Hyperbaric oxygen chamber treatment skills

Hyperbaric chamber treatment

Hyperbaric oxygen chamber, treatment equipment for various hypoxia. The cabin is a closed cylinder, and pure oxygen or purified compressed air is input through pipelines and control systems. The doctor outside the cabin can communicate with the patient through the observation window and the intercom. The large oxygen cabin has 10-20 seats.

【principle】
Oxygen is carried by the blood. When oxygen enters the lungs, it will immediately dissolve in the blood. The dissolution process is like putting a spoonful of white sugar in water and it will be quickly dissolved. The amount of oxygen dissolved in the blood of a normal person is related to the environmental pressure. We live in an environment of atmospheric pressure. Since the oxygen in the air is only 1/5, there is very little oxygen dissolved in human blood, which cannot meet the needs of the human body. Oxygen easily enters the red blood cells and is transported along with the movement of the red blood cells. It is very important that there is little oxygen dissolved in the blood. Because the oxygen carried by red blood cells is dozens of times higher than the oxygen dissolved in the blood, normal people can meet the oxygen intake for transporting oxygen. Such as the hyperbaric oxygen experiment: the Dutch scientist experiment in 1956. The blood of the piglet is drawn from the artery and then saline is injected from the vein, and then put into the hyperbaric oxygen chamber and added with three atmospheres of oxygen. The piglet lives in this hyperbaric oxygen chamber for 15 minutes, and the blood is reinfused into The piglet is still alive after its body. The piglet continues to live by dissolved oxygen. Scientists named this experiment a bloodless life. After many experiments, it is concluded that the oxygen dissolved in the blood in the hyperbaric oxygen chamber increases as the pressure of the oxygen chamber increases. The oxygen dissolved in the blood increased by 14 times after inhaling pure oxygen in a 2 atmospheres oxygen chamber, and it increased by 21 times at 3 atmospheres.
【Scope of application】
Hyperbaric oxygen is suitable for the following diseases: gas, hydrogen sulfide, biogas and other harmful gas poisoning, cerebral thrombosis, cerebral hemorrhage, brain trauma, neuritis, vasculitis, diabetic gangrene, difficult-to-heal ulcers, fetal developmental failure, neonatal asphyxia, Acute air embolism, decompression sickness, altitude sickness, sudden deafness, Meniere syndrome, vertigo.
【Responsibilities of Nursing Staff】
1. Familiar with the work characteristics of hyperbaric oxygen, have a sense of work responsibility and safety awareness, implement various rules and regulations, and work carefully and meticulously.
2. Familiar with the use and operation methods of the main equipment of the hyperbaric oxygen chamber.
3. Understand the main effects of hyperbaric oxygen on the physiological functions of various human systems and possible complications and accidents.
4. Familiar with the precautions before entering the cabin and during the treatment.
5. Be able to enter the cabin to care for patients.
6. Fill in various nursing, treatment and operation records accurately and timely.
7. Strictly implement the treatment plan formulated by the physician of the hyperbaric oxygen department (room), and cannot be changed without authorization.
8. Before hyperbaric oxygen treatment, the cabin should be ready for treatment, rescue medicine and various medical, rescue and inspection equipment.
【Nursing before treatment】
1. Do a good job of propaganda and explanation before entering the cabin, so that the patient can clarify the purpose of treatment, eliminate tension and fear, and prevent the occurrence of "containment terror reaction".
2. Before entering the cabin, you should understand the diagnosis, treatment plan, main routine examination results and health status of each patient, and discover contraindications in time to prevent side effects and accidents of treatment.
3. Before entering the cabin, teach patients the basic knowledge of preventing various barotraumas and understand the methods of eustachian tube ventilation. New patients and those with nasal congestion are given 1% ephedrine or nasal drops 10 minutes before entering the cabin; teach patients the essentials of opening the Eustachian tube, such as the nasal pinching method (also known as Ualalva's Eustachian tube blowing method— Close your mouth, pinch the nostrils with your thumb and index finger, and exhale forcefully to increase the airway pressure to open the eustachian tube orifice to allow air to enter the tympanum and balance the internal and external pressure), and perform pressure adjustments such as mouth opening and swallowing. The patient can be instructed to drink water and chew candy when the pressure is increased, and the patient not to hold their breath when decompressing.
