Manual ventilation with mask

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Summary:

Collaborate and form a team with your child. When you invest the time to form a strong team, children feel more comfortable and less anxious – this will help you complete the care with less stress – for you and your child.

Use these tips, from the start, to set the stage for a positive care procedure:

• Create the right moment: integrate the care in a routine.
• Alert your child to the needed care and communicate together.
• Form a team with your child: Encourage autonomy by offering realistic choices such as the method of distraction. Stay tuned to your child. Manage pain and anxiety, using distraction and positioning for comfort.

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Summary:

• Prepare the environment: Identify a routine place for care. Close windows, doors and fans. Wash and dry the work surface and gather the needed materials for the care and to distract your child.
• Prepare your child: Get help if needed. Position your child for comfort to receive the care and start to use the selected distraction method.
• Prepare yourself: Find the right time when you are ready to provide the care safely. Review the list of care steps. Wash your hands.

Now that you are ready to start the care procedure, take the opportunity to encourage and praise your child.

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Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Check that the bag is in good condition (not damaged, cracked or dirty).
• Compress the bag with one hand and release it; at the same time check with your other hand to ensure that air is coming out of the bag at the air outlet. The bag should rapidly and automatically reinflate.

This step verifies that the bag is in good condition and functions correctly.

• Check that the facial mask is in good condition (not damaged, cracked or dirty).
• Connect the mask to the air outlet of the ventilatory bag.

This ensures that the mask is in satisfactory condition to provide manual ventilation.

• Place your child in a comfortable position that allows you to easily position the mask on the child’s face.

The best position is one that facilitates the delivery of ventilatory assistance.

• Suction the secretions, if needed.
• Remove any previously placed mask (eg, for BiPAP), if present.
• Turn off the ventilatory assistance device, if in use.

This step prepares the child to receive manual ventilation via a mask.

• Place the mask so that it covers the child’s nose and mouth; hold it in place with one hand.
• Put your thumb and forefinger on the mask and your other fingers under the chin.

• Lightly press down on the mask with your fingers, creating a seal between the mask and the child’s face.
• Avoid rubbing the mask on the child’s face to avoid skin injury.
• Ensure that the mask rests on the bridge of the child’s nose and chin.

This step allows manual ventilation to be correctly delivered.

The pressure on the mask prevents air leaks which may decrease the effectiveness of the ventilatory assistance.

• With the other hand, gently compress the air bag, so that your child’s chest rises as the lungs inflate.
• Release the bag and allow it to reinflate.
• Give your child time to breathe out; you should see your child’s chest lower as the lungs deflate.
• Make sure that the depth of the air compressions and the rate of breathing are in accordance to the recommendations of the healthcare team.
• Continue ventilation as long as necessary.
• If your child’s chest does not rise sufficiently when the bag is compressed, then:
  • try to reposition the mask,
  • gently lift your child’s chin to open the airways; do NOT excessively tilt the head backwards or hyperextend the neck.

This step ensures the safety and effectiveness of manual ventilation.

As the bag does not have a device to measure the amount of air supplied, it is important to carefully monitor the rise and fall of your child’s chest to ensure that the lungs are filling and emptying adequately.

Once the period of manual ventilation has finished:

• Remove the mask from your child’s face.

This step puts an end to the manual ventilation.

If your child does not require non-invasive ventilation, go to the next step.

• Replace mask used for the non-invasive ventilation.
• Make sure that the ventilation circuit is securely connected to the mask.
• Start the ventilatory assistance device.
• Verify that the humidifier of the device is working.

This step allows the child to be reconnected to non-invasive ventilation.

• Do not immerse the bag in water.
• Clean and store the equipment according to the recommendations.

This step is required to prevent infections and to maintain the equipment in working order.

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Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.