Operating & troubleshooting a self inflating bag
Contents
1. neoResus The Victorian Newborn Resuscitation Project Operating amp troubleshooting a self inflating bag Presentation developed by Rosemarie Boland Victorian Newborn Resuscitation Project The Victorian Newborn Resuscitation Project SIX key steps to Success e Choose the correct size self inflating bag for newborn resuscitation a 240 mL bag e Choose the correct sized mask according to the size of the newborn infant e Assemble the bag and mask ensuring that all the valves are present and inserted correctly Victorian Newborn Resuscitation Project f The Victorian Newborn Resuscitation Project SIX key steps to Success f lest the functionality of the bag and mask e Create a good seal between the infant s face and the mask using the two point top hold e Continually reassess your ventilation technique to ensure ventilation is effective Victorian Newborn Resuscitation Project DE Choose the correct size bag The 240 mL self inflating bag is the most appropriate size for all newborn infants Why The tidal volume required by a newborn infant is approximately 4 6 mL kg body weight therefore a volume of 240 mL should be more than adequate to inflate any newborn s lungs Australian Resuscitation Council 2006 Guideline 13 4 Victorian Newborn Resuscitation Project omparison of Laerdal adult rcoresu aediatric amp preterm bags Adult Ventilation Bag 16002. as an educational program around neonatal care with the assistance of a grant from the Department of Health Victoria Whilst appreciable care has been taken in the preparation of this material RWH shall not be held responsible for any act or omission which may result in Injury or death to any baby as a result of reliance on this material Victorian Newborn Resuscitation Project NN neoResus The Victorian Newborn Resuscitation Project Copyright This material is copyright NeoResus The Victorian Newborn Resuscitation Project This presentation may be downloaded for personal use but remains the intellectual property of NeoResus and as such may not be reproduced or used for another training program without the written permission of the Victorian Newborn Resuscitation Project Executive Please contact us at admin neoresus org au Victorian Newborn Resuscitation Project
3. and close If pressure is not felt this device is not safe to use Victorian Newborn Resuscitation Project Check that the lip valve opens amp rsrs closes with each squeeze of the bag Lio valve f Disposable single use bags heoResus are tested the same way Victorian Newborn Resuscitation Project he The Victorian Newborn Resuscitation Project Test the pressure relief valve Remove the mask and occlude the patient port connector with your thumb Compress the bag several times Look amp listen for opening of the pressure relief valve n I The pressure relief valve neoRess The pop off valve The maximum pressure Is limited to a factory setting which varies from 35 45 cmH 0 according to the manufacturer of the bag A higher peak pressure PIP can be given by occluding the pressure relief valve whilst squeezing the bag Be aware that pressure relief valves have been shown to activate at a wide range of pressures and well in excess of the factory setting of 35 45 cm H0 Ganga Zandzou et al 1996 Unless you are using an in line pressure manometer you will not know how much peak pressure you are delivering with each inflation Victorian Newborn Resuscitation Project ee Connect an oxygen source amp neoResu check that the reservoir bag inflates At a flow rate of 2 5 L min 97 100 oxygen Is delivered with or without the reservoir bag attached to the Laerd
4. al bag Removing the reservoir bag does not significantly reduce the oxygen concentration Thio et al 2009 Victorian Newborn Resuscitation Project oa Create a good seal between ores the infants face amp the mask Position the infant s head in a neutral position Place a finger onto the chin tip the guide finger Line up the outer edge of the mask into the groove between the guide finger and the chin tip Roll the mask onto the face from the chin upwards Victorian Newborn Resuscitation Project Holding the mask in place USING sex the two point top hold Apply evenly balanced downward pressure onto the mask using the thumb and index finger positioned toward the outer edge of the flat area of the mask two point top hold Apply jaw lift with the remaining fingers so that the upward pressure works against the downward pressure from the two point top hold to create a good seal Victorian Newborn Resuscitation Project f The Victorian Newborn Resuscitation Project Incorrect ways to nold a mask Holding the mask by the stem A or by the outer edge of the rim B will result in a poor seal amp significant mask leak Victorian Newborn Resuscitation Project Leak around face masks Leaks averaging 40 to 70 around face masks are common due to poor mask placement technique gt x 2 z a 4 w z 9 LL Itcannot be assumed that just be