4. The personnel entering the cabin must abide by the oxygen cabin medical safety rules, and it is strictly forbidden to bring flammable and explosive items (such as matches, lighters, alcohol, grease, oil, cooling oil, gasoline, firecrackers, electric toys, pyrophoric toys, etc.) into the cabin . It is not advisable to wear clothing that is prone to static sparks (such as chloran, nylon, acrylic, propylene, woolen bulked yarn, etc.) into the cabin, especially in pure oxygen chambers and hyperbaric oxygen chambers that cannot control the oxygen concentration in the cabin. Wear cotton clothing when entering the cabin to prevent fire and explosion accidents in the cabin. At the same time, watches, pens, thermos cups and other items should not be brought in to avoid damage.
5. Before treatment, you should empty your bowels and bowels. Before entering the cabin, patients with incontinence or coma should be properly handled, and toilets should be prepared. In order to keep the air in the cabin clean and tasteless, paralyzed and unconscious patients should frequently scrub their skin, perineum, and improve oral hygiene to reduce the introduction of bad smells into the cabin. Clean special shoes should be replaced before entering the cabin.
6. Don't be full, hungry or alcoholic before entering the cabin. Generally, it is best to enter the cabin 1 to 2 hours after a meal.
7. When the patient enters the chamber with the treatment catheter, check whether the catheter is unobstructed, and properly fix the catheter to prevent it from shifting, extending into or out of the body to prevent backflow.
8. Various equipment and medicines needed for inspection, medical treatment and nursing should be prepared in the cabin, and the medicines in the cabin should be checked and replaced regularly to prevent expiration and failure.
9. Before treatment, check whether the relevant valves, instruments, communications, lighting, air supply, oxygen supply, ventilation and other systems are operating normally. At the same time, adjust the temperature in the cabin, heating to 18-24℃ in winter and pre-cooling to 28℃ in summer before treatment.
10. Before treatment, check whether the patient's infusion is unobstructed, whether there is any redness and swelling at the venipuncture site, and pay attention to the liquid and medicine needed for treatment in the foot cabin. It is best to use an open infusion bottle for infusion in the cabin to facilitate the addition of medicine and avoid the gas expansion of the glass bottle from breaking during decompression.
【Nursing during treatment】
(1) Nursing during compression
1. Before starting pressurization or performing each operation step, the operator should clearly inform the personnel in the cabin, such as "what is uncomfortable when pressurization is started", etc.
2. Master the appropriate pressurization speed to prevent the occurrence of various barotrauma. Before the cabin pressure rises to 0.16MPa, the pressurization speed should be slow, and the patient should be asked whether there is earache. If the above pressure can be passed smoothly, the compression speed can be increased slightly; if the earache is more obvious, or the comatose patients and children are restless during the compression, the compression should be suspended; if the pressure adjustment is still difficult, the earache If there is no obvious relief, you can properly exhaust and reduce blood pressure, and at the same time, inject ephedrine into the nose. After the above treatment, the pain disappears, and you can continue to pressurize; if the pressure cannot be successfully adjusted after various efforts, you should decompress and leave the cabin.
3. The pressure range of hyperbaric oxygen therapy is generally 0.2-0.3MPa.
4. From the start of pressurization, the time required to rise to the specified pressure is called "pressurization time". If the pressurization process is suspended for some reason, and then pressurized to the specified pressure again, all the time should be Included in the "boost time".
5. Compression rate The conventional treatment pressure is 0.20～0.25MPa, and the compression time takes about 20-25 minutes. In the initial stage of pressurization, the pressurization speed should be slow. After pressurization to 0.06MPa gauge pressure, the pressurization rate is not limited as long as the patient can tolerate it. During the compression process, observe the facial expressions of the comatose patients, and whether they have nose bleeding. Observe whether the hypertensive patients have headaches, dizziness, and the original lung dysfunction or the changes in the respiratory frequency and amplitude of the patients with shallow breathing.
(B) Nursing during the process of oxygen inhalation
1. The stabilization time is the hyperbaric oxygen treatment time. During the entire stabilization period, the cabin pressure should be kept constant. If the cabin pressure rises and falls, the exhaust pressure or intake pressure should be increased in time. The fluctuation range of the cabin pressure should not exceed 0.005Mpa.
2. Mask oxygen: Large and medium-sized hyperbaric oxygen chambers are all pressurized with compressed air, and the patient wears nose and mouth mask to inhale pure oxygen. Severely critical and unconscious patients should be given first-level oxygen inhalation. Pay attention to the following when inhaling oxygen with a mask:
(1) Wear a mask correctly and keep good contact. It is required that the mask should be close to the cheek to prevent air from leaking into the mask.
