A Bag Valve Mask (BVM) often called an Ambu bag is a manual resuscitation device used to provide positive pressure ventilation to patients who are not breathing or are breathing inadequately. It’s a cornerstone of emergency airway management in both prehospital and hospital settings.
Definition
It is an essential, emergency, basic airway management technique that allows for oxygenation and ventilation of patients until a more definitive airway can be established.
Purposes for Bag Valve Mask (BVM) Ventilation
- Administration of high-flow O₂.
- Delivery of positive-pressure ventilation.
- Augmentation of spontaneous ventilation.
Indications
- Hypercapnic respiratory failure.
- Hypoxic respiratory failure.
- Apnea.
- Altered mental status with the inability to protect the airway.
- Patients who are undergoing anesthesia for elective surgical procedures.
Contraindications
- Total upper airway obstruction
- Increased risk of aspiration after paralysis and induction.
| Articles | Purpose |
| Gloves and PPE. | To protect from infection. |
| Bag-valve-mask. | To resuscitate the patient in case of emergency. |
| Oxygen source with tubing. | To deliver the oxygen. |
| PEEP valve. | To maintain pressure on the lower airways at the end of the breathing cycle. |
| Oropharyngeal airway or nasopharyngeal airway. | To prevent aspiration. |
Procedure
| Nursing action | Rationale | |
| 1. | Arrange all the articles at the bedside. | To easily reach. |
| 2. | Perform hand washing. | To protect from infection. |
| 3. | Choose a right-sized mask (upper edge not covering the patient’s eyes and lower edge resting between the lower lip and the chin). | For proper fitness and to prevent air leakage. |
| 4. | Attach oxygen with tubing and adjust the regulator to maximum flow, 15 L. | To provide oxygen |
| 5. | Inspect the oral airway for: Secretion.Mucosal damage.III-fitting dentures.Gag reflex. | To prevent airway blockage |
| 6. | Perform head-tilt, chin-lift maneuver. | Proper position helps to provide adequate oxygenation. |
| 7. | The face mask is placed firmly over the patient’s face to create a seal, air entrainment is reduced, and high oxygen concentrations can be delivered. | To prevent air leakage. |
| 8. | The head positioned (one-handed technique) to fit and seal the bag against the face, placement of the thumb and index finger on the body of the mask, third and fourth digits on the jawbone, fifth digit at the angle of the jaw. | To provide adequate ventilation. |
Special Considerations
Bag mask ventilation (BMV) is a critical emergency procedure that requires careful technique and attention to detail. Here are some special considerations to ensure effective and safe ventilation:
1. Proper Equipment Setup
- Ensure the bag-valve mask (BVM) is correctly assembled and connected to an oxygen source.
- Check for leaks in the mask seal to prevent inadequate ventilation.
- Use a PEEP valve if needed to improve oxygenation.
2. Airway Management
- Position the patient using the head tilt-chin lift or jaw thrust (for suspected spinal injuries).
- Consider using airway adjuncts like an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) to maintain patency.
3. Ventilation Technique
- Deliver slow, controlled breaths to avoid gastric insufflation.
- Observe for adequate chest rise to confirm effective ventilation.
- Use a two-person technique when possible—one person maintains the mask seal while the other squeezes the bag.
4. Monitoring and Adjustments
- Continuously assess oxygen saturation and patient response.
- Adjust ventilation based on respiratory rate and effort.
- Be prepared to switch to advanced airway management if BMV is ineffective.
5. Special Populations
- Obese patients may require additional airway positioning for effective ventilation.
- Edentulous patients (without teeth) may need a modified mask seal technique.
- Pediatric patients require smaller masks and lower ventilation volumes.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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