Bag Valve Mask: What is a Bag Valve Mask Ventilation and How to use it?

Ventilation delivers supplemental oxygenation to respiratory-failing patients. Manual ventilation is a necessary procedure that can be difficult for patients who need ventilatory support. Ventilation such as bag valve masks and mechanical ventilators has to be performed by experienced healthcare workers who are regularly trained in emergencies. 

Key Takeaway

When a patient has a respiratory failure or a hard time breathing, the Bag Valve Mask or Pulmonary Manual Resuscitator enables rescuers operating within almost any environment or situation to deliver lifesaving oxygen to the patient's lungs. It is mainly used in prehospital settings to ventilate patients in respiratory failure/respiratory distress and cardiac arrest. Ventilation has to be performed by experienced healthcare workers who are regularly trained in various medical emergencies like respiratory arrest. It's easier and more effective if 2 responders are doing the ventilation. Practicing the techniques described in this article should be practiced to guarantee successful resuscitation.

What is Bag Valve Mask?

A BVM or Bag Valve Mask is sometimes called an Ambu bag or Pulmonary Manual Resuscitator. It is a handheld tool used to deliver positive pressure ventilation to any subject with insufficient or ineffective breaths. Ventilation with Bag Valve Mask is commonly used to provide manual positive pressure ventilation to respiratory-failing patients or cardiac arrest.

BVM consists of a self-inflating bag, oneway valve, mask, and an oxygen reservoir. There are no parts made from metal, no screws, no washers, springs, or anything else of a complicated nature. The main components are:

  • A self-inflating bag with two valves.
  • An inlet for fresh gas.
  • An outlet that ventilates the patient and expires that ventilation.

What is bag valve mask ventilation?

Bag mask ventilation is an essential airway management technique that allows oxygenation of patients until a more definitive airway can be established. It is also used in cases where an oropharyngeal airway, endotracheal tube, or other definitive airway control is impossible. You can use bag valve masks in the field, ambulance, helicopter, the emergency department, the intensive care unit, and the operating room. This may be the only type of ventilator that can work during disasters because they do not require electricity. However, if you misuse it, BVM ventilation can accelerate hypoxia and exacerbate the airway obstruction that naturally occurs during profoundly depressed levels of consciousness. This can result in serious death or injury.

When to Use Bag Valve Mask Ventilation?

For the emergency medical services team, basic bag mask ventilation is the only option for airway management. In the pediatric population, it is the best option for prehospital airway support. BVM ventilation is also appropriate for elective ventilation in the operating room when intubation is not required, but it is now often replaced in this setting by the laryngeal mask airway.

Bag Valve Mask ventilation is indicated in the following conditions:

  • Respiratory failure/respiratory distress
  • Failed intubation or insertion of an artificial ventilation tube into the trachea
  • Patients who are undergoing anesthesia for elective surgical procedures
  • Apnea (slowed or stopped breathing)

What are the Criteria for BVM Ventilation?

Successful bag-mask ventilation depends on these factors:

  • An open airway (Any obstruction in the airway can affect the ventilation)
  • Mask should be sealed adequately on the face
  • Proper ventilation technique
  • Valve for proper oxygenation

How to Use Bag Valve Mask Ventilation

Bag mask ventilation can be done with one person or two, but two-person BVM ventilation is easier and more effective. Your goal is to achieve a tight seal, which usually requires two hands on the mask.

Two-person BVM technique

The more experienced responder handles the mask in the two-person technique because maintaining a proper mask seal is the most challenging task. Then, the second responder will squeeze the bag.

  1. Responder 1 will stand at the head of the stretcher and the 2nd responder to the side.
  2. Using 2 hands, responder 1 will hold the mask between thumbs and index fingers placed on either side of the connector stem.
  3. Responder 1 will place the nasal portion of the mask over the patient's nose high enough to cover the bridge without air leaks. Then lower the mask over the chin and allow it to seal along with the two malar eminences.
  4. Achieve a patent airway and a proper seal by covering the bridge of the nose, the two malar eminences, and the lower lip. To help create a tighter seal, you may stretch the internal portion of the mask before placing it over the nose and mouth.
  5. Once a proper seal is achieved, the second responder will attach the bag to the mask and begin ventilation.
  6. Responder 2 will squeeze the bag smoothly just until the chest starts to rise.

One-person BVM technique

  1. Hold the mask between thumbs and index fingers wrapped around the connector stem using one hand.
  2. Do not place your hand or the mask on the patient's eyes.
  3. Place the nasal portion of the mask over the nose. Then lower the mask over the patient's mouth.
  4. Achieve a patent airway and a proper seal by covering the nose bridge, the two malar eminences, and the mandibular alveolar ridged by the mask.
  5. Once a proper/tight seal is achieved, use your other hand to begin ventilation.
  6. Squeeze the bag smoothly just until the chest starts to rise.

Contraindications to BVM Ventilation

Bag mask ventilation should be contraindicated in case of paralysis and induction (because of the increased risk of aspiration). It's also contraindicated if the upper airway or passage by which air reaches the lungs is completely blocked.

Complications of BVM Ventilation

The complications of BVM Ventilation include barotrauma from too much lung inflation and gastric insufflation, leading to vomiting and aspiration. In addition, if bag-valve-mask ventilation is used for a prolonged period or improperly performed, air may be introduced into the stomach. If this occurs, a nasogastric tube should be inserted to evacuate the accumulated air in the stomach.

What is the Equipment for BVM Ventilation?

  • Bag-valve apparatus
  • Gloves, mask, gown, and eye protection
  • Oropharyngeal airways, nasopharyngeal airways, lubricating ointment
  • PEEP valve
  • Variably sized ventilation face masks.
  • Oxygen source
  • Suctioning device and Yankauer catheter
  • Pulse oximeter
  • Capnography equipment
  • Nasogastric tube

Positioning for BVM Ventilation

Place the patient into a proper sniffing position to align the upper airway for optimal passage. A proper sniffing position aligns the external auditory canal with the sternal notch. Folded towels may be needed to achieve the sniffing position. Obese patients may need many folded towels or a commercial ramp device to sufficiently elevate the shoulders and neck. In children, padding is required, usually behind the shoulders, to accommodate the enlarged occiput. If there is a concern for cervical spine injury:

  • Position the patient supine or at a slight incline on the stretcher.
  • Stand at the head of the stretcher.
  • Avoid moving the neck.
  • Use the jaw-thrust maneuver or chin lift without head tilt, if possible, to facilitate the opening of the upper airway manually.

Frequently Asked Questions

Can anyone perform a bag valve mask ventilation?

Bag Valve Mask requires training and practice to use it effectively. Even emergency medical responders with much practice find it is difficult to maintain adequate mask seals and ventilate sufficient volumes when only one responder is available to use it.

Are bag valve masks reusable?

Bag Valve Mask can either be reusable or disposable.

Do oxygen masks expire?

Most disposable respirators have an expiry date, and once this date has passed, you should not use the bag mask.

What is the correct volume of air during BVM?

A normal adult BVM holds about 1.5 L of air, almost three times the American Heart Association's recommended 600 mL tidal volume for an adult patient.