This lesson will focus on how to use your bag valve mask, why we might use it instead of the traditional mouth to mask rescue technique, and any concerns that may come with using a bag valve mask (BVM).
There are three sizes of bag valve mask systems – infant, child and adult. There are many mask sizes and styles as well from neonate and infant all the way up to adult. Having the correct size mask helps to create a good seal for the breaths or ventilations. Having the proper size bag ensures enough air is given without an unnecessary risk of too much air into the lungs.
Pro Tip #1: If you only have the adult-size bag valve system, it is not recommended to use on infants or children. Giving too much air can cause trauma to the lungs as well as a decrease in blood flow to the heart. Therefore, for best patient care, using the appropriately sized bag valve for each patient is recommended.
Some aspects to be aware of concerning bag valve masks:
- Sometimes the oxygen reservoir will be attached right out of the bag from the manufacturer; other times you'll have to attach it yourself.
- The reservoir is meant to be used with 100 percent oxygen, so when you ventilate the patient, they're getting a higher concentration of oxygen to compensate for any oxygen deprivation they may be experiencing.
- You may have to first attach the oxygen tubing to the oxygen inlet on the bag as well as the oxygen source (tank or wall mount).
Pro Tip #2: If you don't see the oxygen reservoir bag inflating, or if it's inflating too slowly, put your thumb over the outlet inside the mask. This will seal the bag system so no oxygen is escaping, and the reservoir will fill more quickly.
- The oxygen should be set to high flow to fill the reservoir more quickly and to keep the reservoir inflated while ventilating the patient.
When sealing the mask over the patient's face, there are a couple important points to note:
- The shape of the mask: You have the apex part of the mask that goes over the patient's nose, and the bell part of the mask (the wider end) that goes around the victim's chin and under the bottom lip.
- The specific method for holding and attaching the mask: The CE method. Your index finger and thumb form the C and go around the stem of the mask and are used to balance pressure on one side of the mask when attaching it, while your palm will put pressure on the other side of the mask. Your other three fingers will form the E, as they grab the patient's mandible, or jaw line, and draw it up into the mask.
Warning: Do not push the mask down onto the patient's face. This will not provide a proper seal and may even block the airway. It's your fingers and palm that creates the seal, and it's the drawing of the mandible into the mask that provides the proper head tilt, chin lift before delivering your ventilations.
When a second responder comes in handy: If certain facial features are complicating the sealing of the mask, incorporate the second responder into the effort.
Responder one uses two hands to create the seal, while responder two provides the ventilations using the bag.
Warning: If you do not see the patient's chest rise and fall, your seal is not tight or the airway is not open, and the patient is not receiving the life-saving oxygen they need.
Pro Tip #3: If there is no way to get a proper seal, there are other adjuncts available, but these may be considered advanced life support techniques in your area.
- Supraglottic airways – these are designed to fit the stem of the bag valve without the mask and can help deliver a secured airway with ventilations.
- Endotracheal tubes – these are also designed to be used with the stem of the bag valve and assist with delivering oxygen.
Both options are possibilities if the mask isn't fitting or sealing properly.
Pro Tip #4: If you're not able to deliver ventilations successfully using the bag valve mask, don't use it. Set it aside and use a regular rescue mask with a one-way valve and deliver breaths with the mouth to mask technique. Don't waste time that the patient doesn't have, as they are likely becoming anoxic by the second.
The benefits of using a bag valve mask:
- They can be safer when it comes to infection control.
- They can deliver higher concentrations of oxygen with each breath.
Another important note: Bag valve masks work best when incorporated into the team approach.
Bag valve masks require practice to perfect. So, if you're supposed to be using one as part of your own particular protocol or if you simply see the benefits of using it when compared to the traditional mouth to mask rescue technique, practice as much as you can first.
What do they say about practice? It makes perfect. And perfect use of the bag valve mask could mean the difference between life and death.