• Manual ventilation with a ventilatory bag (or manual ventilatory bag or manual ventilatory device or bag valve mask or self-inflating bag with a non-rebreathing valve or Ambu bag) may be necessary if your child without a tracheostomy is unable to breathe effectively independently. Here are some situations when manual ventilation may be required:
  • to replace a mechanical ventilatory assistance device while it is disconnected for transportation or to facilitate mobility (eg, transferring your child from chair to bed, repositioning, daily care such as bathing, etc.);
  • to change the ventilation circuit or ventilatory assistance device;
  • to do cough assist techniques, ideally with a modified ventilatory bag;
  • to ventilate in an emergency situation such as respiratory distress, breakage of ventilatory assistance device, unresolved ventilatory assistance device alarms etc.;
  • to ventilate during cardiopulmonary resuscitation (CPR).
• Below is a suggested method that can serve as a guide; discuss the specific type of medical supplies and equipment used for your child with the healthcare team.

Considerations:

• The ventilatory bag may be used with a facial mask for manual ventilation and cough assist techniques or with a mask (facial, nasal or nasal pillows) with exhalation valve for non-invasive ventilation.
• Do not confuse the ventilatory bag for the manual ventilation with the modified ventilatory bag which is a specific device used to aid inspiration, cough and clearance of secretions. The modified ventilatory bag does not allow the child to exhale which can be very dangerous. Never use a modified ventilatory bag to perform manual ventilation.
• The rate of compressions of the ventilatory bag corresponds to the respiratory rate required by your child. It is important to maintain a regular rhythm.  The rate required usually varies according the age of the child:
  • Infants: 25 to 40 times per minute
  • Children: 20 to 30 times per minute
  • Adolescents: 14 to 20 times per minute

Verify the specific rate required for your child with the healthcare team.

• In an emergency situation, the rate of compressions of the ventilatory bag should be in accordance with the guidelines for cardio pulmonary resuscitation (CPR), which you have been taught by the healthcare team.
• Evaluate the need for a second person to help keep your child in a safe position during procedure (eg, your child is young or moving around a lot).
• Ensure the comfort of your child during care by using different positioning and distraction techniques.
• Good handwashing is essential before and after providing care.

As required.