NPA/Nasal Trumpet

[Leafylane]

This may seem like a common sense question, but I cannot find any documentation regarding best practice. Here it is: Is it safe for a patient with a nasal trumpet to drink water, swallow pills, etc.? I recently had a conscious patient with an NPA who insisted on drinking water and would aspirate and cough violently for 20 minutes every time.

Thanks in Advance

[MunoRN, RN]

A nasal trumpet typically extends into the pharynx, and would act as a physical barrier to normal swallow coordination, so generally patients should be strict NPO with a nasal trumpet in place. This isn't typically an issue, since generally these are used on patients who would be NPO anyway.

[Double-Helix, BSN, RN]

I agree with Muno. Even though the NPA doesn't extend past the epiglottis, and some swallowing ability exists, a patient who requires a nasal trumpet probably has other issues that contraindicate eating and drinking. I'd want a speech eval before allowing them to take anything PO.

[Leafylane]

That's what I was thinking...that the NPA should still allow for swallowing based on its placement above the epiglottis. Additionally, these patients should still be able to clear their own oral secretions for the most part since they typically don't have continuous suctioning. I just wasn't certain to what degree swallowing would be affected by the device itself outside of other impairments to swallowing.

This particular patient had an NPA strictly for deep suctioning, because she was unable cough hard enough to clear mucus from her lower airway. She did not have any apparent swallowing concerns otherwise. But, I tend to agree that NPO is probably safest, and I obtained an order for the patient to be NPO.

[Wile E Coyote, ASN, RN]

I'm cornfused here... OP, your line about aspirating and coughing violently for 20 minutes doesn't jive with no "apparent swallowing concerns" nor does the violent coughing jive with the statement that the pt's cough was weak.

[Leafylane]

Sorry, that does sound confusing. I had the patient for multiple shifts. She swallowed pills, water, food just fine for the first shift I had her. When I came back on for my second shift with her, the NPA had been placed by the day shift doctor, whose reasoning for the trumpet was her apparent inability to cough up thick mucus in her lower airways. At that point, she insisted on sips of water from the CNA, which she in turn aspirated. I also questioned the necessity of the NPA, but that's another issue.

I was really just wondering the best practice for oral intake with an NPA as I could not find documentation explaining whether or not swallowing would be significantly affected by the device itself.

[heinz57]

If the patient needs a trumpet for airway clearance, they probably need a swallow eval but without the NPA.

The problems often come from improperly sized NPAs. Rarely are several sizes stocked and usually just what is available is shoved up a patient's nose.

You could, however, time the NPA maintenance around the need to swallow pills or water. The NPA will be out at that time .

[Double-Helix, BSN, RN]

When I came back on for my second shift with her, the NPA had been placed by the day shift doctor, whose reasoning for the trumpet was her apparent inability to cough up thick mucus in her lower airways.

Was the NPA supposed to facilitate deep suctioning? Otherwise that rationale makes no sense to me.

[Leafylane]

Yes, it was.

[AnnieOaklyRN, BSN, RN, EMT-P]

Hi,

If a person is awake enough to eat and drink they do not need a nasal airway in.

This is going to sound blunt, but that doctor is a moron! He is going to increase the chances that she actually aspirates her food and drink. What is he thinking???? A nasal airway is not going to have any effect on a patient coughing up thick mucous from the lower airways, the point of a nasal airway is to help open up an airway for an OBTUNDED patient!

I would seriously stop feeding this patient until the nasal airway is removed!

Annie