Hyperbaric Therapy

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Need some opinions. I am a HH nurse who has a patient with an open surgical wound to lower back midline. We have been doing VAC therapy for about 6 weeks now and have only seen minimal improvement. I know he has MRSA, for which he's receiving BID Vanc at home. There is actually some bone exposure at the base of the wound. His surgeon and primary MD as well as the staff at the infectious disease clinic he visits weekly have been telling him/us it looks good, just healing slow due to presence of infection. No obvious S/S of infection other than slow healing. Well last week he went to a wound clinic. They were not pleased at all and said in addition to MRSA, he has 2 other organisms (have not yet seen or confirmed which ones) Patient states Friday they want him to do VAC tx for 6 more weeks and then do hyperbaric treatment for 2 hours a day, 5 days a week, for several weeks. I know very little about this tx. Can someone share any experiences or knowledge they have in this area? Thanks so much!

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HBO tx is an excellent adjunct to wound healing. It uses pressure to force oxygen into the tissues to promote bacterial death and wound healing.

There are strict criteria for getting insurance to pay for HBO and also for being able to get tx. Although from what you have written, sounds like your pt qualifies. HBO tx's usually last for a total of 30 tx's and can be extended if tx is helping but still has a ways to go.

Due to the oxygen under pressure, fire (explosion) is a concern. So safety precautions are taken seriously. In the US, there have not been the bad outcomes but other countries have been lax in their safety protocols.

The pt will be given a gown to wear while in the chamber. They are to go in naked except for the gown or cotton scrubs they are given. They must be clean of all deoderant, perfume, lip gloss, makeup etc. as these can spark and risk an explosion. No jewelry, no watches. Internal pacers/ICDs are ok. They will not be able to take anything into the chamber with them (no books) - the less fuel for a potential fire, the better. Usually there is a television that they will be able to watch or they can sleep. Depending on the facility, they may or may not be able to wear glasses.

Wound vac machines cannot go in the chamber. However the wound vac dressing and tubing disconnected from the machine CAN go into the chamber. But each individual facility is different on whether they will or will not allow the vac drsg in. Be prepared for them using a lot of dressing materials if the facility refuses to allow the vac drsg in. You can download the HBO/wound vac guidelines off of KCI's site to send with your pt to show the staff that it is ok to send in the drsg if needed to preserve your pt's supplies. But it will be up to the clinic's safety officer to make the OK for the drsg to go in. It is just important to disconnect the vac immediately before getting in and putting it back on immediately when the chamber door opens afterwards.

If they have a monoplace chamber (which is more common) it is a giant acrylic test tube laid on its side. The pt gets on a stretcher and is slid into the machine. The door is closed and treatment begins. Due to the pressure changes, they will need to pop their ears (like on the airplane). They may feel some discomfort but if it is really bad and they can't get their ears popped, they need to tell the chamber operator. There is an intercom that allows them to talk to the chamber operator. And being clear, they can see out and others can see in freely.

If your pt is clausterphobic, ask for some valium/ativan for him. Generally the wound clinic will not provide this, he'll need to take it before he gets there. Usually it is a strict schedule so he won't have time to sit around and wait for it to work if he takes it at the clinic.

Because of the risk of increasing/decreasing the pressure in the chamber, you can't just get in/out of the chamber quickly. He needs to go to the bathroom and not need to get out before the 2 hour+ time period. Generally they are at depth for two hours and then it's another 1/2 hour or so to take them to "depth" and bring them back up again. Anticipate being there for 3 hours at least every day.

HBO tx lowers blood sugar. If he is diabetic, they will tell him which meds to take or to hold. He will need to make sure and not skip meals before tx's. If his sugar is too low prior to tx and they can't get it up with juice/snack, they will cancel tx for that day.

Don't freak him out by telling him the chamber could explode. Some people stress this and pt's go nuts. There is always a risk but strict safety protocols are adhered to - just stress that all the protocols are for their safety. I've run the chambers and had no adverse outcomes. It is just tedious and boring to sit inside the chamber if you can't find something they like on the tv.

You can look on the HBO forum here and you will find the URLS for the various hyperbaric organizations to do more checking out of things.

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Wow, thanks so much for all of that information and taking the time to write it!! That helps alot! I had heard of the chambers, but that's about it. Now when he starts talking about it, I don't feel quite as lost!

Oh, about the fire thing, I didn't say anything, but then I didn't know alot. But the clinic had already told him that b/c that's mostly what he kept talking about, catching on fire, when I saw him Friday. But he seemed pretty open to the idea and I think with some education will do fine.

Again, thanks so much!!!!!!!!!!!!!!!!!!!!!!!

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Specializes in Med-Surg, Wound Care.

Make sure the insurance reimbursement is investigated. We went through a hyperbaric evaluation for my husband. The insurance assured us that it was an approved facility and would be reimbursed. One week later, luckily prior to starting treatments, we got a $500 bill from the doctor at the facility. Turns out that the facility was covered, but not the required doctor(there were 5 different docs on a rotation). If we have not found this out we would have been out of pocket for $2500 a week....for 10 weeks.

We cancelled and used other methods for healing.

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I have seen this happen as well. It is pretty ugly to get the bill if each individual doc that is at that clinic is not on the insurance plan.

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