Elective Hyperbaric Oxygen Therapy UHN Information for Patients

Elective Hyperbaric
Oxygen Therapy
Improving Health Through Education
Patient Education
Information for Patients
What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy (HBO) is the use of 100% oxygen at an increased
atmospheric pressure. HBO was developed to treat victims of diving accidents.
We now use it for other medical and surgical problems.
The University Health Network offers hyperbaric oxygen therapy at the Toronto
General Hospital. For our elective therapy program, the Hyperbaric Medicine Unit
has delivered over 30,000 HBO treatments using two monoplace chambers (one-person
treatment equipment).
When do we use hyperbaric oxygen therapy?
Hyperbaric oxygen therapy is supported by the Undersea and Hyperbaric Medical
Society and the University Health Network
to treat:
•
Air or gas embolism
This information is to be used for informational purposes only and is not intended as a
substitute for professional medical advice, diagnosis or treatment. Please consult your
health care provider for advice about a specific medical condition. A single copy of these
materials may be reprinted for non-commercial personal use only.
© 2011 University Health Network. All rights reserved.
Author: Dr. A.W. Evans, Gavin Wort, CHT, Practice Leader and Ray Janisse, RRT, CHT
Created: 07/2006
Form: D-5218 (04/2011)
UHN
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Carbon monoxide poisoning
Carbon monoxide poisoning complicated by cyanide poisoning
Clostridial myositis and myonecrosis (gas gangrene)
Crush injury, compartment syndrome and other acute traumatic ischemias
Decompression sickness
Arterial insufficiencies
Central retinal artery occlusion
Enhancement of healing in selected problem wounds
Severe anemia
Intracranial abscess
Necrotizing soft tissue infections
Osteomyelitis (refractory)
Delayed radiation injury (Soft tissue and bony necrosis)
Compromised grafts and flaps
Acute thermal burn injury
What is a hyperbaric chamber?
A hyperbaric chamber is a specially designed room or cylinder made of metal or acrylic
that can handle increased pressure.
•
When you come for a booked hyperbaric therapy appointment, we will use one of
our one-person (monoplace) chambers.
•
While you are in the chamber, you will be constantly monitored by one of our
highly trained hyperbaric staff members. There is a communication system that will
allow you and the hyperbaric staff to talk.
•
You will lie down for your treatment and you will be able to see out the clear
window in the chamber.
•
To keep you comfortable during your treatment, you can watch television, movies
or listen to music.
Monoplace Chambers
Page 2 of 10
Adapted from: www.panamericahbo.com
How does hyperbaric oxygen therapy work?
At sea level, the atmosphere exerts pressure at approximately 14.7 pounds per square
inch (psig) or 101.3 Kpa. We call this 1 atmosphere absolute (ATA). We use 100%
oxygen at 2 - 3 ATA of pressure during your treatment. This increased pressure helps
get more oxygen to your tissues (there is more oxygen for you to breathe in and more
pressure pushing that oxygen into your tissues).
How do I get oxygen while I am in the chamber?
The monoplace chambers are pressurized with oxygen. So, just by being in the chamber
and breathing in and out, you will receive extra oxygen. We give you an air break from
the oxygen through a mask at the middle point of your treatment.
Who will give me my hyperbaric treatment?
Certified Hyperbaric Technologists, Registered Respiratory Therapists and Registered
Nurses will give you your hyperbaric treatment. The medical director and all staff
physicians for the unit are from the Department of Anaesthesia. All physicians working
within the hyperbaric unit have been trained in the use of hyperbaric medicine.
Arrival for your appointment
Please arrive 30 minutes before your scheduled treatment time.
This allows time:
•
For you to change your clothes.
•
For one of our staff members to check your temperature, blood pressure, heart rate,
blood sugar and breathing, if required.
•
To give you medications if needed.
•
To finish getting you ready for your treatment.
Our treatment times are as follows:
Doors to the Hyperbaric Medicine Unit will open at 7:00 a.m. Although it may be
necessary to alter the treatment schedule from time to time, in general, the
following will apply:
•
1st treatment will start at 7:30 a.m.
Page 3 of 10
•
•
•
2nd treatment will start at 9:45 a.m.
3rd treatment will start at 12:15 p.m.
4th treatment will start at 2:30 p.m.
Please note:
If you are late for your appointment, we may need to reduce your treatment time or
cancel your treatment. If you are repeatedly late or, are absent for your appointments
without adequate notice to us, we may remove you from the program.
Sometimes emergencies and other patient needs make it necessary for us to change
your treatment time. We apologize for this inconvenience and will work to minimize
any disruption this may cause in your day.
