Bag Valve Mask Ventilation

Prepare equipment

1. All relevant infection control methods to be utilised.
2. Position the patient as necessary
3. Prepare equipment required:
   1. Airway adjunct (e.g. OPA, NPA, SGA, ETT) and associated required equipment
   2. Bacterial filter MUST be attached in patients > 20kg (bacterial filter is contraindicated where patient weight is < 20kg)
   3. End-tidal CO2 (etCO2) must be attached regardless of adjunct for any use of BVM (if trained and available)
   4. BVM (see details for specific devices below)
   5. Oxygen
   6. Suction
4. Ensure the BVM is functional; seal the mask connecter with your hand and depress the bag to ensure there are no leaks.
5. Attach BVM oxygen tubing to fir-tree port on O2 cylinder and turn regulator knob to ensure the reservoir bag inflates fully.

Prepare patient

1. Ensure patient is in supine position
2. Place patient in the most optimal position for airway management (consider airway ramping).

Insert airway adjunct

See relevant clinical skill for airway adjunct chosen:

• Oropharyngeal airway (OPA)
• Nasopharyngeal airway (NPA)
• Supraglottic airway (SGA)
• Endotracheal tube (ETT)

Apply BVM

Airway adjunct: OPA/NPA (using mask)

1. Adjust oxygen flow rate to 15 litres per minute and allow reservoir bag to fill.
2. Connect the mask to the bag with the EtCO2 adaptor and bacterial filter in between.
3. Place the apex of the mask over the bridge of the patient’s nose, and then seal the mask over the patient’s chin. Open airway with jaw thrust and chin lift.
4. Utilise the 'anaesthetist grip' to ensure a firm seal of the mask on the patient’s face if only one clinician available to ventilate. As soon as practicable, adopt a two-person technique with one person holding the mask in place with both hands to ensure an effective seal.
5. Ventilate gently to ensure minimal rise and fall of chest. Ensure EtCO2 waveform present. Adjust position as required to achieve mask seal and ventilation.

Airway adjunct: SGA/ETT (connected to airway circuit)

1. Adjust oxygen flow rate to 15 litres per minute and allow reservoir bag to fill.
2. Connect the airway adjunct to the bag with the EtCO2 adaptor, bacterial filter and cobbs adaptor in between.
3. Ventilate gently to ensure minimal rise and fall of chest. Ensure EtCO2 waveform present.

Ventilate

1. Continuously ensure the patient’s airway is patent, use suction if required, apply essential airway management and progress to advanced airway techniques if required.
2. Gently compress the bag to ventilate the patient. Use an inverted hand at the end of the bag to avoid excess volume and pressure.
3. Gauge the effort required to ventilate through the feel of the recoil bag to achieve minimal rise and fall of the chest. Excess pressure and volume is detrimental to the patient. Do not ventilate with higher pressure than maximum indicated for the device (see below).
4. Monitor EtCO2 for effectiveness of ventilation and adjust as necessary.

Cardiac arrest ventilation: between compression cycles

1. Ventilate at the correct ratio for the patient cohort (30:2 for adults, 15:2 for paediatrics 12 years old or under, 3:1 for neonates)
2. Begin ventilation on the decompression phase of the final compression.
3. Compressions MUST NOT be interrupted for more than 2-3 secs to facilitate ventilation. Communication and teamwork as per IMPACT CPR principles should be applied to achieve ventilation with minimal pauses to compressions.
4. Where available, use the metronome on the Corpuls3 to guide compression and ventilation timings.

Cardiac arrest ventilation: asynchronous ventilation (continuous chest compressions) - SGA/ETT only

1. Ventilate at a maximum of the rates in the table below. DO NOT EXCEED.
2. Beginning of ventilation MUST occur on the decompression phase of chest compressions (~after every 10th compression for adults)
3. Do NOT provide asynchronous ventilation in paediatrics

Apnoeic or ineffective breathing ventilation

Ventilate at a maximum of the rates in the table belpw in most situations. These rates may need to be exceeded in rare patient presentations – this should be a deliberate and considered decision. Ensure task focus on ventilation to maintain appropriate rates, hyperventilation is a known effect of distraction.

If patient is not breathing at an effective rate or volume, assisted ventilations are to be performed. Ventilations should be timed with spontaneous breaths to assist ventilation, do not work against patient’s intrinsic respiratory effort.

Ventilation rates

These rates are a maximum under normal circumstances. Certain patient presentations such as asthma or COPD may necessitate a slower ventilation rate – be guided by the CPG for the particular condition.