The Ultimate Ambu Bag FAQ

Questions and Answers about Bag Valve Masks

Most of us have watched enough TV to know that a clear rubber bag is often put to use helping a medical emergency victim breathe. It seems to be a matter of course to hear, “Bag ‘em and get ‘em to the hospital, stat!” on a favorite cop or medical show. Many of us have no idea, though, what that handy breather is called and exactly how it works, let alone its true purpose, proper use, care, history, etc.

Lots of questions arise about this important medical device. Here is a list of frequently asked questions and answers about the Ambu bag:

What is an “Ambu bag”?

An Ambu bag is a medical tool used to force air into the lungs of patients who:  

1. are not breathing; or
2. are not breathing adequately so still need assistance

What does Ambu stand for?

The term “Ambu bag” comes from the acronym for “artificial manual breathing unit” and is used to refer to bag valve masks. The company that invented the Ambu bag was originally called Testa Laboratory and rebranded as Ambu in the 1980s.

Are there other names for the Ambu bag?

The descriptive medical term for an Ambu bag is manual resuscitator or self-inflating bag—most specifically, bag valve mask, or BVM. Ambu bag has become interchangeable with the generic term “bag valve mask,” like Kleenex is a common generic term for a tissue, or Band-Aid is for a small bandage.

What is a manual resuscitator (Ambu bag) and what does it do?

A manual resuscitator, or bag valve mask, is a medical tool used to force air into the lungs of patients who:

1. are not breathing; or
2. are not breathing adequately so still need assistance

How does an Ambu bag work?

With the mask pressed over the patient’s airway, air is forced into the lungs by squeezing the bag. The bag then refills itself with air when released, allowing it to return to its original shape. The bag can be squeezed out and re-inflated rapidly and repeatedly to resuscitate the patient and provide oxygen, even if the patient can’t breathe on their own.

How do you know when to use an Ambu bag to “bag” a patient?

When a patient is not breathing or needs assistance to breathe fully, the Ambu bag is used in place of mouth-to-mouth resuscitation. This might happen in situations such as drowning, cardiac arrest, or a drug overdose. Its use requires training, typically to make sure the patient is getting enough oxygen when it is being used.

Other problems which may result in further injury or even death can occur when using the resuscitator, such as damage to the throat, forcing of air into the stomach, etc. While it may look simple to squeeze the bag and help someone breathe, recognizing when and how to use an Ambu bag is actually highly technical and complicated. It should not be attempted by anyone who isn’t fully trained. This training is only provided to first responders and medical professionals.

How does a trained responder actually use an Ambu bag (bag valve mask)?

1. Connect the bag (or oxygen reservoir, if included), mask and oxygen tube to the BVM.
2. If possible, use an airway adjunct (also known as a glottal-block or bite-block) to keep the tongue out of the way. Otherwise, the tongue may block the airway and force air into the esophagus or stomach.
3. Position themselves behind the patient, above the patient’s head if the patient is lying on the floor.
4. Position the mask on the patient’s face and hold it in place firmly over the nose and mouth. This may be easier with one person holding the mask in place and another person squeezing the bag.
5. To achieve a good seal, pull the chin up (rather than pushing the forehead down) to keep the airway open.
6. Squeeze the bag until the chest rises, count six seconds between bag squeezes, about 10-12 times per minute on an adult.
7. Avoid squeezing too quickly and over-ventilating the patient.

Note that the mask must seal and the patient’s chest must rise when the bag is squeezed. If this isn’t happening, air isn’t getting into the lungs.

What is an Ambu bag laryngoscope?

This is an instrument for examining the larynx used for various medical purposes:                    

• Examination of the throat, larynx (voice box), and vocal chords.
• Various surgical procedures, such as removing blockage or taking a tissue sample.
• Intubation when performing CPR, to ensure that air being administered to a victim goes into the lungs. This provides effective ventilation and avoids complications from air entering the stomach.

How do you use an Ambu bag on a patient with a trach?

An Ambu bag can be connected directly to the trach tube after first removing the face mask. A demonstration video can be found here: How to do CPR on an Adult who has a Trach Tube

How much oxygen does an Ambu bag deliver?

