How would you answer this question?
Your patient Ms. G. is in severe respiratory distress and requires bag-valve mask ventilation. You are having trouble getting a good seal with the ambu bag because her front teeth are missing. The best action to take to ensure a good seal for ventilation is to:
a. Put her dentures in
b. Place the ambu bag just over the nose
c. Use the lower lip placement technique
d. Bag her without using the mask
The correct answer is "c" Use the lower lip placement technique.
It can be very difficult to get a good seal with bag-mask (ambu bag) ventilation in edentulous patients. Various techniques have been proposed in the past to attempt to improve ventilation. Recently, Racine, et al. (2010) found that by placing the lower part of the face mask on the alveolar ridge (the little cleft between the lower lip and the chin) that anesthesiologists were able to deliver larger and more consistent volumes by bag-valve mask compared to other methods.
There is a significant aspiration risk to reinserting dentures, because they can be displaced by the pressure on the face by the mask and be forced into the airway by manual ventilation. Placing the ambu bag just over the nose would allow air to escape from the mouth and decrease ventilatory volume, and the bag would be ineffective without a mask.
If you are having trouble getting a seal with your ambu bag on a patient who is missing teeth, simply slide the top part of the mask up on the nose until the bottom part of the mask is between the lower lip and the chin for better ventilation.
From: Racine, S.X., et al. (2010). Face mask ventilation in edentulous patients: A comparison of mandibular groove and lower lip placement. Anesthesiology, 112, 1190.
Congratulations to Nancy Gayer who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Nancy!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
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