• 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 with 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 mobilize and improve clearance of secretions and/or aspiration of secretions;
  • to ventilate in an emergency situation such as respiratory distress, obstruction or accidental decannulation of the tracheal cannula, 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:

• 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 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.
• 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.