1.55 Manual Resuscitator
Category: UWHC Patient Care Policy
Effective Date: June 1, 2017
Manual: Respiratory Care Services
Hand held device used to manually apply positive pressure and/or airflow to the lungs to assist with
ventilation. Manual resuscitators (MR) are devices incorporating a self-inflating bag and a
nonrebreathing valve mechanism or flow inflation bag.
A. All manual resuscitators will have a dedicated flowmeter.
B. NICU and PICU will use 02 shut-off levers with all manual resuscitators.
1. PICU patients will utilize self-inflation bags with a flow inflation bag stored in the basket
on the headwall.
2. PICU cardia patients with an anatomical shunt and chronic hypoxia will require the use
of an O2/Air blender and will utilize self-inflation bags.
a) Flow inflation bags require validation per shift by RT
b) 10 lpm set on flowmeter
c) Peep of 5 or what is set on the mechanical ventilator
d) Set the PIP to the appropriate level
e) FIO2 is set at 21% or the same as the mechanical ventilator FIO2
C. Patients with flow inflation bags at the bedside will require self-inflating manual resuscitators as
back up during transport.
D. Airway pressure manometer will be used in AFCH
E. All patients will be assessed by the Respiratory Care Practitioner (RCP) to determine if the
appropriate indications for therapy are present.
F. Therapy will be provided in accordance with a provider’s order.
G. Respiratory Care (RC) will supply and maintain MR’s.
1. All intubated or trachea patients receiving positive pressure will receive an MR. A
specific provider’s order will not be required for these patients.
2. All other patients will require a written order from their provider for maintenance of a
MR at bedside.
H. Appropriate size MR, mask and oxygen tubing will be at the bedside.
A. Oxygen flowmeter with nipple, and small bore tubing to connect MR to flowmeter (when
demand valve not in use).
B. O2 shut off lever
C. Appropriate sized facemask.
D. Appropriate sized manual resuscitator with correct peep level set
E. An airway pressure manometer if not incorporated into the MR.
A. Review and acknowledge provider’s order.
B. Review patient’s chart
C. Obtain the appropriate equipment.
D. Introduce yourself to the patient and/or family. Explain the reason for the procedure.
E. Assess the patient throughout the procedure.
F. If oxygen is required with the self-inflating bag, turn the flowmeter to 10-15 lpm.
G. With a flow inflation bag, set the FIO2 on the blender (if indicated) to match the patient’s current
FIO2. Turn the flowmeter to 10lpm. Confirm the peep and PIP are set appropriately. (see
H. Manual resuscitation without an artificial airway.
1. Perform the head-tile chin-lift maneuver or the jaw thrust to open the patient’s airway. In
patients with suspected cervical spine injury. Do not perform a head-tilt; rather, only
perform a chin-lift maneuver.
2. In neonates and small infants, do not hyperextend the neck. Place a rolled towel under
the shoulders slightly dropping the head back. Position the mask.
3. Place the mask on the patient’s face. Cover the nose and mouth with the mask without
extending it over the chin. Hold the mask in place by forming a “C” with your thumb
and index finer over the top of the mask and your remaining fingers around the mandible
and lift it upward toward the mask. If a second person is available to provide ventilations
by compressing the bag, a two hand technique can be used.
4. Create two opposing semicircles with the thumb and index finger of each hand to form a
ring around the mask connector, and hold the mask on the patient’s face. Then lift up on
the mandible with the remaining digits. Avoid applying pressure on the soft tissues of the
neck or on the eyes.
5. Ventilate the patient.
I. Manual Resuscitation with an artificial airway
1. Provide a volume of 6 – 7 ML/kg per breath (approximately 500 mL for an average
2. 4 – 6 L/kg per breath for a child
3. For a patient with a perfusing rhythm, ventilate at a rate of 10-12 breaths per minute or
appropriate for age.
4. Give each breath over 1 second or appropriate for age.
5. Assess the adequacy of ventilation with good breath sounds and equal chest wall
6. Be cognizant of increasing gastric distention.
J. Ensure the oxygen tubing is connected proximal to the flowmeter and distal to the MR.
K. Gently squeeze and release the MR and observe chest wall movement.
L. Return the MR to its designated local and turn off the oxygen if in use.
M. Return the MR to its designated location and turn off the oxygen if in use.
1. Adult: turn off the flow if in use.
2. Pediatric/neonate: return the MR to the lever to shut off the flow.
Respiratory Care Services Policy & Procedure:
#1:40 Cleaning & Changing of Patient Care Equipment
Approved by Director and Medical Director of Respiratory Care: