BLS Certification Manual: Ventilation Equipment

Ventilation Equipment

BLS responders may use barrier devices or bag-mask equipment to provide rescue breaths. Effective ventilation requires an open airway, a good seal, appropriate volume, and avoidance of excessive ventilation.

Pocket Mask

A pocket mask covers the person's mouth and nose and usually contains a one-way valve.

To use a pocket mask:

1. Position the mask correctly
2. Open the airway
3. Create a tight seal
4. Give each breath over approximately 1 second
5. Deliver only enough air to produce visible chest rise

Maintaining a Mask Seal: The E-C Clamp Technique

The E-C clamp technique helps maintain a tight seal with a pocket mask or bag-mask device while keeping the airway open.

• Form a "C" shape with the thumb and index finger of one hand, pressing down on the mask to create a seal
• Form an "E" shape with the remaining three fingers, placing them under the bony portion of the jaw to lift the jaw toward the mask
  This technique allows one rescuer to maintain both the seal and an open airway simultaneously.
  

Adult Equipment on Infants and Children

Adult-sized pocket masks and bag-mask devices are not appropriately sized for infants and should not be used on them. Use age-appropriate pediatric equipment when available.

Bag-Mask Device

A bag-mask device allows trained responders to provide positive-pressure ventilation.

Effective bag-mask ventilation requires:

• Correct mask size
• Appropriate bag size
• Proper positioning
• An open airway
• A tight mask seal
• Appropriate ventilation volume

Selecting a Mask

Choose a mask that fits the person's face appropriately.

The mask should:

• Cover the nose and mouth
• Extend from the bridge of the nose to the cleft of the chin
• Avoid covering the eyes
• Create an effective seal without excessive pressure

For infants and children, use a pediatric-sized mask whenever available.

Selecting a Bag

Use a bag appropriate for the patient's size. Pediatric and infant patients require smaller ventilation volumes than adults. Regardless of bag size, give each breath over approximately 1 second and deliver only enough air to produce visible chest rise.

Avoid squeezing the entire bag simply because it is available.

Infant and Child Considerations

When ventilating an infant or child:

• Use age- and size-appropriate equipment
• Avoid excessive head extension
• Maintain an effective mask seal
• Use only enough ventilation volume to produce visible chest rise
• Avoid excessive pressure and rapid ventilation

Infants require particularly small ventilation volumes.

One-Rescuer Bag-Mask Ventilation

One-rescuer bag-mask ventilation may be difficult because the rescuer must maintain the mask seal and squeeze the bag at the same time. Use proper technique and maintain the airway throughout ventilation.

Two-Rescuer Bag-Mask Ventilation

When two trained responders are available:

• One responder may use both hands to maintain the airway and mask seal
• The second responder squeezes the bag

This approach can improve the quality of the mask seal and ventilation.

Supplemental Oxygen

If supplemental oxygen is available and responders are trained to use it, connect it according to the equipment instructions and workplace procedures.

Avoid Excessive Ventilation

Give each ventilation over approximately 1 second and only until the chest visibly rises. Excessive rate, pressure or volume can reduce the effectiveness of resuscitation.