Courtesy of Virginia Mason
Center
for Hyperbaric Medicine
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| The
hyperbaric chambers at the Virginia Mason Center
for Hyperbaric Medicine in Seattle are used to treat
emergencies, like decompression sickness and carbon
monoxide poisoning. |
Sometimes Claude Wreford-Brown, RN, gets a little giddy
at work-laughing, joking and feeling euphoric. That's
because he's nurse manager at the Virginia Mason Center
for Hyperbaric Medicine in Seattle, and goes in and
out of a decompression chamber where patients are being
treated.
"The patients are breathing 100 percent oxygen,
so they're fine," said Wreford-Brown, an advanced
certified hyperbaric nurse, "but in the chamber,
in effect, you go as deep as 165 feet, and the effect
is nitrogen narcosis, the equivalent of about six martinis."
Hyperbaric chambers, first used in the 1600s, treat
a variety of ailments, including carbon monoxide poisoning,
air or gas embolism, decompression sickness, acute ischemia,
hypoxic wounds, blood loss anemia, necrotizing soft
tissue infections, radiation tissue injury, osteomyelitis
and thermal burns. The treatment also is used as adjunctive
therapy for blood loss anemia when patients refuse blood
or cross-matching is difficult.
Recently, Medicare approved hyperbaric treatment of
diabetic ulcers, bringing the number of conditions approved
for compressed oxygen therapy to 14. Wound care patients
are now the largest group of patients at most hyperbaric
centers.
"The high-pressure oxygen stimulates angiogenesis,"
Wreford-Brown said. "Radiation damages the small
blood vessels, and the high oxygen stimulates the growth
of new blood vessels. This stops patients from getting
wounds that before were typical."
In cases where angiogenesis is the primary goal, 20
to 40 treatments are needed.
Virginia Mason treats emergencies, like decompression
sickness and carbon monoxide poisoning. The chamber
also can be used to treat gas gangrene. The high pressure
doesn't actually kill the bacteria, Wreford-Brown said,
but can put them into stasis mode so they don't progress,
giving antibiotics a chance to work.
"We stay very busy," he said. "The facility
has been here about 30 years, and was originally a research
facility developing saturation tables for North Sea
oil operations."
Kathy Furnas, RN, is a clinical coordinator at the
Hyperbaric Medicine Center at Presbyterian/St. Luke's
Medical Center in Denver, one of the busiest hyperbaric
centers in the country, with a 24-patient multiplace
chamber.
"By the time folks get to us, they've usually
been the rounds," Furnas said. "Everyone else
has thrown up their hands and said, 'There's nothing
else we can do. Try hyperbaric treatment.' So our cases
are very complex."
One of the primary jobs of nurses who work in hyperbarics
is managing patients, said Harry Vincent, MHA, RN, director
of professional development at Total Wound Care Treatment
Center in San Antonio and a certified hyperbaric technologist.
"We assess to see what the individual needs are,
applying the nursing process to manage the patient as
a whole," Vincent said. "Many times in outpatient
therapies, patients get tied up going to this person
for this therapy and that person for that therapy, and
we are the ones tying it all together-nutrition, lifestyle,
help at home-to get them to the point of being well."
Patient education is a big part of the job, said Bobbi
Hall, RN, a certified hyperbaric nurse and nurse manager
at the University of South Carolina's medical school
hospital in Columbia.
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