Bag Valve Mask (BVM)

A BVM is used for patients who are in respiratory failure. The BVM is always to be used in conjunction with manual airway maneuvers such as the NPA, OPA, and/or intermediate/advanced airways. Every time you use this device, think “I need an adjunct and/or intermediate airway & I need ALS.” Despite proper technique and tools this will cause gastric distention and eventually vomiting. Be prepared to suction!

Side note on manikins – The manikins you use in class were designed to be breathed for; humans, not so much. Follow these steps carefully as breathing for humans is MUCH harder than it is on a manikin.

1. Recognize the need for assisted ventilations (low respiratory rate, respiratory effort, or tidal volume).
2. Select the appropriate size mask & bag for the patient.
3. Connect BVM to oxygen at a flow rate of 15 lpm.
   1. If available, attach HEPPA filter to exhaust port to reduce the spread of COVID and other airborne infectious diseases.
4. Place patient supine on a firm surface.
5. Position yourself at the head, your shoulders should be squared with the patient.
6. Place the mask in your non-dominant hand.
7. Use your thumb and index finger in “C” technique as shown below – be sure to keep fingers on hard plastic to create a good face seal.
8. Place the nose of the mask on the bridge of the patient’s nose.
9. Lower the mask over the patient’s mouth.
10. Using the middle, ring, and pinky finger in the “E” technique along the bottom of the jawbone.
11. Lock your elbow and lean back, bringing the patient’s face “up” into the mask this is called the “sniffing position”.
12. In your dominant hand, hold the oxygen bag out to the side of the patient.
13. With the head remaining tilted into the sniffing position gently squeeze the bag until you see chest rise.
14. The goal is to deliver each breath over 1 second to minimize gastric distention or lung trauma.
15. Deliver breaths for an adult once every 5-6 seconds or children every 2-3 seconds.
16. Include adjunct airways as indicated as soon as possible.
17. If resources exist, use two-person BVM technique
    1. One rescuer holds the mask with both hands in the “E / C” technique or thumb down technique.
    2. The other rescuer squeezes the bag at above mentioned rates, just enough to see the chest rise.