ACLS Provider: Course

Oropharyngeal Airway (OPA) Insertion

The oropharyngeal airway (OPA) is a rigid curved device inserted into the mouth to prevent the tongue from occluding the airway in unconscious patients. It is a simple but essential adjunct in airway management, particularly useful during bag-valve-mask (BVM) ventilation and as a bridge to more advanced airway techniques.

Indications

  • Unconscious patients without a gag reflex.
  • Patients receiving BVM ventilation during resuscitation.
  • Temporary airway support prior to intubation.

Contraindications

  • Conscious or semi-conscious patients (may provoke gagging or vomiting).
  • Presence of a gag reflex.
  • Significant oral trauma or anatomical disruption.

Sizing and Preparation

  • Size: Measure from the corner of the mouth to the angle of the jaw or earlobe.
  • Too short: May not relieve obstruction effectively.
  • Too long: May push the epiglottis into the airway and worsen obstruction.

Insertion Technique

  1. Ensure the patient is unresponsive with no gag reflex.
  2. Open the mouth using the crossed-finger technique.
  3. Insert the OPA upside down (curve pointing toward the roof of the mouth).
  4. Advance gently until resistance is met, then rotate 180° into position.
  5. Alternatively, use a tongue depressor and insert directly without rotation.

Confirmation of Placement

  • Unobstructed chest rise with ventilations.
  • No signs of gagging or resistance.
  • Clear breath sounds during assisted ventilation.

Potential Complications

  • Gagging and vomiting: Avoid by ensuring the patient lacks a gag reflex.
  • Airway trauma: Use gentle technique and correct sizing.
  • Improper placement: May worsen obstruction if sized or inserted incorrectly.

Key Considerations

  • Always monitor for signs of airway compromise or intolerance.
  • Be prepared to switch to an NPA or advanced airway if OPA is ineffective or contraindicated.
  • OPAs are a temporary solution—plan for definitive airway management if needed.