5. cause the l Reference Wood et al 2008 mask is on the face Archives of Disease in Childhood that there isa good Fetal amp Neonatal Edition 93 p F231 Seal Victorian Newborn Resuscitation Project Victorian Newborn Resuscitation Project Air or oxygen for resuscitation Air 21 should be used initially Oxygen should be introduced if the newborn does not improve during the first minutes of life Hyperoxia should be avoided especially in the preterm infant Slowly wean the FiO once pre ductal SpO gt 90 ee Is your technique effective If your ventilation technique is effective three Signs are observed The heart rate increases to above 100 bom The chest amp upper abdomen rise with each inflation The newly born infant should begin to look pink f these signs are not seen the technique of ventilation needs to be improved Intubation should also be considered Victorian Newborn Resuscitation Project LTE Victorian Newborn Resuscitation Project References Australian Resuscitation Council ARC 2006 Section 13 4 Airway management and mask ventilation of the newborn infant Accessed April 27 2009 from hittp www resus org au Ganga Zoudou P S Diependaele J F Storme L Riou Y Klosowski S amp Rakza T et al 1996 Is Ambu bag ventilation a simple question of finger touch Archives of Pediatrics 3 12 1270 1272 Johnston K L amp Aziz K 2009 The self
6. inflating resuscitation bag delivers high oxygen concentrations when used without a reservoir implications for neonatal resuscitation Respiratory Care 54 12 1665 1670 Laerdal Medical 2006 Laerdal silicone resuscitators Interactive presentation Accessed April 27 2009 from _ http www laerdaltraining com Isr Victorian Newborn Resuscitation Project LN Victorian Newborn Resuscitation Project References Reise K Monkman S amp Kirpalani H 2008 The use of the Laerdal infant resuscitator results in the delivery of high oxygen fractions in the absence of a blender Journal of Resuscitation 2008 08 021 Thio M Bhatia R Dawson J A amp Davis P G 2009 Oxygen delivery using neonatal self inflating resuscitation bags without a reservoir Archives of Disease in Childhood Fetal amp Neonatal Edition online Accessed June 7 2010 from http fn bm com content early 2009 1 0 19 adc 2009 166462 abstract Wood F E Morley C J Dawson J A Kamlin C O Owen L S Donath S amp Davis P G 2008 Improved techniques reduce face mask leak during simulated neonatal resuscitation Study 2 Archives of Disease in Childhood Fetal amp Neonatal Edition 93 F 230 F234 Victorian Newborn Resuscitation Project Victorian Newborn Resuscitation Project Disclaimer This teaching program has been developed by the Newborn Emergency Transport Service NETS part of The Royal Women s Hospital RWH
7. ml 87 01 50 51 0I 03 mmm Intake Reservoir Valve 87 54 00 O Rings pkg 10 5 0 12 Flas aes pke 3 lt gt OD 25 mm ID 25 mm 51 04 04 ID 23 mm Lip Valve 54 01 03 Patient Valve OD 22mm w Pressure Relief Valve Disk Membrane 85 12 50 54 01 05 Pressure Relief Valve Preterm Ventilation Bag 240 ml 85 12 52 Adult Mask 4 5 Multi Function Mask Cover 87 02 20 Patient Valve w Lock Clip 85 13 50 Ie A Intake membranes y iii i N i pkg 10 d IXY The Victorian Newborn Resuscitation Project Reusable Oxygen Reservoir Bag 2600 ml 53 19 01 Reusable Oxygen Reservoir Bag 600 ml 55 1901 Reusable Oxygen Reservoir Bag 600 ml 55 19 Ol neoResus The Victorian Newborn Resuscitation Project Choose the correct size mask The rim of the mask should cover the tip of the chin the mouth amp the nose but not the eyes It should not extend under the chin If the mask Is too big a good seal cannot be achieved and effective ventilation will be impossible Victorian Newborn Resuscitation Project EPE Assemble the Laerdal The Victorian Newborn Resuscitation Project 240 mL preterm ventilation bag Pressure Relief Valve Preterm Ventilation Bag 240 ml _ Test the bag before use Place the mask firmly against your hand Squeeze the bag repeatedly You should feel air pressure against your hand and see the lip valve open
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