
Birth • Term Gestation? • Clear of Meconium? • Breathing or crying? • Good Muscle Tone? • Routine Care • Provide warmth • Clear Airway if needed • Dry • Assess color Yes No 30 seconds • Provide warmth • Position clear airway • (as necessary) • Dry, stimulate, reposition Evaluate Resp, HR and Color Breathing, HR>100, Pink Breathing, HR>100, Cyanotic Pink HR < 100 Apnea Persistent cyanosis Observational Care Give Supplementary Oxygen • Provide positive pressure ventilation Endotraheal intubation may be considered at several steps
Use of Bag and Mask In this lesson we will learn • When to give Positive-pressure ventilation • The similarities and difference between flow-inflating, self-inflating bags and T-piece resuscitator • The operation of each device to provide PPV • The correct placement of mask on newborn’s face • Testing and trouble shooting of bag • Evaluating success of bag and mask ventilation
Indications of Bag & Mask Ventilation After 30 seconds of Initial steps if • Baby is not breathing or is gasping • Heart rate is less than 100 bpm and /or • Is Cyanotic despite supplemental oxygen
Flow inflating bags Fills only when oxygen from a compressed source flows in to it Self inflating bags Fills spontaneously after it is squeezed, pulling oxygen or air in to the bag Different Types of Resuscitation Devices T-piece resuscitator Also works when gas from compressed source flows into it. The gas is directed into the baby by occluding the opening on T-piece
Flow Inflating Bags Flow-control valve Oxygen
Self Inflating Bags Oxygen
PEEP Adjustment Circuit Pressure Inspiratory Pressure Control Maximum Pressure Relief Gas Outlet Gas Inlet T-piece Resuscitator
Flow Inflated Bags Advantages • Delivers 21-100% oxygen depending on source • Easy to determine when there is a seal on the patient’s face • Can deliver free flow oxygen • Can deliver PEEP or CPAP
Flow Inflated Bags Disadvantages • Requires a gas source to inflate • Requires a tight seal between the mask and the patient to remain inflated • Usually does not have a safety pop off valve
Self Inflating Bag Advantages • Will always refill after being squeezed even with no compressed gas source • Pressure-release valve makes over-inflation less likely
Self Inflating Bag Disadvantages • Will Inflate even if there is no tight seal • Requires a reservoir to deliver 100% O2 • Cannot be used to deliver free-flow oxygen reliably • Cannot deliver CPAP and can deliver PEEP only when special valve is connected
T-piece resuscitator Advantages • Consistent pressure • Reliable control of PIP & PEEP • Reliable delivery of oxygen • No Fatigue from bagging
T-piece resuscitator Disadvantages • Requires gas supply • Compliance of lung can’t be felt • Requires pressures to be set prior to use • Changing inflation pressure during resuscitation
General Characteristics • Size of bag – 240 to 750 ml • Oxygen capacity -- capable of delivering 90-100% oxygen • Safety features – capable of avoiding excessive pressures • Size of mask – appropriate sized mask
2. Oxygen inlet 7.Pressure manometer site 3. Patient outlet Self Inflating Resuscitation Bag
Safety Features • Pop – off valve set at 30 – 40 cm H20 • Port to attach a manometer Pop off Valve
Face Mask • Cushioned rims – less traumatic, better fit • Shape – round or anatomical • Size – appropriate fit
Correct Incorrect Incorrect Face mask positions
Face mask positions Correct
Preparing the Equipment • Attach oxygen tubing and oxygen reservoir • Adjust flow to 5 – 10 l/min • Block patient outlet or the mask by the palm of the hand and squeeze the bag * Feel pressure against the hand ? * Pressure valve is opened?
Prerequisites for PPV • Select the appropriate-sized mask • Be sure there is a clear airway • Position the baby’s head • Position yourself at the bedside
Position yourself at bedside Incorrect Correct Correct
Signs of Effective Positive-pressure Ventilation • Rapid rise in heart rate • Improvement in color and tone • Audible breath sound • Chest movement
How much to squeeze the bag • Initial breath after delivery >30 cm H2O • Normal lungs 15-20 cm • Immature or diseased lungs 20-40 cm
Squeeze Squeeze Release ------------------- Frequency of BM Ventilation 40 – 60 breaths per day Breath ----- two -----three ----- Breath
When to stop PPV • Increasing heart rate : HR > 100 • Improving color • Spontaneous breathing • Improving muscle tone
Baby not improving on PPV • The seal is inadequate • The airway is blocked * Position * Secretions * Small nares in premature • Not Enough Pressure
Inserting Orogastric Tube • Needing PPV longer than several minutes • Measure the length to be inserted • Insert the tube through the mouth • Gently aspirate stomach contents • Leave the end of the tube open • Tape the tube to the cheek of the baby
Inserting Orogastric Tube Equipment Required • 8 F feeding tube • 20 - syringe
Measuring the length of tube 10 cm 12 cm 9 cm
Inserting Orogastric tube Insertion
Inserting Orogastric tube Aspiration
Inserting Orogastric tube Remove syringe and leave end open
Inserting Orogastric tube Tape the tube
If the Baby Is Not Improving • Is the chest movement adequate • Is the face-mask seal tight • Is the airway blocked: Improper position or Secretions • Is he equipment working • Is air in stomach interfering with chest expansion
If the Baby Is Not Improving • Is adequate oxygen being used • Is oxygen tube attached to ventilation device and to oxygen source • Is gas flowing through the flow meter • Self-inflating bag, is the oxygen reservoir attached • If using cylinder (rather than wall oxygen), is there oxygen in the cylinder
Next Step • If after 30 seconds of effective PPV with supplemental oxygen the baby is not improving: Evaluate • Not breathing: Perform ET intubation and continue PPV • Breathing but HR < 100 continue PPV • Breathing, HR > 100, central cyanosis + continue PPV • Heart rate < 60 Initiate Chest compressions