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Bag Valve Mask Manual Ventilation

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Bag Valve Mask Manual Ventilation

Key Points

  • Use BVM for respiratory arrest or inadequate breathing, and select the correct bag-mask size to reduce lung injury.
  • Set oxygen flow to 15 L/min when connected to oxygen, which delivers approximately 100% FiO2.
  • Deliver breaths only until visible chest rise, with each breath over about 1 second, to reduce gastric inflation and lung trauma.
  • Two-rescuer technique is preferred when possible because one rescuer can maintain a leak-proof mask seal and jaw thrust while the other controls bag timing and depth.

Jaw-thrust airway maneuver during manual ventilation to maintain airway patency without cervical extension Illustration reference: OpenStax Medical-Surgical Nursing Ch.33.1.

Equipment

  • Appropriately sized bag valve mask (adult, child, or infant)
  • Oxygen source with flowmeter set to 15 L/min
  • Optional exhaust-port filter to reduce spread of airborne infection

Procedure Steps

  1. Identify absent or inadequate breathing and position the patient supine on a firm surface.
  2. Select the appropriate mask and bag size for the patient.
  3. Connect the BVM to oxygen and set flow to 15 L/min; add an exhaust filter if available.
  4. Position at the head of the patient with shoulders square to the patient.
  5. Place the mask using the non-dominant hand, with the nose portion over the bridge of the nose and mask over the mouth.
  6. Create the mask seal using the E/C technique: keep thumb and index finger on the hard mask shell (C), with remaining fingers lifting the jaw (E).
  7. Maintain head tilt in a sniffing position while preserving a leak-proof seal.
  8. Squeeze the bag with the dominant hand until chest rise is visible.

Manual resuscitator hand-squeeze technique demonstrating controlled bag compression for effective chest rise Illustration reference: OpenRN Respiratory Therapy Ch.1.1.

  1. Deliver each breath over 1 second, then ventilate at ordered emergency cadence (adult about every 5-6 seconds; pediatric guidance in this source ranges from every 3 seconds to every 2-3 seconds).
  2. Prefer a two-rescuer approach when possible: one rescuer maintains seal and jaw thrust, and the other controls bag timing and depth.
  3. When one rescuer is sealing the mask, lock elbow and lean back slightly to bring the patient’s face into the mask while preserving jaw lift.
  4. Coordinate breaths with patient inhalation if the patient is still breathing to avoid asynchrony.
  5. Continue until airway and ventilation stabilize or advanced airway management is established.

Common Errors

  • Poor mask seal → inadequate tidal volume and poor oxygenation.
  • Excessive squeeze volume or pressure → gastric inflation, aspiration risk, and lung injury.
  • Incorrect breath timing → breath stacking or patient-ventilator asynchrony.
  • One-rescuer fatigue during prolonged use → reduced ventilation quality over time.
  • Gripping soft mask edges instead of hard shell during E/C technique → unstable seal and air leak.

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