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Delivering Free-flow Oxygen

Oxygen maskFlow-inflating bag and maskT-piece resuscitatorOxygen tubing

Free-flow Oxygen Given Via Oxygen Mask

Free-flow Oxygen Given Via Oxygen Mask

Free-flow Oxygen Given Via T-piece Resuscitator

Free-flow Oxygen Given Via Oxygen Tubing

Free-flow Oxygen Given Via Oxygen Tubing

Types of Positive-Pressure Devices

Self-inflating bagFlow-inflating bag (anesthesia bag)

T-piece resuscitator

Types of Positive-Pressure Devices

Self-inflating Bag

Self-inflating Bag

Flow-inflating Bag

T-piece Resuscitator

Safety Features: Self-inflating Bags With Pressure-release Valve

Safety Features: Flow-inflating Bag

Safety Features: T-piece Resuscitator

Resuscitation Masks

Rim- Cushioned- Non-cushioned

Shape- Round- Anatomically shaped

Size- Small- Large

Resuscitation Masks

Resuscitation Masks: Round ShapeDisadvantages If the correct size is not selected, a seal can not form

If the mask is too large, eye damage may develop

Resuscitation Masks: Anatomically Shaped

AdvantagesEasier to obtain a seal

Less chance of eye damage

Resuscitation MasksSizeSmallLargeMask should coverTip of chinMouthNose

Resuscitation Masks: SizeThe correct size will cover the tip of the chin, the mouth, and the nose but not the eyes.

Too large → Eye damageToo small → Will not cover the mouth and nose and may occlude the nose.

Size of BagBags used for newborns should have a volume of 200 to 750 mL. Term neonates only require 15 to 25 ml with each ventilation (5-8 mL/kg).

Preparation ChecklistBefore beginning PPV:Select appropriate-sized mask

Be sure airway is clearPosition baby’s headPosition yourself at baby’s side or head

Positioning Mask on Face

Ventilation Rate40-60 breaths per minute

Signs of Improvement

Improvement is indicated by the following signs:Increasing heart rateImproving colorSpontaneous breathingImproving muscle tone

Signs of Improvement

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Infant Not Improving and Chest Not Adequately Expanding

•Possible causes•Inadequate seal•Blocked airway•Inadequate pressure

Causes and Solutions for Inadequate Chest ExpansionConditions Actions1.Inadequate seal

Reapply mask to face and lift the jaw forward.

Causes and Solutions for Inadequate Chest ExpansionReapply mask to face

Causes and Solutions for Inadequate Chest ExpansionLift the jaw forward

Causes and Solutions for Inadequate Chest ExpansionConditions Actions2. Blocked airway Reposition the

head.Check for secretions; suction if necessary.Ventilate with the newborn’s mouth slightly open.

Causes and Solutions for Inadequate Chest ExpansionConditions Actions3. Inadequate pressure

Increase pressure until there is a perceptible movement of the chest.Consider endotracheal intubation.

Continued Positive-Pressure Ventilation

Orogastric tube should be inserted to relieve gastric distentionGastric distention mayElevate diaphragm, preventing full lung expansion

Cause regurgitation and aspiration

Continued PPV

Insertion of Orogastric Tube

Equipment8F feeding tube

20-mL syringe

Insertion of Orogastric TubeMeasuring correct length

Insertion of Orogastric Tube

Insert tube through mouth. Resume ventilation

Attach 20-mL syringe and aspirate gently

Remove syringe and leave tube end open to air

Tape tube to newborn’s cheek

Insertion of Orogastric Tube