PATH Practical selection of neonatal resuscitators

Publication date: 2006

Practical selection of neonatal resuscitators A fi eld guide Updated November 2006 Version 2 1A fi eld guide Neonatal Resuscitators PATH initially evaluated a variety of reusable neonatal resuscitators including both bag and mask and tube and mask designs. Th is updated version of the “Practical selection of neonatal resuscitators: a fi eld guide” off ers additional information about devices that are priced at less than US$30 each. Th is guide presents information about the criteria used during the device evaluation, evaluation results for each device, and suggestions for choosing a resuscitator. Importance of Resuscitation Birth asphyxia refers to the condition when a baby does not breathe at birth. Asphyxia is estimated to account for one-third of the estimated four million neonatal deaths that occur annually. Th is results in over one million neonatal deaths and an unknown number of infants with long-term neurological disability. Reducing birth asphyxia and neonatal death requires appropriate care including a resuscitator available at every birth. Neonatal resuscitators, when properly used, can lower the incidence of mortality associated with neonatal asphyxia. In order to achieve this, resuscitators need to be made available to all birth attendants in conjunction with adequate training. Mechanics of Resuscitation* Newborn resuscitation should begin as soon as asphyxia is identifi ed. Aft er clearing the airway and correctly positioning the newborn’s head and neck, the health worker positions the mask over the mouth and nose and holds it with light pressure to form an * Th is section provides a brief overview of a resuscitation procedure but is not meant to be a substitute for proper instruction. More information can be found from the Neonatal Resuscitation Program– online at http://www.aap.org/nrp/nrpmain.html and from the International Guidelines for Neonatal Resuscitation at http://pediatrics.aappublications.org/cgi/content/full/106/3/e29 [accessed November 8, 2006]. 2 Practical selection of neonatal resuscitators airtight seal. Breaths should then be delivered at a rate of 40–60 breaths per minute. While it may be uncommon to have an in-line manometer (pressure gauge), caregivers should observe the infant’s chest to ensure chest rise with each breath. Typical pressures may exceed 30 H2O for the initial breath and then typically diminish to 15–20 cm H2O. Tidal volumes are small, typically 5–8 ml/kg of newborn weight. How to Choose a Resuscitator 5 Choose desired features. Features on most resuscitator models are similar, but variation exists. Depending on your program, features such as oxygen ports and reservoirs, high-quality packaging, or a compact profi le may be important. 5 Choose bag and mask or tube and mask. Both types of resuscitators can reduce the incidence of neonatal mortality, but each has distinct advantages and disadvantages. 5 Decide between disposable and reusable. Depending on the nature of your program and the rate of neonatal asphyxia, single-use or multiuse resuscitators may be more cost-eff ective. If the environment of use indicates that resuscitators will always be reused, it may be advisable to invest in a multiuse resuscitator to permit correct cleaning and disinfection aft er use. 5 Decide on a price range. Resuscitators are now available from a wide variety of manufacturers and can vary widely in price despite having many of the same features. Resuscitators manufactured in the United States or Europe are oft en higher priced than similar resuscitators manufactured in other countries. Th e resuscitators in this fi eld guide are divided into resuscitators costing under US$30 and over US$30. 3A fi eld guide Important Features for Safe and Proper Resuscitation Properly Sized and Form-Fitting Mask Proper resuscitation depends on a good seal between the resuscitator and the neonate. Resuscitators are equipped with a variety of mask types including air- fi lled anatomically shaped masks or round, one- or two-piece masks (with a silicone fl ange). Resuscitators generally include one mask size, and purchasers will want to purchase an additional mask for each resuscitator (to cover both low and normal-birthweight neonates). Pressure Relief Valve Preventing lung damage is a paramount concern for anyone performing resuscitations. A pressure relief valve is designed to limit the pressure that the resuscitator can deliver. All bag and mask resuscitator models tested had a relief valve except the Blue Cross resuscitator. Note: Many of the models evaluated lacked any indication regarding the position of the valve—enabling the user to disable the relief valve without their knowledge. - Single-use (disposable) resuscitators can be lower priced than similar reusable models. However, single use resuscitators are often manufactured with lower cost materials that cannot be reprocessed and are often sealed to prevent disassembly. Single-use models are not included in this guide. Mult-iuse (reusable) resuscitators are often higher priced than similar disposable models. Reusable resuscitators are typically designed for both disassembly and reprocessing (including autoclaving). Due to the possibility of reuse, the cost per use of mult-iuse resuscitators may be lower than similar single-use resuscitators. Single-Use vs. Mult-iuse Resuscitators pressure relief valve 4 Practical selection of neonatal resuscitators Minimal Dead Airspace Resuscitators that minimize dead airspace between the neonate’s face and the nonrebreathing valve prevent the neonate from rebreathing expelled air with a higher concentration of CO2. Note: Dead airspace volume was not determined during this evaluation. Designed for Assembly/Disassembly Ridged surfaces on parts that disassemble help identify these parts to the user as well as make the resuscitator easier to disassemble with wet hands. Color coding can help users distinguish diff erent components, and quality design can augment the ease of assembly and disassembly. Critical decision Bag and Mask Pros • Pressure-limiting valve on most models reduces risk of lung rupture. • More familiarity on part of providers. • Wider variety on the market. Cons • Higher cost. • More parts. 5A fi eld guide Properly Sized Bag (bag and mask only) A bag specifi cally designed for providing appropriate tidal volumes for neonates can help reduce errors during use and simplify training. Most bag and mask models had bags that evaluators felt were appropriately sized. Standard Mask Connections Standard-sized connections are important to ensure compatibility with replacement components and masks from other manufacturers. Standard connections are a 15 mm inner diameter and a 22 mm outer diameter mask connector. Similarly, mask stems should have a 15 mm outer diameter or 22 mm inner diameter. Which is right for your program? Tube and Mask Pros • Often lower cost than bag and mask devices. • Users may feel greater control delivering the pressure and monitoring the neonate’s progress. • Fewer parts. Cons • Fatiguing to use. • Users may need additional training and practice to provide proper and consistent resuscitation. • Caregiver cannot give instructions or counseling during resuscitation. 6 Practical selection of neonatal resuscitators Guide to the Device Comparison Tables (pp. 10–27) For each of the devices, the following information is provided in order to assist the reader in making an informed choice when purchasing a neonatal resuscitator. More information about specifi c resuscitators may also be available from the individual manufacturer or distributor. Th e ASTM standard used as the basis for several evaluations is F920-93 Standard Specifi cations for Minimum Performance and Safety Requirements for Resuscitators Intended for Use with Humans. Device Information Th is section provides basic information on model number, supplier, website (to get more information electronically), and cost (as of June 2006). Features That Count Th is section provides information on features that have been identifi ed as particularly important in resuscitator selection. • Mask size: Size of mask(s) included with resuscitator. • Mask type: Type of mask included with resuscitator. • Properly sized bag: Based on user input and international guidelines. • Pressure relief valve/position indication: More information on proper valve operation can be found in the Laboratory Evaluations section (see pg. 7). • Designed for assembly/disassembly: Whether the resuscitator was designed to facilitate assembly and disassembly. • Standard mask connections: Whether the resuscitator has standard mask connections that will permit it to be used with masks from other manufacturers or diff erently sized masks (e.g., normal neonate, low-birthweight neonate). 7A fi eld guide Device Features Th is section provides information on: • Components: Extra components included with the resuscitator. • Features: Additional features of the resuscitator that are not required for basic operation. • Packaging: Description of resuscitator packaging. • Single-use/multiuse: Whether the resuscitator is designated by the manufacturer for single or multiple uses. Laboratory Evaluations Th is section provides information from laboratory testing on: • Pressure-limiting valve: Th e pressure recorded at the patient connection port when air at a fl ow rate of 15 L/min was passed through the resuscitator (per ASTM standards). Th is test evaluates the proper function of the pressure-limiting valve in relation to the manufacturer’s designation. • Cleaning–eff ectiveness: Evaluated by introducing blood into the device via the face mask, allowing the resuscitator to dry for one hour, and cleaning the resuscitator in a detergent solution using a soft -bristled brush. Score is based on the amount of blood remaining on the device aft er one minute of cleaning. • Disinfection–device durability: Disassembled resuscitators were submerged in a 0.5% chlorine solution for 48 hours and evaluated for damage. No microbiological evaluation was conducted to determine the degree of disinfection. • Instructions–completeness: Instructions included with the resuscitators were evaluated for completeness based on complete and correct information, accompanying diagrams, technical information, and reuse instructions. 8 Practical selection of neonatal resuscitators • Instructions–ease of reading: Instructions were evaluated using a Flesch Reading Ease score, a method based on the length of words and sentences. Flesch scores are assigned a grade level as follows: Very diffi cult–post graduate; Diffi cult– college; fairly diffi cult–high school; Standard–8th to 9th grade; Fairly easy–7th grade; Easy–5th to 6th grade; Very easy–4th to 5th grade. Usability • Ease of use/comfort: Describes the ability of the user to intuitively adopt correct and consistent use of the resuscitator. • Disassembly/reassembly: Describes the ease and completeness of disassembly and reassembly by users without written instructions. • Device ergonomics: Describes an ergonomic analysis of the resuscitators as performed by the evaluation team. Th is includes size of device in relation to hand size, features to improve comfort or usability, and interaction of users with the device. 9A fi eld guide Devices Under US$30 10 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number IR-01 Supplier Anand Medicaids Private Limited 33/16, Punjabi Bagh New Delhi, 110 026 INDIA Tel: 91-11-42464264/ 25225225 Fax: 91-11-25225062 sales@anandind.com Website www.anandind.com Cost (as purchased) US$18.00 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Note: cannot lock down Packaging Zippered bag with clear panel Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 54 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness No instructions Instructions—ease of reading No instructions U sa b ili ty Ease of use/comfort o Dissassembly/reassembly o Device ergonomics o Anand Medicaids Priv. Lim. Silicone Infant Resuscitator n � o � p � q � r Very good Good OK Fair Poor 11A fi eld guide D ev ic e In fo rm at io n Model Number RG401-S2 Supplier Apothecaries Sundries Mfg. Co. ASCO House, I-30(a) Kirti Nagar, New Delhi 110 015 INDIA Tel: 91-11-25410008/ 25420779 Fax: 91-11-25410007 Tel USA: (718) 713-8038 info@asco.in Website www.ascoindia.com Cost (as purchased) US$22.00 Fe at u re s Th at C o u n t Mask size Normal birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Note: cannot lock down Packaging Zippered bag with clear panel Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 40 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness No instructions Instructions—ease of reading No instructions U sa b ili ty Ease of use/comfort o Dissassembly/reassembly o Device ergonomics p Note: larger bag may be diffi cult for small- handed users Apothecaries Sundries Mfg. Co. Artifi cial Resuscitator Silicone n � o � p � q � r Very good Good OK Fair Poor 12 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number BE-1303 Supplier Besmed Health Business Corp. No. 2, Lane 106, Wu-Kong 3rd Road Wu-Ku Industrial Park, Taipei Taiwan, Republic of China Tel: 886-2-2290-3959 Fax: 886-2-2299-9076 info@besmed.com Website www.besmed.com Cost (as purchased) US$27.70 Plastic box available for US$3.80 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate (0) Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Note: cannot lock down Packaging Plastic bag Optional plastic box Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 24 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness p No instructions specifi c to neonate Instructions—ease of reading Very diffi cult U sa b ili ty Ease of use/comfort n Dissassembly/reassembly o Device ergonomics o Besmed Health Business Corp. Silicone Infant Resuscitator n � o � p � q � r Very good Good OK Fair Poor 13A fi eld guide D ev ic e In fo rm at io n Model