Proper technique is essential to perform successful bag-valve-mask (BVM) airway management. Patients should be in the supine position, neck in a neutral position and the occiput slightly elevated (on a folded blanket, sheet, small pillow, etc.) to achieve a “sniffing position,” with the opening of the ears at the same level as the sternal notch. Masks should be of the proper size and should be fitted to the face to obtain a seal. This is best achieved by first placing the tapered portion of the opening of the mask over the bridge of the nose, then covering the patient’s mouth. If using the one-person method, the non-dominant had should use the “C & E” method with the thumb and index finger forming a C to cover the mask, and the middle, ring and small fingers forming an E on the bone of the mandible effectively lifting the jaw into the mask (rather than pressing the mask onto the face).
The other hand should gently squeeze the bag delivering a breath at a rate of one squeeze every 5-6 seconds. There should not be a leak around the mask, and you should be able to observe the rise and fall of the patient’s chest. An ETCO2 monitor may be placed in-line with the bag and mask. PEEP should be used with the BVM and initially set to 5mmHg. Every attempt should be made to maintain a seal to ensure continued PEEP. If the patient is breathing spontaneously, careful observation and delivery of an assisted synchronous breath should be a priority.
Some additional considerations are below: