King Airway Insertion

For use in respiratory failure without the presence of a gag reflex. Always used in conjunction with a BVM.

  1. Confirm lack of gag reflex with OPA insertion.
  2. Pre-oxygenate using BVM and adjuncts while the device is being prepared.
  3. Select proper size based on manufacturer recommendation.
  4. Remove from packaging.
  5. Inflate distal cuffs to ensure there are no leaks – deflate both cuffs before inserting.
  6. Lubricate distal tip with water-based lubricant.
  7. Remove the OPA if present.
  8. Grasp the patient’s tongue and lower jaw and pull forward to open the mouth.
  9. Insert King Airway up to the colored connection.
  10. Inflate distal cuffs to manufacturer recommendation & remove syringe.
  11. Failure to remove the syringe will result in the cuffs deflating and ineffective seal.
  12. Attach BVM and deliver small “puffs” via BVM while retracting King Airway from the patient.
  13. Stop retracting when you see chest rise and resistance on the bag is decreased.
    1. Note – you may see the balloon in the back of the mouth, this is normal.
  14. Confirm placement using stethoscope and auscultating lung sounds and the absence of epigastric sounds.
  15. Additional confirmation needed – increase in SpO2, improvement in skin color, presence of good chest rise.
  16. Ongoing confirmation needed with every ventilation. Whichever team member is assigned to the BVM needs to continually assess for effectiveness of ventilations.
  17. If gag reflex returns and/or vomiting begins, immediately turn the patient onto their side, remove the device and suction as needed.
    1. Return to BVM with a mask when airway is clear.
Photo of King airway with 60cc syringe.
Equipment images by Jamie Kennel and Carmen Curtz, CC BY-NC-SA 4.0.
Gloved EMT standing at foot of manikin providing ventilations via BVM.
Image by Holly Edwins, licensed under CC BY-NC-SA 4.0.
Cutaway image of a head with King airway inserted. The balloon of the King laryngeal tube is located between the soft palate and mandible due to its structural characteristics.
Image reproduced from Emergent use of a King laryngeal tube for traumatic intraoral bleeding: two case reports, available in PubMed Central CC BY-NC.
King Airway Skills Verification Table

King Airway





5 (instructor)


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Oregon EMS Psychomotor Skills Lab Manual Copyright © 2023 by Chris Hamper, BS, NRP; Carmen Curtz, Paramedic, BS; Holly A. Edwins, Paramedic, B.S.; and Jamie Kennel, PhD, MAS, NRP is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

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