What is important to avoid when using an NPA?

Avoiding basilar skull fractures when using a nasopharyngeal airway (NPA) is critical due to the potential for worsening neurological injury or entering the cranial cavity. If a patient has a basilar skull fracture, there is a risk that inserting the NPA could traverse the fracture site and cause intracranial complications, such as introducing pathogens into the cranial space or exacerbating bleeding. This concern is based on the anatomical considerations surrounding the nasal passages and how they relate to the skull base, which is highly vulnerable during traumatic injuries.

The other options, while they may seem relevant, do not carry the same level of concern regarding immediate patient safety and complications associated with inserting an NPA. Using lubricant is generally standard practice to facilitate insertion, and inserting it straight into the nostril is necessary for proper placement. Although the presence of extensive facial injuries may complicate the use of an NPA, it does not carry the same immediate risk of causing further injury as a basilar skull fracture. Thus, maintaining awareness of the presence of a basilar skull fracture is paramount when considering the use of an NPA.