Bag-Valve-Mask Ventilation: Key Steps

Bag-valve-mask (BVM) ventilation saves lives by helping patients who can’t breathe effectively. Here’s what you need to know:

• What it is: A BVM includes a self-inflating bag, one-way valve, and face mask to deliver oxygen effectively.
• When to use: Common in respiratory arrest, severe distress, pre-oxygenation, or post-intubation support.
• How to use: Position the patient properly, ensure a tight mask seal, and deliver controlled breaths (1 every 6 seconds for adults).
• Key tips: Avoid over-squeezing, check for chest rise, and troubleshoot leaks or obstructions promptly.

Mastering BVM ventilation requires practice and attention to detail to ensure effective oxygen delivery and patient safety.

How To Do Bag-Valve-Mask Ventilation

Setup Steps

Getting started with a BVM (bag-valve-mask) requires proper preparation and positioning.

Equipment Setup

Make sure all necessary components are ready for safe and effective ventilation:

• Self-inflating bag (choose adult, pediatric, or infant size as needed)
• Face mask that fits the patient properly
• Oxygen tubing and reservoir
• Bacterial/viral filter (if available)

Before use, test the equipment:

1. Squeeze the bag to check for proper recoil.
2. Test the pop-off valve to ensure it functions correctly.
3. Inspect the mask for any signs of damage or wear.
4. Confirm the oxygen tubing is securely connected.

Patient Position

Positioning the patient correctly helps keep the airway open and supports effective ventilation:

• Lay the patient flat on their back on a firm surface.
• Use a pillow or rolled towel to achieve the "sniffing" position.
• For trauma patients, maintain a neutral neck alignment. Otherwise, a slight neck extension is recommended.
• Adjust the bed height to minimize the risk of aspiration.
• For patients with obesity, consider a ramped position to improve airway access.

Proper setup and positioning are key to effective BVM use.

BVM Technique Steps

Mask Seal

Getting a proper mask seal is key for effective ventilation. Use the "C-E" hand technique for positioning:

• C-hand: Create a "C" shape with your thumb and index finger around the mask’s connector.
• E-hand: Use your middle, ring, and pinky fingers to grip the patient’s jaw and lift the mandible.

Apply firm downward pressure while lifting the jaw to secure the seal. For patients with facial hair or unique facial structures, a two-handed approach works best. In this case, one person focuses on sealing the mask while another squeezes the bag.

Once the seal is secure, focus on delivering controlled breaths.

Breath Delivery

When delivering breaths, pay attention to timing and volume:

• Rate: Provide one breath every 6 seconds (around 10 breaths per minute) for adults.
• Volume: Squeeze the bag just enough to see the chest rise.
• Duration: Each breath should take about 1 second to deliver.

Keep an eye on these key indicators during ventilation:

Avoid over-squeezing the bag, giving breaths too quickly, or adding extra squeezes after the chest rises. Signs of effective ventilation include improved skin color, steady chest movement, oxygen saturation above 94%, and the patient regaining spontaneous breathing. If using supplemental oxygen, set the flow rate to at least 15 L/min to keep the reservoir bag full.

For further learning and exam prep, check out resources like Respiratory Cram.

sbb-itb-b787f78

Problem-Solving

Once you’ve nailed down the basics of BVM setup and technique, it’s time to tackle common issues that can arise during use.

Fixing Mask Leaks

Mask leaks are a frequent challenge during BVM ventilation. Here’s how to spot them:

• You can hear air escaping around the mask edges.
• The patient’s chest doesn’t rise when you compress the bag.
• Oxygen saturation readings are lower than expected.
• You notice visible gaps between the mask and the face.

To fix these leaks:

• Reposition the mask: Align it properly between the nose bridge and chin.
• Adjust your grip: Apply firm but not overly strong pressure to create a seal.
• Try a different mask size: If the current mask doesn’t fit well, switch to one that matches the patient’s face better.

