Question 1

Is the ButterflyBVM™ FDA cleared?

Accepted Answer

Yes

Question 2

How do I set tidal volume?

Accepted Answer

Hold the device so that you can clearly see the indicator arrows from a top-down view (see below).

Then squeeze and hold the bellows compressed.

Rotate the tidal volume dial to the desired setting.

Release the bellows (see below).

Question 3

Am I required to stay on a given tidal volume setting for a given patient?

Accepted Answer

No. If you feel you need more (or less) volume, you should adjust your tidal volume up (or down) as needed.

Question 4

I’m trying to hit the max volume indicated on the Large Adult setting, but I’m not reaching it. What should I do?

Accepted Answer

To hit the max volume indicated on the tidal volume dial for any of the adult settings (Small, Medium, or Large), you should first eliminate pressure relief by turning the PIP dial to “Override,” and then you may need to compress the device with a two-handed squeeze.

Question 5

May I use the ButterflyBVM™ more than once?

Accepted Answer

No, a ButterflyBVM™ unit should only be used one time on a given patient and then discarded.

Question 6

Can I leave the ButterflyBVM™ compressed for storage or transport?

Accepted Answer

No. The ButterflyBVM™ may lose its ability to open if left compress for extended periods of time. Never leave it in a compressed state including for storage or transport.

Question 7

What is the shelf life of the ButterflyBVM™?

Accepted Answer

Three years from the date of manufacture.

Question 8

May the ButterflyBVM™ be used on any size of patient?

Accepted Answer

In the pre-hospital (ambulance) setting, the ButterflyBVM™ may be used on any size of patient.

In the hospital setting, the ButterflyBVM™ may be used on any size of patient except for neonates (defined as patients under 28 days of life).

Question 9

What if I am not getting chest rise?

Accepted Answer

Remember the acronym M – V – P

Mask – first, troubleshoot your mask seal

Volume – then if you still don’t have chest rise, go up one or two settings on your tidal volume

Pressure – if you still aren’t getting adequate chest rise, you can then go up on your peak inspiratory pressure by turning the dial to a higher setting.

Remember if you later intubate the patient, you should consider going back down on the device’s tidal volume and peak pressure settings.

Question 10

Why does the ButterflyBVM™ have a PEEP dial on top?

Accepted Answer

It doesn’t. The dial on top is a Peak Inspiratory Pressure (PIP) dial. It controls the maximum amount of pressure a patient’s lungs will experience during compression of the BVM. PEEP is pressure left in a patient's lungs at the end of exhalation when the BVM is released. They are controlled in different ways with the ButterflyBVM™. The following charts may help:

Question 11

What setting should I put the PIP dial on?

Accepted Answer

When in doubt, it is advisable to leave the PIP dial on its factory setting of 40cmH2O.

However, there may be clinical scenarios where other pressures could be helpful for a patient. For example, the Neonatal Resuscitation Program recommends a starting peak inspiratory pressure of 20-25cmH2O when caring for neonates. By contrast, when caring for extra-large adults, inspiratory pressures of 60cmH2O or higher may be needed to achieve adequate ventilation.

Question 12

Is the rate control feature too slow?

Accepted Answer

According to the American Heart Association and European Resuscitation Council, the standard recommended respiratory rate for most adult patients during a resuscitation is 10 breaths per minute. The ButterflyBVM™ has been tuned to be able to give a maximum of up to 16 breaths per minute while on the large adult setting, up to 21 BPM on the medium adult setting, and up to 26 BPM on the small adult setting all while compressing with just a single hand. Pediatric rates on the device are even faster than this. If you needed to deliver breaths even more rapidly than these rates, this can be done with the ButterflyBVM by using two hands to pull the arms of the device apart between breaths. Doing this will enable a rate of over 30 BPM on the large adult setting with even faster rates achieved on smaller patient settings. However, this option should only be considered in rare circumstances, such as when caring for a patient in acidosis.

Thus, the ButterflyBVM™ will discourage a user from delivering breaths at a dramatically elevated rate while allowing for strategic hyperventilation in select patients when needed.

Users should always personally monitor the rate at which they deliver breaths to patients when using the ButterflyBVM™ and not simply squeeze when the device has reopened.

Question 13

Does the ButterflyBVM™ fit typical BVM accessories?

Accepted Answer

Yes. The patient connection of the ButterflyBVM™ fits standard masks (adult, pediatric, infant, and neonatal), LMAs, ETTs, ET-CO2 samplers, CPAP devices, and more.

The exhalation port of the ButterflyBVM™ will fit common (30mm) filters and PEEP valves.

Question 14

How do I attach a PEEP valve?

Accepted Answer

Typical (30mm) PEEP valves can be attached to the transparent 30mm exhalation port located on the side of the device.

Question 15

When should I use a PEEP valve?

Accepted Answer

Use PEEP when it is indicated for the patient as determined by local and national guidelines.

Question 16

At what rate should I add oxygen?

Accepted Answer

The maximum recommended rate for supplemental oxygen is 15 liters per minute (LPM).

At 15 LPM of pure oxygen introduced to the device, you can expect to deliver a minimum Fraction of Inspired Oxygen (FiO2) of approximately 90% or higher to your patient.

Question 17

Is the ButterflyBVM™ stable in extreme cold / hot temperatures?

Accepted Answer

The ButterflyBVM™ has been tested at the extreme temperatures for storage and usage expected by the International Organization for Standardization (ISO).

Storage: -40°C to 60°C (-40°F to 140°F)

Operating: -18°C to 50°C (0°F to 122°F)

Question 18

Is the ButterflyBVM™ made in America?

Accepted Answer

All custom components of the ButterflyBVM™ are made in Indiana and New Jersey (USA)

The ButterflyBVM™ is assembled in Indiana (USA)

Question 19

Is the ButterflyBVM™ robust?

Accepted Answer

Yes.

The ButterflyBVM™ underwent the same rigorous drop and temperature testing required of all BVMs.

Check out this video for a demonstration.

Question 20

Is the ButterflyBVM™ intended for lay-person use?

Accepted Answer

No, the ButterflyBVM™ is only intended for use by trained medical professionals.

Question 21

Can I use the ButterflyBVM™ to give “blow-by” oxygen?

Accepted Answer

No. To prevent inadequate oxygenation. Do not use the ButterflyBVM™ for administering free-flow oxygen (“blow-by oxygen”) or use on a patient’s face without squeezing.

Question 22

How was the ButterflyBVM™ tested? Is it accurate?

Accepted Answer

The ButterflyBVM™ was developed with American and Swiss engineering. Tidal volume settings were established through testing on a calibrated, high-precision Michigan Instruments AI3 dual-lung system. Additional testing, including peak inspiratory pressure and oxygen blend, was performed on the same system and on an IMT Analytics Citrex H4 with SmartLung Adult.

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