Equipment guidelines: Pearls and pitfalls

Published on 10/02/2015 by admin

Filed under Emergency Medicine

Last modified 22/04/2025

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8 Equipment guidelines

Pearls and pitfalls

This section is intended to assist you by providing practical tips that are usually only learnt by experience. For all the disposable and reusable equipment, advice is given based on a combination of evidence, best practice, familiarity and availability of possible alternative options.

Resuscitation equipment

Bag–valve resuscitator

The bag–valve resuscitator must be tested before use. This can be done in the following easy steps:

The infant bag–valve resuscitator should be used on children less than 10 kg. The paediatric bag–valve resuscitator can be used on patients weighing 10–39 kg. The adult bag can be used on patients weighing more than 40 kg. The adult bag can be used on patients weighing less than 40 kg – during ventilation the bag–valve resuscitator should be compressed only with the force required to obtain adequate chest rise.

The oxygen flow rate should be sufficient to ensure that the reservoir bag does not fully collapse at any stage through the respiratory cycle. This flow rate will vary depending on whether an infant, paediatric or adult bag is used. The pop-off valve is designed to prevent pressures in excess of 35–45 cm H2O from being transmitted to the child’s lungs. Certain circumstances may require the pop-off valve to be disabled or locked, such as the ventilation of an asthmatic child with bronchospasm. The high airway pressures will trigger the pop-off valve without allowing adequate ventilation.

Oxygen flow is limited by the duckbill/fishmouth valve at the patient-connection end of the bag–valve resuscitator. It also increases the patient’s work of breathing in spontaneously breathing patients. Hence the healthcare provider must compress the self-inflating portion of the bag–valve resuscitator in time with the patient’s respiratory effort in order to deliver a sufficient flow-rate of oxygen to the child.

The head and neck of the child should be placed in a neutral ‘sniffing’ position. Hyperextension should be avoided as this can compromise the airway. The proportionately larger head in neonates and infants can lead to flexion of the neck. This can be overcome by placing some padding/linen underneath the shoulders of the infant to lift up the body relative to the head, and to decrease lower cervical spine flexion. The pre-school child (between 1 and 6 years of age) is well-positioned with their head flat. The child over 6 should be positioned with the usual padding/linen under the occiput to achieve the ‘sniffing’ position.

Normal vital signs

With reference to the Charts in Chapter 5.

Initial ventilator settings

The paediatric resuscitation room

The amount of equipment required in order to perform a full resuscitation on a paediatric patient is extensive. Instead of rushing to try and search for each weight-dependent component, it is much easier to pre-pack all the equipment for each weight group in its own box. There can be one box of reusable equipment and another for the disposable equipment for each weight group. Each weight group box should have an inventory which is checked along with the rest of the resuscitation equipment at each change of shift and should be replenished after use.

The box with reusable equipment should have the following contents:

A typical weight group box will have the following disposable equipment:

Adequate preparation prior to necessity is the key to any resuscitation but in paediatrics is pivotal. Just familiarizing yourself with the equipment and its use, as well as having this reference text for the drug dosing, will help in mitigating your fear associated with resuscitating children.