Clearing Airways

Airway obstructions can happen during BVM ventilation. Here’s a quick reference for diagnosing and addressing them:

If the obstruction continues:

• Stop ventilation immediately.
• Reposition the head and neck.
• Perform a jaw thrust maneuver.
• Use an airway adjunct if necessary.

Reducing Stomach Inflation

Stomach inflation happens when air enters the esophagus instead of the lungs, potentially causing vomiting or aspiration. To prevent this:

• Control breath delivery: Deliver each breath gently over 1 second, aiming for a slight chest rise.
• Position the head correctly:
  • Tilt the head back appropriately.
  • Avoid overextending the neck.
  • Keep the neck neutral, especially in trauma cases.

If stomach inflation occurs, reduce breath volume and slow down the delivery. For more detailed solutions, consult advanced guides or instructional videos.

Advanced BVM Methods

Once you’ve mastered the basics and troubleshooting, it’s time to tackle more complex ventilation challenges with advanced techniques.

Airway Tools

Using airway adjuncts can help keep the airway open and improve ventilation success. Here’s a quick guide:

How to Use an OPA:

• Measure the device from the corner of the mouth to the earlobe to ensure the correct size.
• Insert it with the curve facing the roof of the mouth.
• Rotate it as you advance it past the tongue.
• Check that it’s placed correctly by confirming airflow.

How to Use an NPA:

• Lubricate the device before insertion.
• Insert it at a downward angle, following the nasal floor.
• Select a diameter that matches the size of the patient’s smallest finger.
• Use the right nostril whenever possible.

Oxygen Setup

Adding oxygen to your ventilation process is straightforward. Follow these steps:

• Connect the oxygen tubing to a flow meter set at 15 L/min.
• Attach a reservoir bag to deliver high oxygen concentration.
• Let the reservoir bag fill completely before ventilating.
• Keep an eye on the reservoir bag to ensure it stays inflated during use.

2-Person Method

This technique involves teamwork for better ventilation control. Here’s how it works:

• The primary provider ensures a proper mask seal using the "C-E" grip.
• The secondary provider focuses on:
  • Squeezing the bag with steady pressure.
  • Watching for chest rise to confirm effective ventilation.
  • Maintaining an appropriate ventilation rate.
  • Adjusting oxygen flow as needed.

Communication Tips:

• Use clear signals like "Ventilate now" to coordinate breaths.
• Say "Adjust seal" if there are leaks.
• Call out "Check chest rise" to confirm ventilation is working.

For those looking to sharpen their advanced BVM skills, check out Respiratory Cram for video demos and practice scenarios. Their resources are available online at https://blog.respiratorycram.com.

These advanced techniques build on the basics to improve patient care and outcomes.

Summary

To perform effective BVM ventilation, focus on these core steps:

Preparation Steps:

• Position the patient with a slight extension of the neck.
• Choose the correct mask size for the patient.
• Set oxygen flow to 15 L/min.
• Keep airway adjuncts on hand for use if needed.

Important Techniques:

• Use the "C-E" grip to ensure a proper mask seal.
• Deliver each breath over 1 second, aiming for about 10 breaths per minute.
• Check for chest movement on both sides to confirm proper ventilation.
• Continuously assess how effective the ventilation is.

Troubleshooting Tips:

• If ventilation isn’t working, check the mask seal first.
• Adjust the head position or switch to a two-person technique if needed.
• Use airway adjuncts if other adjustments don’t resolve the issue.

Regularly review and practice these steps to improve your technique. For additional guidance, check out Respiratory Cram for video demonstrations and practice scenarios. Consistent practice helps you refine these skills and ensures reliable ventilation every time.

Related Blog Posts

• 5 Critical Care Concepts Every RT Student Must Know
• Pulse Oximetry vs. Capnography: Key Differences
• Post-Intubation Airway Stabilization: Key Steps
• 5 Positioning Tips for Ventilating Obese Patients