Optimal Bag Mask Valve Ventilation

What are all the things that must be done to achieve optimal BVM?

Here are some ways to remember and various pearls.

3X4 ways to BVM

There is the 3 step program (3 sets of quadruplets).

1) BVM, PEEP at 15, Mask O2 at 15, Nasal O2 at 15

BVM step 1

2) OAW, Jaw thrust, Clear FB’s and fluids, Position head and neck with head of bed up

BVM step 2

3)  Two person BVM, good Mask seal, Considering shock, Considering pulse ox lag/poor sat reading

BVM step 3


And then there is @cptjcook‘s (Jason N. Cook) Sex (6) steps to #SexyBagging

Update 2016-04-16

Sex steps to SexyBagging

Previously …

SexyBagging step 0.png


Step 1: Use airways (oral and nasal)

SexyBagging step 1.png

And some tweeted thoughts about that

Step 2 Two thumbs down mask seal grip with jaw lift

SexyBagging step 2

Lift the jaw and face into the mask and feel for leaks. Little, ring +/- middle fingers reach behind the angle of the jaw to pull it up.

Step 3 Two person BVM technique

SexyBagging step 3.png

An underhand grip on the BVM is preferred. You tend to squeeze the bag less hard and you have a firm hold on the bag.

Step 4 Position optimally for the airway

SexyBagging step 4.png

I usually don’t use pillows for positioning

I love this pearl from George Kovacs on dynamic head positioning and this can be for both BVM as well as intubation and insertion of supraglottic airways.

My mantra for positioning of all airway interventions (except cric where neck is hyperextended if possible):

Step 5 Squeeze with care and coordination

SexyBagging step 5.png

Also there is JAWS: Love this from Rich Levitan!

Step 6 Use PEEP

SexyBagging step 6.png

Other options might be Mapleson C-Circuit (I have no experience) and the Oxylator.

Yen Chow and Sameer Mal at Ornge on BVM

Tips from Nick Chrimes at SMACC

This was from smaccGold (Hat tip to @DentonGavin for reminding me!)

What else?

Tweet me or leave me comments on your favorite approach to optimal BVM or if I have missed anything or other good resources! I will update this page from time to time as more things come to me. (Yen 2016-01-23)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s