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

Indications

• respiratory failure
• pre-oxygenation
• emergent need to oxygenate/ventilate

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
• 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" 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)
• 2nd person bags

Rate

• adult bag at 10-12/min
• children 16-20/min
• infants 30/min

Tidal Volume

• avoid hyperinflation
• bag until chest rise is seen

Complications

• poor seal
• poor oxygenation/ventilation
• overinflation of the stomach causing emesis/aspiration

See Also

• Intubation