Number ENT-1014 Supplier Enter Medical Corporation No. 16-1, Lane 564, Wen Hua San Road Gui Shan Xiang, Tao Yuan Hsien Taiwan, Republic of China Tel: 886-33283653/ 33975247 Fax: 886-33285723 shine.ball@msa.hinet.net Website www.shineball.com.tw Cost (as purchased) US$15.00 Fe at u re s Th at C o u n t Mask size Normal birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag Features Pressure-limiting valve Note: cannot lock down Packaging Plastic resealable bag Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 41 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness No instructions Instructions—ease of reading No instructions U sa b ili ty Ease of use/comfort o Dissassembly/reassembly o Device ergonomics o Enter Medical Corporation Silicone Rsuscitator n � o � p � q � r Very good Good OK Fair Poor 14 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number #AN108 Supplier Global Products Corporation (GPC) Medical G3 Vikas Puri New Delhi 110018 INDIA Tel: 91-11-28541648/ 25841244 Fax: 91-11-28546244 info@gpc-medical.com Website www.gpc-medical.com Cost (as purchased) US$12.40 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Packaging Zippered bag with clear panel Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 43 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness No instructions Instructions—ease of reading No instructions U sa b ili ty Ease of use/comfort n Dissassembly/reassembly o Device ergonomics n Global Products Corporation (GPC) Medical Silicone Resuscitator n � o � p � q � r Very good Good OK Fair Poor 15A fi eld guide D ev ic e In fo rm at io n Model Number 70-555-03 Supplier Hospital Equipment Manufacturing Company 26, Deepak Building 13, Nehru Place New Delhi 110019 INDIA Tel: 91-11-26420769/ 26476106 Fax: 91-11-26221441/ 26212026 hospital@del2.vsnl.net.in Website www.hemcindia.com Cost (as purchased) US$14.00 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Packaging Zippered bag with clear panel Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 42 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness No instructions Instructions—ease of reading No instructions U sa b ili ty Ease of use/comfort n Dissassembly/reassembly o Device ergonomics n Hospital Equipment Manufacturing Co. Silicone Resuscitator n � o � p � q � r Very good Good OK Fair Poor 16 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number Silicone resuscitator Supplier Kay and Company 25, Netaji Subhash Marg New Delhi 110002 INDIA Tel: 91-11-23263859 Fax: 91-11-23282678 sales@kaycoindia.com Website www.kaycoindia.com Cost (as purchased) US$21.00 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / Yes Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Packaging Zippered bag with clear panel plus separate red drawstring bag Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 25 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness r (brief and incomplete) Instructions—ease of reading Easy U sa b ili ty Ease of use/comfort n Dissassembly/reassembly o Device ergonomics n Kay and Company Silicone Resuscitator n � o � p � q � r Very good Good OK Fair Poor 17A fi eld guide D ev ic e In fo rm at io n Model Number 820050 Paediatric Pocket Mask Supplier Laerdal Medical Limited Laerdal House Goodmead Road Orpington, Kent, BR6 0HX Tel: 01689 876634 Fax: 01689 873800 customer.service@laerdal. co.uk Website www.laerdal.co.uk Cost (as purchased) US$14.60 Fe at u re s Th at C o u n t Mask size Infant / Child Mask type Round one-piece silicone Properly sized bag N/A Pressure relief valve/position indication No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Nitrile gloves; antimicrobial hand wipe Features N/A Packaging Zippered nylon bag Single-use/multiuse Labeled as single-use La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) N/A Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness o Instructions—ease of reading Fairly Easy U sa b ili ty Ease of use/comfort q Dissassembly/reassembly n Device ergonomics q N o te ***This resuscitator was evaluated in 2003 under a different but similar protocol to the other resuscitators included in this guide.