Manually Ventilating Your Child with a Tracheostomy and Ventilator

When do I use manual ventilation?

You may use manual ventilation on your child:

• During airway emergencies

• Before and after suctioning

• During tracheostomy changes

• During ventilator tubing change

• When you are troubleshooting a ventilator problem

• When transporting your child without a portable ventilator, you will need to give the same number of breaths and PEEP (if needed)

What supplies will I need? (Keep these with your child at all times.)

• Self-inflating (ambu) bag of the correct size

• Oxygen source with oxygen tubing and reservoir, (if oxygen needed)

• Flowmeter (if oxygen needed)

• PEEP valve (if needed)

What is the correct way to use the bag?

*: Popoff valve not available on an adult bag.

1. If your child is on a ventilator (and has a PEEP greater than 5), make sure the PEEP valve is connected to the bag.

2. If oxygen is needed, attach oxygen tubing to the flowmeter. Attach self-inflating bag to oxygen source and set flowmeter to 10 LPM Flow.

3. Connect the patient end of the bag to your child’s tracheostomy tube or the swivel/connector on the tracheostomy tube.

4. Squeeze the resuscitation bag with one or two hands. You need to squeeze in enough air to make your child’s chest go gently up and down.

5. Adjust PEEP valve to maintain same level of PEEP, as the mechanical ventilator.

6. Let go of the bag and allow it to refill. Squeeze and release the bag at the rate your child normally breathes in a minute or the same number of breaths that the ventilator gives.

• If your child is on a ventilator, you will want to give your child the same number of breaths per minute that they get from the ventilator.

• For example: If the ventilator gives your child 20 breaths per minute, you will manually ventilate your child at 20 breaths per minute (one squeeze every 3 seconds).

7.Do not leave the bag attached to your child without squeezing it to give breaths. This makes it impossible for your child to breathe.

8. Make sure pop-off valve is open. If the pop-off valve activates, you are squeezing the bag too hard. Try using a little less pressure. The goal is to see a gentle rise and fall of the chest.

9. For a patient needing high pressure ventilation, the pop-off valve should stay closed. Your healthcare team will discuss this with you prior to discharge.

Reviewed April 2024 by Amanda Manzi, DNP and Janessa Shainline, MSN, RN