To ventilate a child with a bag-mask device, you need to ensure a proper mask fit and airtight seal, delivering breaths that gently raise the chest to approximate normal ventilation.
Ventilating a child using a bag-mask device (often called a BVM or Ambu bag) is a critical skill in emergency situations. It involves using a mask to cover the child's nose and mouth and a self-inflating bag to deliver breaths. The primary goal is to provide adequate oxygen and ventilation until more advanced support is available.
Here's a breakdown of the process:
Key Steps for Pediatric Bag-Mask Ventilation
Proper technique is essential for effective ventilation. Follow these steps carefully:
-
Position the Child:
- Place the child on a firm, flat surface.
- Open the airway. For infants and young children, a "sniffing position" (head slightly extended, neck neutral) is usually effective. Avoid overextending the neck, which can close the airway.
-
Select and Position the Mask:
- Choose the correct mask size. The mask should be large enough to cover both the nose and mouth but not so large that it covers the eyes or extends beyond the chin.
- The mask should extend from the bridge of the nose to the cleft of the chin, enveloping the nose and mouth but avoiding compression of the eyes.
- Position the narrow end of the mask over the bridge of the nose.
- Bring the wider end down over the mouth and chin.
-
Ensure an Airtight Seal:
- This is crucial for ventilation effectiveness.
- Use the "E-C" clamp technique: With one hand, make an "E" shape with your last three fingers (ring, middle, index) under the bony part of the jaw to lift it slightly. Make a "C" shape with your thumb and index finger around the mask to hold it firmly on the face.
- The mask should provide an airtight seal. This prevents air from leaking out during ventilation.
-
Connect Bag and Oxygen (if available):
- Connect the self-inflating bag to the mask.
- If supplemental oxygen is available, connect the oxygen tubing to the bag's oxygen inlet and set the flow rate as appropriate for the device (often 10-15 L/min for high-concentration delivery).
-
Deliver Breaths:
- Squeeze the bag gently and smoothly.
- Observe the child's chest. The goal of ventilation with a bag and mask should be to approximate normal ventilation. This means delivering just enough volume to see a gentle rise of the chest over about one second, rather than forcing air rapidly or excessively.
- Avoid stomach distension by using appropriate volume and avoiding excessive pressure.
-
Observe Effectiveness:
- Look for visible chest rise with each breath. This confirms air is entering the lungs.
- Listen for breath sounds with a stethoscope if possible.
- Note if the child's color improves (e.g., pinking up).
Ventilation Rate
The rate of ventilation depends on the child's age and situation (e.g., CPR vs. respiratory support). Generally, for infants and children, a rate of 20-30 breaths per minute (about one breath every 2-3 seconds) is often appropriate for respiratory support alone. During CPR with a pulse but inadequate breathing, provide 1 breath every 2-3 seconds (20-30 breaths/minute). If no pulse, follow CPR guidelines for compressions and ventilations.
Remember that seeing gentle chest rise is the best indicator of adequate volume, ensuring you approximate normal ventilation.