*** One-way valve can be purchased separately for use with other masks appropriately sized for neonates for US$5.95. Laerdal Paediatric Pocket Mask n � o � p � q � r Very good Good OK Fair Poor 18 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number HF-I Supplier Ningbo David Medical Device Co. Ltd #11 722 Lane Sangtian Rd. Ningbo, Republic of China Tel: 0086-574-87800009 Fax: 0086-574-87801111 guojibu@nbip.net Website www.chinadavid.cn Cost (as purchased) US$26.00 Fe at u re s Th at C o u n t Mask size Normal and low- birthweight neonate Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Packaging None Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 40 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness p No use instructions Instructions—ease of reading Very diffi cult U sa b ili ty Ease of use/comfort n Dissassembly/reassembly o Device ergonomics o Requires fi rm pressure on mask Ningbo David Medical Device Co. Ltd Neonate Silicone Resuscitation Bag n � o � p � q � r Very good Good OK Fair Poor 19A fi eld guide D ev ic e In fo rm at io n Model Number SW72302B Supplier Shinmed (Shining World Health Care Co., Ltd.) 6F, No. 8, Lane 7, Wu-Chun Road, Wu-Ku Industrial Park Taipei County, 248 Taiwan, Republic of China Tel:886-2-22900966 Fax: 886-2-22903966 shinmed20@shinmed.com Website www.shinmed.com.tw Cost (as purchased) US$30.00 Fe at u re s Th at C o u n t Mask size Normal and low-birthweight neonate (0 & 1) Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / Yes Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Packaging Plastic box Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 40 cm H 2 O Cleaning—effectiveness n Disinfection—device durability o Spring rusted during disinfection Instructions—completeness p No instructions specifi c to neonate Instructions—ease of reading Fairly diffi cult U sa b ili ty Ease of use/comfort p Stiff bag Dissassembly/reassembly o Device ergonomics n Shinmed Silicone Resuscitator n � o � p � q � r Very good Good OK Fair Poor 20 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number Topster SR-003 Supplier Sturdy Industrial Co., Ltd. No. 168, Sec. 1, Jungshing Rd. Wugu Township, Taipei Country, 248 Taiwan, Republic of China PO Box 1-027 Wugu, Taiwan, Republic of China Tel: 886-2-29837622 Fax: 886-2-29848208 foreign@sturdy.com.tw Website www.sturdy.com.tw Cost (as purchased) US$13.50 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate (0) Mask type One-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / Yes Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector; 40-, 50-, 60-mm airways Features Pressure-limiting valve Packaging Cardboard box Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 39 cm H 2 O Cleaning—effectiveness n Disinfection—device durability o Spring rusted during disinfection Instructions—completeness o Instructions—ease of reading Fairly diffi cult U sa b ili ty Ease of use/comfort o Stiffer bag Dissassembly/reassembly o Device ergonomics n Sturdy Industrial Co., Ltd. Topster Silicone Reuscitator n � o � p � q � r Very good Good OK Fair Poor 21A fi eld guide D ev ic e In fo rm at io n Model Number N/A Supplier F2H (Frontiers For Health) Jl. Cilaki 35 Bandung 40114 INDONESIA 62-22-7273125 Contact: Mrs. Atte Triyanti (Product Division) Website N/A Cost (as purchased) US$9.00 Fe at u re s Th at C o u n t Mask size Normal birthweight neonate Mask type Round two-piece mask with silicone face piece Properly sized bag N/A Pressure relief valve/position indication No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components No additional components Features N/A Packaging Sealable plastic bag Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) N/A Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness Instructions in Indonesian; line drawings; training information Instructions—ease of reading Not evaluated due to language U sa b ili ty Ease of use/comfort p Dissassembly/reassembly o Device ergonomics p Tekno n � o � p � q � r Very good Good OK Fair Poor 22 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number BlowSafe Mouth to Mask Supplier Zeal Medical 4/19-A, Piramal Nagar Indl.Est, SV Road, Goregaon(W) Mumbai 400062 INDIA Tel: 022-28760274 Fax: 022-28761905 zealmedi@bom3.vsnl.net.in Website www.zealmedical.com Cost (as purchased) US$15.00 Fe at u re s Th at C o u n t Mask size Normal birthweight neonate (0/1) Mask type Round one-piece silicone Properly sized bag N/A Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components No additional components Features Pressure-limiting valve Note: cannot lock down Packaging Zippered bag Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 20 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness No instructions Instructions—ease of reading No instructions U sa b ili ty Ease of use/comfort p Dissassembly/reassembly o Device ergonomics p Zeal Medical BlowSafe Mouth to Mask Resuscitator n � o � p � q � r Very good Good OK Fair Poor 23A fi eld guide Devices Over US$30 24 Practical selection of neonatal resuscitators n � o � p � q � r Very good Good OK Fair Poor D ev ic e In fo rm at io n Model Number #4525 Supplier BLS Systems Limited 1108 South Service