Bag Valve Mask(BVM) Ventilation
Bag Valve Mask(BVM) Ventilation
OBJECTIVES :
- Identify patients who will benefit from BVM ventilation e.g. in respiratory failure and do not require ETT.
- Select the appropriate mask size.
- Identify the proper technique for applying BVM.
INDICATION:
- Inadequate respiratory rate
- Infant / toddler < 20.
- Child < 16.
- Adolescent < 12
- Adult < 8.
- Inadequate respiratory effort
- Absent or diminished breath sounds.
- Paradoxical breathing (chest and abdomen moving in opposite directions).
- Cyanosis on 100 % oxygen via NRB mask.
- Bradycardia
- Infant HR < 80.
- Child HR < 60.
- Adult HR < 60.
- Cardiac arrest
- Altered mental status, GCS <9.
PROCEDURE:
- Undertake universal precautions.
- Select the most appropriate mask and bag size for the patient age and size as per chart below.
- Have suction device available since vomiting may occur.
- Place patient in supine position (unless in severe dyspnea).
- For a single provider to achieve an adequate seal and avoid pressure on the soft tissues of the face or neck use the E- C clamp technique by placing the 3rd, 4th, and 5th fingers along the Jaw to provide a chin lift (forming an E), and use the thumb and index finger to hold the mask on the face (forming a C).
- If the patient does not have adequate chest rise and breath sounds with BVM, consider the following interventions
- Disable the pressure pop-off valve to increase the delivery of air into the patient.
- Use a larger bag to increase the volume of air delivered into the patient.
- Evaluate and treat the patient for gastric distension by manually decompressing the stomach or insertion of gastric tube.
MASK AND BAG SIZES
| Age | Mask Size |
|---|---|
| Premature Infant | Neonatal (# 0 - # 00) |
| Newborn to 1 Year | Infant (# 1) |
| 1 - 4 Years | Toddler (# 2) |
| 4 - 10 Years | Pediatric (# 3) |
| 10 - 14 Years | Small adult (# 4) |
| Adult | Adult (# 5) |
| Age | Bag Size |
|---|---|
| Newborn to 3 Months | Neonatal 450 - 500 Ml |
| Child less than 3kg weight | Pediatric 750 Ml |
| Child over 30kg weight | Adult 1000 - 1200 Ml |
| Adult | Adult 1000 - 1200 Ml |
COMPLICATIONS. :
- Gastric distension.
- Vomiting.
- Increased intracranial pressure as a result of increased vagal stimulation if mask is applied over the patient’s eyes.
