Persevere into Problem Solving: Using an Ambu Bag

Someone once told me that having a child will be your greatest reward and greatest challenge. It made sense when I had my first child, but it brought a whole new meaning when my second child came around. Cole was born with a significant number of abnormalities from head to toe, internally and externally. The most severe complication, which led him to getting a tracheostomy at two days old, is his extremely small airway. At birth, Cole was not breathing so he required mechanical ventilation through an endotracheal tube, which is also called intubation. This is where a plastic tube is inserted through the nose or mouth into the windpipe and oxygen is blown in and out of the lungs under pressure.

We have created a resume on Cole so that we can explain to doctors, hospitals, and schools about him and all of his needs. I could definitely write a book. However, for this article I would like to specifically focus on one particular part that my husband and I had to learn the hard way in hopes that this article is able to help someone else. While in the hospital you are trained on your child’s tracheostomy care, feeding tube care, kidney care, and so forth, not much time is spent on resuscitating your child in our experience.

Learning to Bag with an Ambu Bag

A short time after bringing Cole home after he spent 254 days in the NICU, the ventilator was not enough support. We found ourselves hooking the Ambu bag to the end of his tracheostomy and manually resuscitating to provide positive pressure ventilation since he wasn’t breathing. This is commonly known as “bagging.”

This would be the first time of more times than I would like to admit over the last almost five years. It was extremely scary at first, but now it’s become more of a daily occurrence, and we tend to remain very calm when bagging my son. We have even taught my seven-year-old daughter to do this in an emergency, and my son knows to use ASL to sign “bag me” when it’s needed. My son is nonverbal, deaf, and unable to make any noise due to subglottic stenosis of his upper airway, which simply means his upper airway is so small that air cannot pass through his vocal cords to make noise.

You might be wondering why Cole ever needs to be bagged, and I’m not confident I can tell you every reason. What I can share is Cole is going to be five years old next month and he is still in a neonatal 3.5 tracheostomy since his airway is too small for any larger size. Therefore, the smallest amount of thick secretions can cause a blockage in his airway. In addition, Cole also has tracheomalacia and bronchomalacia, which is the medical jargon for a collapsing and floppy airway. When Cole coughs a handful of times, it’s almost definite that he will require a few breaths from the Ambu bag to allow him to catch his breath and open up his airway. In addition, if he is under the weather, the bagging becomes much more frequent, sometimes for hours a day.

How to Use an Ambu Bag

When the Ambu bag is hooked up to the tracheostomy, the simple procedure is to squeeze the bag on count 1, then count 2 and 3 without bagging and squeeze on 1 again. It’s a constant 1, 2, 3 squeeze until his color comes back and he begins breathing on his own again. Sometimes this occurs for just a couple breaths and other times it’s needed for much longer. For kids without a trach, it is also possible to bag in the same manner using a mask hooked up to the Ambu bag.

As Cole continues to get older and better at ASL, he has learned to sign “all done with bagging.” This is extremely helpful, and I encourage kids who are nonverbal to learn sign language, because this has been a lifesaver both medically and behaviorally, especially in preventing temper tantrums and frustrations. Temper tantrums also result in bagging, because when Cole is upset and cries, his airway also collapses.

Most people will spend an entire life never needing to resuscitate someone in an emergency. My hope is that someone reading this article can benefit and understand what bagging means and how to bag effectively to help their child who is medically complex or perhaps someone else’s.

Wendy Kubista is a working mother with a demanding job and two beautiful children, one who happens to be medically fragile and require 24/7 specialized care. Like any other working mom, there are times she feels like there are simply not enough hours in a day. Fortunately, she has a wonderful husband/partner who is an unbelievable chef, extremely handy, a true problem solver, and the most incredible father. It’s one thing to be a working mom, which requires a constant juggle between family, work, home, but when a child who is medically fragile child — who has needed to be resuscitated hundreds of times in his little four years of life — is added to the mix, the juggle becomes that much more real and stressful. Her family has taken the stance that instead of complaining over circumstances, they will persevere into problem solving. The positive outlook enables them to live life to the fullest, travel often, and be grateful for what they do have and not focus on what they don’t.