Bag valve mask ventilation

Overview

  • Simple, life-saving skill that is critical in airway management
  • Deliver oxygen at positive pressure via a bag containing oxygen connected to a mask placed over a patient's nose and mouth
  • Oxygenation and ventilation prior to definitive airway placement or bridge to sedative metabolization

Indications

Contraindications

No absolute contraindications

Difficult BVM (MOANS)

  • Mask seal
  • Obesity
  • Aged
  • No teeth
  • Stiffness (resistance to ventilation)

Equipment Needed

  • Bag connected to oxygen at 15L/min
  • Mask connected to the bag
  • Consider PEEP valve (provides PEEP between ventilations)
  • OPA/NPA/adjuncts to facilitate successful BVM ventilation
  • Suction
  • SpO2 monitor helpful

Children

  • Proper-sized mask (covers nose and chin)
  • Proper bag (enough to see chest rise)

Procedure

EC technique with modified chin lift.
EC technique with modified chin lift.
Two-handed technique.

"EC" Hand Position

  • Thumb and index finger holding mask in a "C" position
    • Thumb superior and index inferior
  • 3rd, 4th, 5th finger hold the mandible and perform a jaw thrust
  • Other hand used to bag

2-person

  • One person holds the mask with both hands (lateral edges)
    • With double EC technique, index fingers and thumbs of both hands form C over mask and digits 3-5 lift the jaw at the rami of mandible
    • Can also press thumbs and thenar eminences over lateral edges of mask and use digits 2-5 to lift jaw at the rami of the mandible
    • Important to life jaw into mask and not press mask down into jaw; can occlude the airway and cause difficulty with ventilation
  • 2nd person bags

Rate

  • Adult bag at 10-12/min
  • Children 16-20/min
  • Infants 30/min
  • Neonates 40-60/min

Tidal Volume

  • Avoid hyperinflation
    • Average bag volume is approximately 1600 cc; only necessary to delivery approximately 500 cc
  • Bag until chest rise is seen

Complications

  • Poor seal
    • Remove dentures to intubate; keep them in to bag/mask ventilate
    • For a beard can smear lube to help create better seal
  • Poor oxygenation/ventilation
  • Overinflation of the stomach causing emesis/aspiration

See Also

External Links

References