Road West Oakville, Ontario L6L 5T7 CANADA 905-339-1069 Website www.blssystemsltd.com Cost (as purchased) US$45.00 Fe at u re s Th at C o u n t Mask size Low-birthweight neonate (0) Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / No Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag; oxygen tubing connector Features Pressure-limiting valve Packaging Plastic drawstring bag Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 36 cm H 2 O Cleaning—effectiveness n Disinfection—device durability n Instructions—completeness o (not specifi c for infant resuscitation) Instructions—ease of reading Diffi cult U sa b ili ty Ease of use/comfort o Dissassembly/reassembly o Device ergonomics o BLS Systems Rescuer Silicone BVM Resuscitator 25A fi eld guide n � o � p � q � r Very good Good OK Fair Poor D ev ic e In fo rm at io n Model Number 860056 Supplier Laerdal 167 Myers Corners Rd Wappingers Falls, NY 12590-8840 UNITED STATES 800-431-1055 Website www.laerdal.com Cost (as purchased) US$195.00 Fe at u re s Th at C o u n t Mask size Normal birthweight neonate (0/1) Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / Cannot disable Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Oxygen reservoir bag Features Pressure-limiting valve Packaging Plastic resealable bag inside cardboard box Single-use/multiuse Multiuse La b o ra to ry Ev al u at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 32 cm H 2 O Cleaning—effectiveness p Disinfection—device durability n Instructions—completeness n Instructions—ease of reading Diffi cult U sa b ili ty Ease of use/comfort p Dissassembly/reassembly p Device ergonomics p Laerdal Silicone 26 Practical selection of neonatal resuscitators D ev ic e In fo rm at io n Model Number CH436-51.5000.00.100 Supplier P.J. Dahlhausen & Co. Emil-Hoffmann-Str. 53 50996 Koln GERMANY 49-2236-39-130 Website www.dahlhausen.de Cost (as purchased) US$122.55 Fe at u re s Th at C o u n t Mask size Normal and low-birthweight neonate included Mask type Round one-piece silicone Properly sized bag Yes Pressure relief valve/position indication Yes / Cannot disable Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components None included Features Pressure-limiting valve Packaging Disposable bag inside cardboard box Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) 23 cm H 2 O Cleaning—effectiveness o Disinfection—device durability n Instructions—completeness n (in English and German) Instructions—ease of reading Fairly diffi cult U sa b ili ty Ease of use/comfort p Dissassembly/reassembly p Device ergonomics o P.J. Dahlhausen n � o � p � q � r Very good Good OK Fair Poor 27A fi eld guide D ev ic e In fo rm at io n Model Number IBW-01 Supplier Blue Cross Emergency Co. 3-12-9, Hongo, Bunkyo-ku Tokyo 131-0033, JAPAN 81-03-3815-2220 Website www.bluecross-e.co.jp/ Cost (as purchased) US$95.99 Fe at u re s Th at C o u n t Mask size Normal birthweight neonate Mask type Round two-piece Clear hard plastic top Opaque silicone face seal Properly sized bag Yes Pressure relief valve/position indication No / N/A Designed for assembly/ disassembly Yes Standard mask connections Yes D ev ic e Fe at u re s Components Open-end oxygen reservoir Features Packaging Plastic resealable bag inside cardboard box Single-use/multiuse Multiuse La b o ra to ry E va lu at io n s Pressure-limiting valve (@ 15 L/min air fl ow) N/A Cleaning—effectiveness p Disinfection—device durability p Instructions—completeness o (indicates that 50 cm H 2 O pressure should be generated) Instructions—ease of reading Standard U sa b ili ty Ease of use/comfort p Dissassembly/reassembly p Device ergonomics p Blue Cross n � o � p � q � r Very good Good OK Fair Poor 28 Practical selection of neonatal resuscitators Notes 29A fi eld guide Notes This research was made possible in part by the generous support of the American people through the US Agency for International Development under the HealthTech program managed by PATH under Cooperative Agreement #GPH-A-00-01-00005-00. The opinions expressed herein are those of the authors and do not necessarily refl ect the views of the US Agency for International Development. Copyright © 2006, Program for Appropriate Technology in Health (PATH). All rights reserved. The material in this document may be freely used for educational or noncommercial purposes, provided that the material is accompanied by an acknowledgement line. The mention of specifi c companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by PATH or the US Agency for International Development in preference to others of a similar nature that are not mentioned.

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