If you need special assistance to get to your hyperbaric appointment or need more time
to get dressed, please add extra time before and after your scheduled appointment and
arrange for a family member or friend to come with you. This may be difficult for you,
but it will help to make sure that we are able to give you your full treatment.
Treatment time
•
On your treatment day, please be prepared to spend at least 2 hours in our
hyperbaric department. On selected days, you will be seen by our hyperbaric
physician and more time will be needed.
•
Your actual treatment time in the chamber will be just over 1.5 hours.
•
Although not always possible, we try to schedule your appointment time to best
meet your needs. Please let us know if you have specific requests.
When you start your hyperbaric oxygen therapy, your appointment time may be
inconvenient for you. If a more convenient time becomes available, we will change your
appointment to meet your needs.
Preparation for your treatment at the Hyperbaric Medicine Unit
There are several safety precautions that we ask you to follow before your treatment:
1. Remove your bra.
2. Use the special hyperbaric clothing that we give you.
3. If you are diabetic, check your sugar levels. (Assistance may be provided.)
4. Inform us if you are wearing any medication patches. (Nicotine, Nitroglycerin, pain relief.)
Page 4 of 10
5. Make sure to empty your bladder just before your treatment.
6. Let your technician know on your treatment day if there are any changes to your
medical condition.
On the day of your treatment, before you arrive:
•
Have a healthy snack 1 hour before your treatment.
•
Avoid caffeinated drinks like coffee and cola at least 2 hours before your treatment time.
•
Do not to smoke before your treatment
•
Wear 100% cotton underwear.
•
Bring slippers or other non-outdoor footwear.
•
Remove any make-up including lipstick, eyeliner or nail polish
or perfume.
•
Remove any:
¾ Body lotion or oils
¾ Hairspray, hair mousse or gel
¾ Nylon stockings
The following items are NOT permitted inside
the Hyperbaric Chamber:
Personal care products
Oil based or Vaseline based products, glycerine
based products, alcohol based products, perfume,
colognes, after shaves, skin lotions, all make up,
hair spray, gels, mousse, moustache wax, and
nail polish
Personal items
Wigs or hair pieces, dentures, smoking materials,
gum or candy
Other devices or items
Electronic devices, batteries, books, papers, pens,
pencils ,
all toys
Metal objects
All metal objects, watches
Page 5 of 10
How often will I have my treatments?
We create your treatment plan based on your medical condition.
•
Most patients have treatment once per day, 5 days per week for 6 to 8 weeks,
Monday to Friday.
After reviewing your medical condition, we will discuss the treatment plan suited to
your needs. Our hyperbaric physician will explain the purpose and expected results of
your hyperbaric oxygen therapy. We will contact you with your appointment dates.
Will the changes in the Hyperbaric chamber pressure cause
any pain or discomfort?
Compression phase (when we increase the chamber pressure)
During this phase, oxygen is being added to the chamber and being pressurized to meet
the required treatment pressure. The compression of the oxygen will make the
temperature slightly warmer. Also during compression, you will feel fullness in your
ears. It will feel the same as flying, scuba diving or coming down in an elevator.
•
Before you start your treatment, we will show you how to “clear” or “equalize”
this pressure in your ears. If you feel pain, or have any trouble clearing your ears
during your treatment, it is important to tell your attendant right away. The
attendant will stop the pressurization and help you.
•
If you are unable to clear your ears, we may send you to an Ear, Nose and Throat
specialist, where a simple procedure of placing tubes in your ears may be done.
These tubes will stay in your ears while you are being treated at the Hyperbaric
Medicine Unit to help stop pressure build-up in your ears.
Decompression phase (when we decrease the chamber pressure)
During this phase, the chamber pressure is safely being lowered back down to
atmospheric pressure. At this time, the decompression of the oxygen will make the
temperature cool off slightly. For this reason, we will give you sheets and blankets to
keep you comfortable.
•
As the pressure in the chamber decreases, you may feel a “popping” sensation in
your ears. This ear “popping” is normal. It sounds like “rice krispies” and feels a
bit odd. It does not hurt. Please continue to breathe normally. In this phase of your
Page 6 of 10
treatment, pressure equalization in your ears will happen without you doing
anything special.
Eyes
Sometimes, patients receiving daily hyperbaric treatments develop temporary changes
in their eyesight. These are usually minor and make close up reading clearer. If this
happens to you, your vision will usually return to normal within 4 to 8 weeks after
you finish your treatment.
Smoking
You must not smoke during the entire time that you are having hyperbaric treatment.
