Smaller BVM?

[Chief1C]

I have been "charged" with looking into better equipment, newer technology.

I'm looking for a Bag Valve that is smaller than your standard, Infant size, BVM. If you were to order a Neonate BVM now, chances are it would be an Infant bag w/ a Neonate mask.

Also.. A mask, that is smaller than an Ambu Neonate. I've had two different Neonate masks, one Ambu and one probably Life Support Products; and they weren't even the same size. Ambu was smaller, and IMO, the LSP mask was an Infant mask w/ the wrong package. IMO anyway.

I have catalogs of all of the big name companies; I haven't found anything yet. I'd appreciate some thoughts tossed in.

[AZCEP]

BVMs aren't really optimal for use in neonates anyway. The flow-inflating (anesthesia) bags are better suited to neonates.

They will only inflate when the mask has an adequate seal, and will deliver oxygen when it doesn't have one. A self-inflating BVM will only deliver oxygen when it is being compressed.

[VentMedic]

I do not recommend flow inflating bags for transport or for providers who have limited experience. Regulating flow, VT and PEEP can be difficult if one has not done this several times on different babies. A manometer would definitely be needed. Also, if you lose your gas source, you and the baby are SOL. The flow regulator on your tank may jump from 5 L/m to 10 L/m with no inbetween settings. The flow dependent bag and the baby may prefer 6 - 8 liters. And, if you have a baby with a known and unrepaired cyanotic heart disease you may not have an air tank or blender to run the bag off. With a self-inflating bag you can either use without O2 or take off the reservior bag to run at 35 - 40% O2 percentage instead of 90 - 100%. There are some new NRP guidelines but many EMS companies probably have not changed their protocols accordingly and with reasons.

Here are a few websites for comparing a few different models and companies.

http://www.ventlab.com/Resuscitation.htm

http://www.cardinal.com/us/en/distributedp...%20Accessories;

http://www.smiths-medical.com/catalog/manu...-resuscitation/

Different size masks can be ordered separately since it would get costly for a NICU or ambulance to have a bag stock a each sized mask. Usually a neonatal bag will come with a neonatal mask but a smaller preemie size is available. A medium infant mask may come with an infant bag but there may also be small infant and large infant sizes available separate from the bag.

The bags with a built in manometer are also recommended.

Below is a decent article explaining the anatomy of an infant BVM and how to use it.

http://www.emsresponder.com/print/Emergenc...r-Babies/1$6895

[tniuqs]

I do not recommend flow inflating bags for transport or for providers who have limited experience. Regulating flow, VT and PEEP can be difficult if one has not done this several times on different babies. A manometer would definitely be needed. Also, if you lose your gas source, you and the baby are SOL. The flow regulator on your tank may jump from 5 L/m to 10 L/m with no inbetween settings. The flow dependent bag and the baby may prefer 6 - 8 liters. And, if you have a baby with a known and unrepaired cyanotic heart disease you may not have an air tank or blender to run the bag off. With a self-inflating bag you can either use without O2 or take off the reservior bag to run at 35 - 40% O2 percentage instead of 90 - 100%.

I have to strongly agree with VENTMEDIC the use of Flow Inflating / Jackson Reese manuel resusitation should be restricted to the "practiced" and experianced provider.

Just the concept of pressure ventilation vs conventional volume ventation is NOT even closely addressed in the vast majority of Paramedic programs, that I have encountered. If one were to ask the typical REMT-P what influence say for example increasing Ti (with RR remaining constant) would have on oxygenation or Vt of a neonate, most would be stumped. I suspect very few paramedics would even have a justafiable number of "calls" to warrent anything other than Self Inflating Bagger for this piece of 'kit" on their trucks.

I also must agree that a Manometer "should" become a standard on ALL Manuel Resusitators for every level of Practitioner.

Question to 4cmk6 ... why do you even want a smaller size BVM anyway, maybe I am missing something here ???

[Chief1C]

Question to 4cmk6 ... why do you even want a smaller size BVM anyway, maybe I am missing something here ???

The incident in question, mouth to mouth was the only way we could ventilate. The child was born pulseless and apenic, and premature. Too small to get a seal with a neonate mask. The child was resuscitated on scene, and to my knowledge is doing well.

We had everything required, and everything on board as suggested by the lists from that EMS for Children organization. Still, it would be nice to have one set of smaller equipment, just in case. Really, I just posted this to find out if smaller equipment existed. As far as cost, I'm really not concerned about that.

[mobey]

We have one about the size of a golf ball, the mask that is... I dunno where it came from, but they are available so keep looking!!

Good luck

[VentMedic]

If you like the BVMs you are using, you can order Premie, Neonatal, Infant S, M, L as well as various sized pedi masks from any company. We mix and match all the time since we may favor one bag but the masks that come with it are not of the same quality. Some babies are just hard to fit at whatever gestational age. We keep at least 5 different sizes of preemie, neonatal and infant masks near the infant resuscitation bag regardless of what comes with it.

The masks may also deteriorate long before the bag depending on your climate. We just make sure we have extra masks around so there are no surprises that we can't handle.

People can still deliver a "too" large volume with a neonatal bag also. With a pressure manometer, an infant bag and gentle, attentive hands will work just fine on the preemies if a neonatal bag is not around. Too many get hung up on the "recipe" of equipment rather than the how the equipment actually works and application.

I hope the person that did mouth to mouth has had a couple of follow up physicals with lab work.