Manual Resuscitators and Manual Ventilation
Key Points
- Manual resuscitators are used when patients have respiratory-arrest or inadequate breathing from respiratory-failure.
- A BVM supports ventilation and oxygenation, and connected oxygen flow at 15 L/min provides approximately 100% FiO2.
- Correct size selection (adult, child, infant) and a leak-proof face seal are essential to avoid under-ventilation and lung injury.
- Deliver each breath over about 1 second and only until visible chest rise to reduce gastric inflation and lung trauma.
Pathophysiology
Manual ventilation temporarily replaces or supplements spontaneous breathing to maintain alveolar gas exchange when ventilatory drive or mechanics are inadequate. In acute deterioration, assisted ventilation prevents worsening hypoxemia and hypercapnia while definitive airway and cause-directed treatment are organized.
Bag valve mask systems directly influence airway pressure, delivered volume, and oxygen concentration. Excess pressure or volume can cause barotrauma and gastric insufflation, while inadequate seal or poor technique produces ineffective ventilation and progressive oxygen debt.
Classification
- Self-inflating bag: Delivers breaths when squeezed and can be used with or without oxygen source.
- Flow-inflating bag: Requires continuous oxygen inflow and excellent mask seal; deflates if seal is poor.
- Use environment distinction: Flow-inflating bags are commonly used in anesthesia and pediatric settings for finer control of pressure and volume.
Nursing Assessment
NCLEX Focus
Priority questions often test recognition of ineffective BVM technique and immediate correction of seal, timing, and pressure.
- Assess breathing adequacy, chest rise, and signs of persistent hypoxemia during assisted ventilation.
- Evaluate mask seal quality and jaw positioning continuously to detect leaks and poor ventilation delivery.
- Monitor synchronization with spontaneous breaths when the patient is still inhaling to prevent asynchrony.
- Reassess rescuer performance and fatigue because prolonged manual squeezing can degrade ventilation quality.
Nursing Interventions
- Choose the correct bag-mask size and initiate oxygen at 15 L/min when oxygen source is available.
- Use two-rescuer technique when possible: one rescuer maintains jaw thrust and leak-proof seal while the other squeezes the bag.
- Deliver breaths over 1 second at source-described cadence (adult every 5-6 seconds; pediatric guidance in this section includes every 3 seconds and every 2-3 seconds).
- Coordinate assisted breaths with patient effort in partial respiratory failure to improve ventilation effectiveness.
- Escalate to advanced-airways-and-intubation when mask ventilation is inadequate or prolonged support is expected.
Overinflation Injury Risk
Overpressurization and overinflation can cause lung injury and gastric inflation, increasing aspiration risk.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| oxygen-therapy | High-flow oxygen during BVM support | Set and verify 15 L/min source flow and monitor oxygenation response closely. |
| inhaled-bronchodilators | Albuterol context | If bronchospasm contributes to failure, coordinate bronchodilator therapy with ventilation support plan. |
Clinical Judgment Application
Clinical Scenario
An adult becomes apneic after rapid respiratory decline. A rescuer starts BVM ventilation, but chest rise is minimal and oxygen saturation continues to fall.
Recognize Cues: Minimal chest movement and persistent hypoxemia suggest ineffective ventilation delivery. Analyze Cues: Poor mask seal and technique are likely limiting tidal volume despite bag compression. Prioritize Hypotheses: Immediate priority is correcting seal, positioning, and breath technique. Generate Solutions: Convert to two-rescuer E/C technique, verify oxygen flow, and reassess chest rise after each breath. Take Action: Implement two-rescuer BVM and prepare advanced airway equipment. Evaluate Outcomes: Chest rise improves and oxygen saturation stabilizes while definitive airway plan proceeds.
Related Concepts
- bag-valve-mask-manual-ventilation - Procedure-level steps for hands-on BVM operation.
- airway-adjuncts - Adjuncts can improve upper-airway patency during manual ventilation.
- advanced-airways-and-intubation - Escalation pathway when mask ventilation is insufficient.
- respiratory-failure - Common indication for assisted ventilation support.
- respiratory-arrest - Emergency state requiring immediate manual ventilation.
Self-Check
- Why does poor mask seal reduce BVM effectiveness even when compression rate appears correct?
- What findings indicate that two-rescuer technique should be prioritized over single-rescuer technique?
- How does overinflation during manual ventilation increase risk for aspiration and lung injury?