first rescue | LMA / supraglottic | Surgical airway (CICO) |
| CICO — cannot oxygenate by any method | Surgical cricothyrotomy | — |
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Association for Respiratory Care (AARC) · GOLD (COPD) / ATS / CHEST. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →