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