The amount of oxygen delivered by an Ambu bag varies, depending on:

• The size of the bag (adult, child, or infant)
• Whether the Ambu bag is attached to an oxygen tank
• The size and/or flow setting of the oxygen tank used

How do you use an Ambu bag with oxygen?

Most Ambu bags have a connection port for an oxygen tube which delivers pure oxygen from a cylinder, where the amount of oxygen being supplied can be controlled.

Can you use an Ambu bag without (extra) oxygen?

Yes, an Ambu bag can be used without extra oxygen.

Who can use an Ambu bag?

An Ambu bag should be used only by trained medical personnel, including doctors, nurses, EMTs and paramedics. Serious complications from misuse of a BVM can occur; it must be used properly for sufficient respiration to be provided and to avoid injuries or complications from misdirection of air, etc. Learn more about BVM usage and complications.

How much does an Ambu bag cost?

A single-use disposable BVM (bag valve mask) is available for under $20, while reusable units with oxygen reservoir can reach costs over $300.

Are Ambu bags reusable?

Some Ambu bags can be cleaned (sterilized) and used repeatedly.

Does an Ambu bag expire or wear out?

Some Ambu bags are disposable after one use, others are reusable depending on their manufacture.

How do you clean an Ambu bag after use?

If an Ambu bag is of the reusable type, it must be disassembled and thoroughly cleaned, first of any “gross soiling” through meticulous hand-rinsing, washing, and re-rinsing. Some Ambu bags can be sterilized in an autoclave at 134° C or 272° F.

Otherwise, it must be sterilized through the use of the recommended disinfectant solution. Glutaraldehyde 2% is an appropriately high-level disinfectant; the bag must be immersed in the solution for at least 20 minutes.

Because of the complicated structure of the Ambu bag, it is recommended that disposable models be used in cases where proper cleaning and sterilization protocols and equipment are not in place.

How long does an Ambu bag last?

Life of any Ambu bag depends on its design, what materials it is made from, how it has been cleaned, and in what situations it has been used. Any Ambu bag being reused must be disassembled, thoroughly cleaned and sterilized, then reassembled and tested after each use.

How do you check to see that an Ambu bag is functioning?

There are three quick checks to make sure an Ambu bag is working properly:

1. Squeeze to make sure the BVM self inflates, which indicates the valves are working correctly.
2. Block the patient connection (where the device would enter the patient’s mouth) and attempt to squeeze the bag. The pop-off valve should open.
3. Remove the reservoir and block the patient intake valve. The bag should not inflate.

Watch a video of a simple test sequence for an Ambu bag.

Are there different types of Ambu bags?

Yes, there are different sizes of Ambu bags, different materials used for disposable vs. reusable bags, and different styles depending on the manufacturer.

• Sizes: Adult, child, and infant.
• Materials: The Ambu disposable bag is made of SEBS (Styrene Ethylene Butylene Styrene), a plastic considered safer than PVC. The reusable version is made of silicone rubber, 100% latex free.
• Structure: The Ambu bag was first produced by the Ambu company. The name “Ambu” then became generalized. The true Ambu bag has developed and changed with time as new technology and materials have made improvements possible. There are now various manufacturers, so Ambu bags (BVMs), while all similar in structure, take varied forms.

How do you use an Ambu bag with CPR?

Use an Ambu bag to provide two ventilations for every 30 chest compressions. The Ambu bag can be put in place as the first compressions begin.

What is a “laerdal” Ambu bag?

Laerdal is a maker of Ambu-style bag valve masks, so technically one would refer to a Laerdal bag valve mask. They can be purchased from AED Superstore. You can find a full listing of bag valve masks here.

Who invented the Ambu bag? When?

The Ambu bag was invented in 1953 by German engineer Holger Hesse and his partner, Danish anesthetist Henning Ruben. In 1986, “Ambu” became the name of the company Hesse had started. It began under the name Testa Laboratory in the 1930s, with the invention of a blood hemoglobin test. Many innovations have followed, and the company is still prospering today, with international demand for its emergency resuscitation and medical products.