A for Airway (Adjuncts)
Airway Adjuncts Explained Simply
A plain-English guide to every airway adjunct used in clinical practice. What each device is, how it works and who can use it.
- What is an airway adjunct?
- Guedel (oropharyngeal) airway
- Nasopharyngeal airway (NPA)
- Laryngeal mask airway (LMA)
- i-gel supraglottic airway
- Endotracheal tube (ETT)
- Bag valve mask (BVM)
- Suction catheters and Yankauer
What Is an Airway Adjunct?
An airway adjunct is a medical device used to help keep a patient's airway open and clear. The airway is the passage that carries air from the mouth and nose down into the lungs. When this becomes blocked or obstructed, whether through unconsciousness, a medical emergency, anaesthesia or trauma, the patient cannot breathe safely on their own.
Airway adjuncts range from simple devices that any trained first aider can use, through to complex equipment that requires years of specialist training to insert safely. This guide covers all of them in plain English so that students, qualified clinicians and anyone interested in how emergency care works can understand what each one does and why it is used.
Airway management is a clinical skill that requires proper training and competency assessment before use in practice. This guide is for educational purposes only. No airway adjunct should be used in a real patient situation without the appropriate training, supervision and clinical authorisation.
In an unconscious patient, the tongue falls back and obstructs the airway. This is the most common cause of airway obstruction and is why positioning and adjuncts are so critical.
From basic positioning and suction through to full endotracheal intubation, airway management is described in levels of complexity and invasiveness.
Nurses, ODPs, paramedics, anaesthetists and doctors all use airway adjuncts in different settings, each within their own scope of practice and competency.
The brain begins to suffer irreversible damage after around four to six minutes without oxygen. Airway management is one of the first priorities in any emergency.
Skill level key used in the cards below:
Airway Adjuncts Explained
A rigid, curved plastic tube inserted through the mouth and over the tongue to hold the airway open. It works by preventing the tongue from falling back and blocking the throat in an unconscious patient. It comes in multiple sizes and the correct size is estimated by measuring from the centre of the mouth to the earlobe or from the corner of the mouth to the angle of the jaw.
A soft, flexible tube inserted through one nostril and into the back of the throat to maintain an open airway passage. Unlike the Guedel, it can be used in patients who have a partial level of consciousness or a gag reflex, making it more versatile in emergency situations. It is lubricated before insertion to reduce discomfort and trauma to the nasal passage. A safety pin can be placed through the flange to prevent it from being inhaled, depending on the brand.
A reusable or single-use device that sits above the larynx (voice box) and creates a seal around the opening of the airway. A tube connects to a soft inflatable oval cuff that is passed through the mouth and positioned at the back of the throat. Once inflated, the cuff forms a seal that allows ventilation without the need for the device to enter the trachea. It is widely used in anaesthesia for routine surgery and in emergency airway management.
A second-generation supraglottic airway device made from a soft, gel-like material that moulds to the shape of the patient's airway without the need for an inflatable cuff. This makes it quicker to insert and reduces the risk of over- or under-inflation. The i-gel also includes a gastric channel, a separate small tube that allows a gastric tube to be passed to drain the stomach and reduce the risk of aspiration. It is widely used in cardiac arrest and emergency airway situations.
The gold standard for airway management. A plastic tube that is passed through the mouth or nose, through the vocal cords and directly into the trachea (windpipe). An inflatable cuff at the lower end creates a seal that provides full protection against aspiration and allows controlled mechanical ventilation. Insertion requires direct or video laryngoscopy and is performed by anaesthetists, ODPs, intensivists and some paramedics. This is called a definitive airway as it provides the most secure and protected route for breathing.
A hand-held device used to deliver positive pressure ventilation to a patient who is not breathing adequately or at all. It consists of a face mask that seals over the patient's mouth and nose, a self-inflating bag that refills with air or oxygen after each squeeze, and a one-way valve that prevents exhaled air from re-entering the bag. It can be used with or without supplemental oxygen and can be connected to any airway adjunct including an ETT or LMA. Effective BVM ventilation is a core emergency skill and requires good technique to maintain an airtight mask seal.
A rigid, curved plastic suction device used to clear the mouth and throat of blood, vomit, secretions and debris that would otherwise block the airway. It connects to a suction unit via flexible tubing and uses a thumb-control hole to regulate suction. When the thumb is placed over the hole, suction is activated. When released, suction stops. The Yankauer is one of the most commonly used airway adjuncts in both emergency and routine clinical settings and should always be available and ready to use at the bedside of any patient at risk of airway compromise.
Which Device for Which Situation?
Every airway situation is different. The right choice of adjunct depends on the patient's level of consciousness, the clinical environment, the skills available and the urgency of the situation. Here is a simple summary to help make sense of when each device tends to be used.
Guedel airway is the first choice. Quick to insert and effective at lifting the tongue away from the airway.
Nasopharyngeal airway is better tolerated. Avoid in suspected head or base of skull injury.
LMA or i-gel is the most common choice. Fast to insert and well tolerated. Does not enter the trachea.
i-gel is widely used due to the speed of insertion and the gastric channel. ETT may follow if a skilled clinician is available.
Endotracheal tube provides the only fully secure and protected airway. Required for long-term ventilation in ITU.
Yankauer suction must be used first to clear the airway before any adjunct can work effectively.
The best way to learn airway adjuncts is to handle them in a simulation or skills lab setting before you encounter them clinically. Ask your mentor or educator to show you how each device is assembled, sized and inserted using a manikin. Familiarity with the equipment in your hands makes a significant difference when you need to act quickly in a real situation.
Designed by an NHS ODP for healthcare workers across every specialty.