Smoking decreases oxygen delivery to your tissues. When you smoke, the nicotine in
the cigarette causes your small arteries to close or narrow. This makes it impossible for
blood to get to the tissues that need to heal. If blood does not get there, the oxygen does
not get there. Even after smoking 1 cigarette, these small blood vessels can stay closed
or narrowed for several hours.
For the majority of our patients, hyperbaric therapy is used to create new blood vessel
growth in areas that have poor circulation. We need to keep these vessels open. The
nicotine from smoking works against this. That is why we say: “No smoking!”
Diet
Good nutrition is important for wound healing.
•
Follow Canada’s Food Guide to eat a balanced diet.
Do not eat or drink anything with caffeine (e.g., coffee, tea, carbonated beverages,
Tylenol with codeine, chocolate) while having your hyperbaric treatments.
•
Caffeine affects how much oxygen that your blood can carry and may decrease
oxygen delivery through blood vessels.
•
If you cannot stop eating or drinking foods with caffeine, please do not have any
for 2 hours before and 2 hours after your treatment.
Please tell us if you are diabetic
Please let us know if you are on insulin (insulin dependent) or not (non-insulin dependent).
Page 7 of 10
Hyperbaric oxygen treatment may drop your blood sugar. To have your treatment, your
blood glucose reading must be a minimum of 10mmol/L. By changing your eating plan
or your medications, we can help you to control this.
•
During your treatment, we may give you a calorie supplement,
for example, we will give you juice to drink. You may find bringing a healthy snack
along will be helpful.
•
We will need to know your glucose level before and after
your treatment.
•
We may adjust your diabetes medication. For instance, we may ask that you
decrease your morning diabetic medication or, wait to take it until after your
treatment for the day is done.
Medications
Please tell the hyperbaric physicians what medications you are taking. There are some
medications that you cannot take during your hyperbaric therapy. We will work with
you to deal with this. If you are on a medication and you need to take it during your
treatment time, please bring it to your appointment in its original labelled container.
We will make arrangements for you to take it before or after your treatment.
Illnesses
If you get sick with a cold, flu, or sinus problem, you may not be able to clear your ears
during pressure changes in the chamber. Please call the Hyperbaric Unit and talk with
our staff. We may need to cancel your treatments until you are feeling better.
Visitors in the Hyperbaric Unit
Visitors are not allowed in the Hyperbaric Unit treatment areas. During your treatment,
your family or friends may wait in the Hyperbaric Unit waiting area. If a member of
your family would like to see the Hyperbaric Unit, speak to one of our staff. We may be
able to make arrangements for this.
Our location and contact information:
Hyperbaric Medicine Unit
Ground Floor, Clinical Services Building
200 Elizabeth St., Room 405
Toronto, ON M5G 2C4
Page 8 of 10
Telephone:
Fax:
(416) 340-3598
(416) 340-4481
Directions
From the TGH Elizabeth Street entrance:
You will be in the Eaton Building. Walk past the Information Desk toward the food
court. At the food court intersection, turn left, and then follow the signs to the
Hyperbaric Medicine Unit. We are located just down the hall, Room 405.
From the TGH Gerrard Street entrance:
You will be in the Gerrard Building. Walk past the information desk down the hall to
your left. Look for the sign Hyperbaric Medicine, Room 405.
Closest Subway
•
The nearest subway entrances to TGH are the College Station at Yonge and College
Streets or Queen's Park at University Avenue and College Street.
•
From either station you can walk to College and Elizabeth Street (one street east of
Queen's Park station or 2 streets west of College station).
Page 9 of 10
•
Turn south on Elizabeth Street and walk about half a block until you reach the
Eaton Wing.
Parking
Parking is available at various parking lots around the Toronto General Hospital.
Rates vary between $15 - $25.
Toronto General Hospital
Hyperbaric Medicine Unit
Confirmation of Instructions
This is to confirm that I, ___________________________ , have been given
(print patient name)
Instructions about my Hyperbaric Oxygen Therapy, such as:
1. Explanation of Hyperbaric Oxygen Therapy (HBOT).
2. When HBOT is used and why it is being used for me.
3. Explanation of a hyperbaric chamber.
4. How the treatment works.
5. Duration of my treatment.
6. My treatment times and department hours.
7. Tardiness and missed appointments.
8. What I need to do to prepare for my treatments.
9. Changes of pressure and the possible effects on my body.
10. Unit staffing.
11. Visitor’s rights and limitations.
____________________________________
Patient’s Signature
______________
Date
Page 10 of 10