Module 2: Breathing with

Bag ventilation is one of the methods that can be used to get additional air down into the lungs when a patient requires manual respiratory support. The bag is a thick-walled, self-expanding rubber ‘balloon’ that is inflated with ambient air and then squeezed to blow air into the patient. Consequently, the bag is a spare ventilator.

A bag ventilator must be used when the ventilator is out of order or in other emergency situations. It can be used during transportation, to mobilise mucus and during tracheal suctioning. Everyone who has a ventilator and tracheostomy shall have a bag. The bag must be accessible at all times, and complete and ready to use. The objective is to maintain normal breathing when carrying out procedures and/or disconnecting from a ventilator.

Equipment

For manual ventilation, you need a ventilation bag with a mask for an adult that covers the mouth and nose, and a paediatric mask that covers the stoma and bag attachment of the tracheostomy.

Method

Otherwise, good hand hygiene is paramount. Wash your hands or alternatively use an approved anti-bacterial soap.

1. Wear clean gloves.
2. Connect the bag to the cannula or mask.
3. Ventilate the user by squeezing the bag -
   1. squeeze with one hand;
   2. ventilate approx, every five seconds between each squeeze or ventilate following the user’s own breathing pattern.
4. Work calmly and observe the user.
5. Disconnect the bag from the cannula and use suction to remove the mucus in the cannula.
6. If there is still mucus in the cannula, repeat this procedure.

The video below demonstrates manual ventilation with bag ventilation connected to a tracheostomy.

Cleaning

Clean the bag every day or as needed in the following way:

1. Disassemble the bag.
2. Rinse the parts with running tap water.
3. Place the parts in lukewarm water (30 to 40 degrees) for at least two minutes.
4. Add detergent (washing-up liquid) and hot top water (60 to 70 degrees).
5. Thoroughly clean all surfaces and use a brush if necessary.
6. Rinse all the parts in lukewarm water.
7. Dry all parts.
8. Check that all the parts are clean and dry before reassembling them.