Q&A: Using Hyperbaric Oxygen Therapy as an Advanced Wound-Care Modality
The following Q&A is taken from Chapter 26, “Hyperbaric Oxygen Therapy” (by Yvette Ponce- Hall, CHT; E. Patricia Rios, RN, MSN, CHRN-C; and Jayesh B. Shah, MD) in the Wound Care Certification Study Guide, 2nd edition (Jayesh B. Shah, MD; Paul J. Sheffield, MD; and Caroline E. Fife, MD, editors). This chapter discusses the use of hyperbaric oxygen therapy (HBOT) as an advanced wound-care modality for specific wound types. Readers should be able to describe how HBOT works, identify approved indications or contraindications to therapy, recognize any potential side effects from receiving therapy, and understand the importance of safety and emergency protocols.
1. A febrile patient is at the greater risk of which of the following while in the chamber?
a.) nitrogen narcosis
b.) oxygen toxicity
2. Which item must be completed prior to the start of a hyperbaric treatment?
a.) hyperbaric risk assessment
b.) patient orientation and instruction
c.) physician orders, which specify hyperbaric treatment protocol
d.) all of the above
3. When it comes to fire safety, which of the following is always the main priority?
a.) patient diagnosis
b.) hyperbaric risk assessment
d.) Navy diving protocols
4. In the case of a seizure in the chamber, the chamber should be decompressed once the patient is in the tonic phase.
5. A class B chamber is classified as a hyperbaric chamber that is meant for which of the following?
a.) animal use only
b.) multiple human occupancy
c.) single human occupancy
d.) commercial divers
6. When a suspected pneumothorax occurs, the chamber operator should do which of the following?
a.) Stop travel, ascend slowly, notify physician, and assess the patient.
b.) Notify physician and nurse, stop travel, maintain depth until directed to terminate treatment, and ascend slowly under supervising direction.
c.) Stop travel, maintain depth until directed to terminate treatment, notify physician and nurse, and ascend slowly under supervising physician’s direction.
d.) Stop travel, notify physician and nurse, maintain depth until directed to terminate treatment, and ascend slowly under supervising physician’s direction.
7. Which of the following is not a UHMS-accepted hyperbaric oxygen therapy indication?
a.) compromised grafts and flaps
b.) cerebral palsy
c.) osteomyelitis (refractory)
d.) necrotizing soft tissue infections
b) Vital signs should be taken prior to hyperbaric treatment to determine the patient's stability. Patients with a temperature greater than 101°F are greater risk of having a seizure in the hyperbaric chamber. The supervising physician should consider an antipyretic prior to treatment.
d) All of the above apply to an initial start of hyperbaric treatment. Patients should be informed of the risks and benefits of the treatment. An orientation should consist of a description of the environment as well as a clear list of approved and prohibited items in the chamber. Patients should have a basic understanding of how the hyperbaric oxygen treatments assist with accelerated healing. A hyperbaric risk assessment should be completed by the nurse or hyperbaric physician. Any contraindications should be addressed by the hyperbaric physician prior to the start of treatment. Finally, there should be clear and concise physician orders written that specify the indication for treatment, the treatment protocol, and the number of treatments ordered.
c) Prevention is the main priority in fire safety. A safety checklist should be completed prior to the patient's entrance into the chamber. All potentially hazardous items should be prohibited from entering the chamber. If there is ever a doubt about an item, it is best to prohibit it from entering the chamber. Remember, “If in doubt, leave it out.”
b) Never decompress a patient who is in the tonic phase. The chamber operator, under the supervision of the attending physician, must wait until the patient resumes normal breathing and completes the tonic phase of seizure before starting the ascent (decompression) of the chamber. Due to Boyle's law, barotrauma can occur from the increase of volume within the lungs during the decompression of the chamber.
c) A class B chamber is commonly referred to as a monoplace. These chambers are meant for only single human occupancy.
d) In the case of a suspected pneumothorax, the chamber operator should first stop travel. While the chamber pressure idles, the hyperbaric physician and nurse may be notified. The chamber operator must maintain depth until directed by the physician to terminate the treatment. This time could be used to prepare for the removal of the patient. A code team, crash cart, and chest tube cart could be retrieved during this time. Once the physician gives the order, slowly decompress the chamber.
b) Although hyperbaric oxygen studies have been performed on cerebral palsy patients, it is currently not a UHMS-approved indication.
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