Bag Valve Mask

 

Clinical Indications:

 

  • Respiratory failure or arrest with inadequate oxygenation and/or ventilation.
  • Pre-oxygenation for advanced airway
  • Artificial ventilation after placement of advanced airway..

 

Clinical Contraindications:

 

  • Complete upper-airway obstruction

 

Procedure:

 

  1. Prepare all equipment
  2. Select the appropriate size BVM (Adult, Pediatric, Infant/Neonate)
  3. Attach BVM to 100% oxygen at 15 liters per minute and ensure the reservoir bag fills completely.  See Newly Born COG for neonatal resuscitation.
  4. Attach PEEP valve and set at appropriate pressure if indicated for adult patients.
  5. Place patient into optimal position.
  6. Consider suctioning airway and utilizing airway adjunct.
  7. Two person BVM technique is preferred.
  8. Place the apex of the mask over the bridge of the patient's nose, and seal the mask over the patient's chin.
  9. Open airway utilizing either the V-E or C-E Two handed mask grip.
  10. Gently compress the bag to ventilate the patient. These can be timed with spontaneous breaths if necessary.
  11. Gauge the effort required to ventilate through the feel of the recoil bag to achieve minimal rise and fall of the chest. Excess pressure and volume is detrimental to the patient.
  12. Ventilation rate/minute should be 30 for neonates, 25 for toddlers, 20 for school age and 10 to 12 for adults.
  13. Maintain an EtCO2 between 35 and 45.
  14. If equipped, utilize the integrated manometer to help deliver safe inspiratory pressures to your patient. Most patients do not need more than 30 cm of Peak Inspiratory Pressure (PIP) pressure.
  15. If equipped, consider overriding integrated pressure relief valve if clinically indicated.

 

Certification Requirements:

 

  • Maintain knowledge of the indications, contraindications technique, and possible complications of the procedure.  Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations or other mechanisms as deemed appropriate by medical control. Assessment should include direct observation once per certification cycle