What to Know About HBO
(Hyperbaric Oxygen Therapy)
Presented by
Catherine Rogers, APN, BC, CWCN, CWS, FACCWS Advanced Practice Nurse/Program Manager
SwedishAmerican Health System Rockford, IL Wound Care and Hyperbaric Clinics
Objectives
Upon completion, the participant will:
z
State at least two conditions for hyperbaric
oxygen treatment,
z
Recall a minimum of 3 safety issues that
must be addressed prior to treatment,
z
Describe what the patient experiences
during each treatment,
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Cite one benefit of HBO for diabetic foot
ulcers.
What is HBO?
z
Hyperbaric oxygen therapy is the
breathing of oxygen molecules under
pressure.
z
What HBO is not: breathing in air or O2 by
nasal cannula or topically applied O2 to an
extremity
A Brief History of HBO
z
Studies as far back at 1660’s
z
Research in the 1960’s—Dr. Boerema
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Research in 1977—Dr’s Hunt and Davis
pioneered studies in hypoxia, hyperoxia
and wound healing
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Best known for treatment of divers
suffering from the bends
How HBO affects the body
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Transport of O2 via the blood by
{Binding to hemoglobin {Dissolved in plasma
z
HBO is able to
{Increase the amount of O2 dissolved in plasma
How HBO affects the body
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Physics that apply to hyperbaric oxygen
{Increases the distance that dissolved oxygencan diffuse in the tissues {Increases PO2 levels
z
Gas laws that apply to hyperbaric oxygen
{BoylesHow HBO affects the body
z
In some indications for HBO therapy there
is tissue/bone
infection-{Oxygen tension is increased and O2 molecules can reach leukocytes
{Produces oxygen radicals which are bactericidal on anaerobic bacteria
z
In some indications for HBO therapy the
patient has a
wound-{Wounds have a zone of hypoxia
{The periwound area is usually malperfused
HBO affects on the body
z
Cellular energy and metabolism
z
Antibacterial effect
z
Regeneration of tissue
HBO affects on the body
z
Cellular energy and metabolism
{Improved local tissue oxygen levels {Improved cell energy use/formation {Decreased local tissue edema {Nitric oxide production
HBO affects on the body
z
Antibacterial effect
{Improved leukocyte-bacterial-killing {Increased effectiveness of antibiotics
HBO affects on the body
z
Regenerating wound tissue effects
{Enhanced uptake of growth factors {Promotion of collagen deposits {Promotes extracellular matrix {Promotes angiogenesis
Use of HBO today
z
Regulation and Reimbursement:
z
UHMS
{Undersea and Hyperbaric Medical Society
z
CMS/LCD
{HBO is a modality in which the entire body is exposed to O2 under increased atmospheric pressure—the patient is in a pressure chamber breathing 100% O2 at greater than one atmosphere pressure.
Use of HBO today
zDecompression illness, gas embolism
zCarbon monoxide or cyanide poisoning
zBlood loss anemia
zAcute thermal burns
zClostridia myonecrosis zPreservation of compromised skin grafts/flaps zCrush injury, compartment syndrome zOsteoradionecrosis
zSoft tissue radionecrosis
zRefractory osteomyelitis
Equipment needed to provide HBO
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Typical clinic examples/set ups
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Monoplace chambers
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Multiplace Chambers
Equipment needed to provide HBO
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Training/education requirements
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Physician role
z
Safety Director
z
Staff role
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Emergency procedures/equipment
Equipment needed to provide HBO
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Examples of monoplace chambers
Equipment needed to provide HBO
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Examples of multiplace chambers
Patient selection for HBO therapy
zIndications for usezContraindications zPre-treatment testing {Ears {Lungs {Arterial tests {Physician exam {Hypoglycemic issues {Prostheses {Claustrophobia issues
Patient selection for HBO therapy
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Indications for use
{CMS approved diagnosis {Acute applications {Chronic applications
{Off-label uses/non covered diagnosis
Patient selection for HBO therapy
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The diagnosis is appropriate, but is the
patient appropriate?
{If indicated, document hypoxia
{Are there any absolute contraindications? {What about relative contraindications?
Patient Selection for HBO therapy
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Documenting tissue hypoxia
{Obtain a baseline TcPo2 test {Normal values > 50mmHg {A low result indicates hypoxia {Test results <40mmHg in non-diabetic
<50mmHg in diabetic patients indicate patient is candidate
Patient selection for HBO therapy
z
Absolute contraindications
{Untreated pneumothorax
{Current administration of chemotherapy or amiodarone
{Administration of bleomycin within the last 12 months
{Pregnancy in non-life threatening conditions {Terminal patients
Patient selection for HBO therapy
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Relative contraindications
{Patient ability to understand and communicate problems
{Risk of middle ear trauma {Risk of pulmonary trauma {Risk of CHF, implanted device {Potential for oxygen toxicity {Other potentials……
Patient selection for HBO therapy
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Any absolute contraindications will
eliminate patient from being a candidate
for HBO therapy
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Any relative contraindication needs to be
investigated and managed if possible
Patient selection for HBO therapy
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Next, the patient goes through an
orientation:
{Teach and demonstrate ability to clear ears {Understand treatment expectations {Signing consent forms
{Assignment of treatment times {Expectations of on-time arrival {Review of safety issues
Safety Issues
zCodes, standards and guidelines specific to HBO {ASME {ASME/PVHO-1 {ASME/PVHO-2 {NFPA 99 {FDA {CGA {UHMS {OSHA
{Fire Safety and Fire/Safety/Disaster Management Plan
Safety Issues
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Prohibits flammable gases and liquids,
vapors, polyester fabrics, lotions, oils, etc
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Postings within the clinic prohibit:
{Personal warming devices {Cell phones and pagers {Sparking toys
{Personal entertainment devices
During an HBO treatment
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What to wear?
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What to do?
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How long will it take?
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How will it feel?
During an HBO treatment
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What to wear?
{Changing rooms
{100% cotton gowns, sheets
{If you weren’t born with it, it doesn’t go into the chamber
{No makeup, hairspray
During an HBO treatment
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What to do?
{Most chambers today have television/DVD options
{Piped in music {Sleep
During an HBO treatment
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How long will it take?
{Treatment plans are developed based on the reason HBO is needed:
zSome treatments may be completed once per day, 5 days a week, 90 minutes at pressure,
zOther treatment plans require twice a day up to 120 minutes at pressure,
zIn general, most often the patient can be in and out in 120 minutes (2 hours).
During an HBO treatment
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How will it feel?
{How do you do in small spaces? {Have you been in a plane? {Have you ever been diving?
The treatment is complete
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Upon leaving the chamber
{Check the ears {Check vitals
{Check the blood sugar
Completion of HBO treatments
zHow do we know when treatments arecompleted?
{Most reimbursement is based on 20 treatments {Baseline TcPo2 tests provide before HBO measure of
hypoxia
{Follow up TcPo2 tests provide evidence of effectiveness of HBO treatments/failure of treatments
{Patient ability to continue tolerating treatments/overall health
{Resolution of infection
{Filling in of wound bed/advancing epithelial tissue {Compliance issues
Case Studies
z
Diabetic Foot Ulcers
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Osteomyelitis
Case Studies
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Others
{Carbon monoxide poisoning {Necrotizing infections {Radiation latent affects {Compromised flaps/grafts
October 2008 ISAPN Conference Rogers: HBO
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