Bag Valve Mask Ventilation

Topic Outline
1. Definition
2. Purposes
3. Principles and Concepts

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4. Equipment’s needed
5. Proper procedure of Bag Valve Ventilation

Learning Outcomes
After studying this unit, you will be able to:
 Define the different terms associated with Bag Valve Ventilation
 What are the indications of Bag Valve Ventilation
 Determine the importance of Bag Valve Ventilation

Introduction
In BVM ventilation, a self-inflating bag (resuscitator bag) is attached to a nonrebreathing valve and then
to a face mask that conforms to the soft tissues of the face. The opposite end of the bag is attached to an oxygen
source (100% oxygen) and usually a reservoir bag. The mask is manually held tightly against the face, and
squeezing the bag ventilates the patient through the nose and mouth. Unless contraindicated, airway adjuncts
such as nasopharyngeal and/or oropharyngeal airways are used during BVM ventilation to assist in creating a
patent airway. Positive end expiratory pressure (PEEP) valves should be used if further assistance is needed for
oxygenation without contraindications to its use.

Discussion

Successful BVM ventilation requires technical competence and depends on 4 things:

 A patent airway
 An adequate mask seal
 Proper ventilation technique
 PEEP valve as needed to improve oxygenation

Establishing a patent airway for BVM ventilation requires

 Keeping the oropharynx clear of physical obstructions (eg, secretions, vomitus, foreign bodies)
 Proper patient positioning and manual maneuvers to relieve tongue and soft tissue obstruction
of the upper airway
 Airway adjuncts such as a nasopharyngeal or oropharyngeal airway to facilitate effective air
exchange (see also Airway Establishment and Control)

Rapid provision of successful ventilation and oxygenation is the goal.

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in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 Indications for BVM Ventilation

 Emergency ventilation for apnea, respiratory failure, or impending respiratory arrest

 Pre-ventilation and/or oxygenation or interim ventilation and/or oxygenation during efforts to
achieve and maintain definitive artificial airways (eg, endotracheal intubation)

Contraindications to BVM Ventilation

Absolute contraindications:
 There is no medical contraindication to providing ventilatory support to a patient; however, a

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legal contraindication (do-not-resuscitate order or specific advance directive) may be in force.

Relative contraindications:
 None

Complications of BVM Ventilation

If bag-valve-mask ventilation is used for a prolonged period of time or if improperly performed,

air may be introduced into the stomach. If this occurs and gastric distention is noted, a
nasogastric tube should be inserted to evacuate the accumulated air in the stomach.

Additional Considerations for BVM Ventilation

 Two-person bag-valve-mask (BVM) ventilation is used whenever possible. Bag-valve-mask

ventilation can be done with one person or two, but two-person BVM ventilation is easier and
more effective because a tight seal must be achieved and this usually requires two hands on the
mask.
 Unless contraindicated, a pharyngeal airway adjunct is used when performing BVM ventilation.
An oropharyngeal airway is used unless the patient has an intact gag reflex; in such cases, a
nasopharyngeal airway (nasal trumpet) is used. Bilateral nasopharyngeal airways and an
oropharyngeal airway are used if necessary for ventilation.
 Among the many factors that can make achieving an air-tight seal difficult are facial deformity
(traumatic or natural), a thick beard, obesity, poor dentition, trismus, and cervical pathology. In
such situations, BVM is attempted, but if it is unsuccessful, a supraglottic airway is placed (unless
contraindicated).
A positive end expiratory pressure (PEEP) valve may be used during BVM to improve
oxygenation. PEEP can increase alveolar recruitment and thus oxygenation if oxygenation is
compromised even with 100% oxygen due to atelectasis. PEEP has also been shown to prevent
lung injury. However, PEEP should be used cautiously in patients who are hypotensive or pre-
load dependent because it reduces venous return.

Positioning for BVM Ventilation

The sniffing position—only in the absence of cervical spine injury

 Position the patient supine on the stretcher.

Align the upper airway for optimal air passage by placing the patient into a proper sniffing
position. Proper sniffing position aligns the external auditory canal with the sternal notch. To
achieve the sniffing position, folded towels or other materials may need to be placed under the
head, neck, or shoulders, so that the neck is flexed on the body and the head is extended on the
neck. In obese patients, many folded towels or a commercial ramp device may be needed to
sufficiently elevate the shoulders and neck. In children, padding is usually needed behind the
shoulders to accommodate the enlarged occiput.

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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 N235 RELATED LEARNING EXPERIENCE
The head is flat on the stretcher; the airway is constricted. B: The ear and sternal notch are
aligned, with the face parallel to the ceiling (in the sniffing position), opening the airway

Key Terms
 Airway
 Bag Valve Mask
 Sniffing Position
 Ventilation
 Apnea

Read
Medical-Surgical Nursing (Brunner and Suddarth 14 th Edition)
Terms and definitions: https://www.msdmanuals.com/professional/critical-care-
medicine/how-to-do-basic-airway-procedures/how-to-do-bag-valve-mask-bvm-ventilation

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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.
 Demonstration Link (Patient Risk Assessment)

View this demonstration by clicking the following link to learn more about Bag Valve Ventilation.
https://www.msdmanuals.com/professional/critical-care-medicine/how-to-do-basic-airway-
procedures/how-to-do-bag-valve-mask-bvm-ventilation

N235 RELATED LEARNING EXPERIENCE

Readings and References
Medical-Surgical Nursing (Brunner and Suddarth 14th Edition)

https://www.msdmanuals.com/professional/critical-care-medicine/how-to-do-basic-airway-
procedures/how-to-do-bag-valve-mask-bvm-ventilation

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All information contained in this module are property of UCU and provided solely for educational purposes. Reproduction, storing in a retrieval system, distributing, uploading or posting online, or transmitting
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise of any part of this document, without the prior written permission of UCU, is strictly prohibited.