Bag-Valve-Mask (BVM) Ventilation

BVM operation for a solo CFR

Among the three main brands of this self-inflating resuscitation system are;

Laerdal
Ambu
Air Viva

It is a hand-held device used on patients who are not breathing or not breathing adequately. A self-filling bulb that re-expands after being manually collapsed and has the facility for additional O2. Via an oxygen inlet nipple .

Manual squeezing of the bulb causes the air or gas inside the inflatable bag portion to be forced  into the patient via a one-way valve and delivered through a mask into the patient’s trachea, bronchus and into the lungs.

Squeezing the bag once every 5–6 seconds for an adult or once every 3 seconds for an infant or child should provide an adequate respiratory rate (10-12 respirations per minute in an adult and 20 per minute in a child or infant).

The BVM needs to deliver between 500 and 800 millilitres of air to a normal male adult patient’s lungs to be effective, but if supplemental oxygen is provided, 400 ml may still be adequate.

It needs to be properly sealed around the patient’s face if no,t essential pressure that is needed to force-inflate the lungs is released into to the environment, not into the patient.

It is very difficult when a single CFR is attempting to maintain a face mask seal with one hand and at the same time squeezing the bag with other. The video above demonstrates some techniques.

The BVM or Bag Valve Mask requires considerable practice and skill to use for ventilating a patient, especially for a solo first responder.

The skill required is to be able to open the airway with a jaw thrust whilst simultaneously holding the mask to the patient’s face and forming an absolute seal.

The head tilt-chin lift is carried by using one hand to apply downward pressure on the forehead, whilst the other hand lifts the ‘patient’s chin.

The jaw thrust manoeuvre is much safer for the patient if there is a suspected spinal injury.

This is carried out by placing both hands on the angles of the mandible to displace the jaw anteriorly.

Always avoid extending the patient’s neck. Both of these manoeuvres should improve their airway and facilitate BVM ventilation.

The use of either an OP or NP airway could well be a very important accessory in successful use of the BVM ventilation.

Obtaining a good seal between face and mask.

The following is taken from the distance learning First On Scene Course (click for details)

Solo use of a BVMOne of the most important aspects of BVM ventilation is ensuring a good seal between mask and face.

There is no doubt that competency with a solo operator technique is invaluable and absolutely necessary for first responders. Generally called the ‘EC‘ hand position, this is the best way to obtain an optimum seal.BVM one handed

The ‘E’ represents the three fingers holding the mandible while performing the jaw thrust, and the ‘C’ represents the thumb and index finger holding the mask.

Most air leaks are located around the nasal bridge.