(2) If the severely critical and comatose patients use a first-level oxygen inhalation device, the rubber sac is connected to the lungs. When the rubber sac is squeezed, collided or overfilled, the pressure in the lung is greater than the pressure on the chest wall. Cause "pulmonary barotrauma". Therefore, it is strictly forbidden to slap the rubber bag when inhaling oxygen, and pay attention to the oxygen filling degree in the bag at all times.
(3) During oxygen inhalation, the patient must be closely observed for signs of anaerobic poisoning. If the patient is found to have irritability, facial and lip muscle twitching, cold sweats, or sudden dry cough, shortness of breath, or the patient complains of dizziness, vertigo, nausea, weakness, etc., they should be dealt with immediately. If the condition does not improve, decompression Out of the cabin.
(4) In order to prevent oxygen poisoning, intermittent oxygen inhalation method is adopted, such as oxygen inhalation for 30 minutes—inhalation of air for 5 minutes—inhalation of oxygen for 30 minutes—inhalation of air for 5 minutes—last oxygen inhalation for 20 minutes, or oxygen inhalation for 40 minutes—inhalation of air for 10 minutes—inhalation of oxygen for 40 minutes . Under 0.3MPa, with this intermittent oxygen inhalation method, the total oxygen inhalation time should not exceed 120min. Under 0.2MPa, the oxygen inhalation time does not exceed 240min, which belongs to the safe oxygen inhalation range.
(5) If the patient wears rubber and is allergic to the mask, sterile gauze should be placed under the mask to prevent it from directly contacting the skin to cause allergic reactions.
3. The oxygen supply pressure is generally 0.4-0.5MPa. Patients with more than 0.6MPa may experience chest fullness, and patients with less than 0.4MPa may feel insufficient and laborious. The oxygen supply is generally 10-15L/min.
4. Pay attention to ventilation: that is, through the intake valve of the hyperbaric oxygen chamber, fresh compressed air or compressed oxygen (single-person pure oxygen chamber) is injected into the cabin, and the exhaust valve is opened to discharge the turbid air in the cabin. However, care must be taken to control the inlet air volume equal to the air outlet volume to keep the cabin pressure constant.
(3) Nursing during stress reduction
After the treatment, the process of reducing the cabin pressure from high pressure to normal pressure is called decompression. Because the patient and the cabin crew stayed in a high-pressure environment for a long time, more compressed gas, especially nitrogen, has been dissolved in the body fluids and tissues in the body. Therefore, the decompression must be controlled at an appropriate decompression speed.
There are two types of decompression methods: uniform decompression and stage decompression. Care should be taken to note the following during decompression:
1. Strictly follow the hyperbaric oxygen treatment plan for decompression, and do not shorten the decompression time or change the decompression plan at will.
2. During the decompression process, the patient should be instructed to breathe freely and never hold his breath.
3. An open infusion bottle should be used for infusion in the cabin. The gas in the Murphy's dropper will expand during decompression, and the pressure in the bottle will increase. The gas may enter the vein and cause air embolism. Therefore, pay attention to the liquid in the Murphy's dropper. fill fully. In the case of a closed infusion, a sterile needle of sufficient length should be inserted into the bottle above the liquid level to maintain exhaust.
4. All drainage tubes and thongs should be open during decompression.
5. In coma patients, those with tracheal intubation or tracheotomy, those whose blood pressure has not stabilized after physical rescue, or those with recurrent cerebral edema, the speed of decompression should be slowed down.
6. When decompression, the gas expands and absorbs heat, so that the temperature of the cabin decreases. Keep warm.
7. The temperature in the cabin drops sharply during decompression. If the fog point is reached, mist will appear in the cabin. This is a normal physical phenomenon. Proper ventilation and control of the decompression speed can reduce or avoid this phenomenon.
8. Due to the stimulation of high air pressure on the respiratory tract, the secretions of the respiratory tract increase, so you should pay attention to sucking sputum at any time to keep the respiratory tract unobstructed. In the final stage of decompression, the secretions are difficult to discharge due to the change of negative pressure. Empty needles can be used if necessary Suction.
9. At the initial stage of decompression, due to the expansion of the gas in the middle ear tympanum and accessory sinus cavity, there will be a feeling of fullness. When the pressure exceeds a certain level, the gas can be discharged from the Eustachian tube, and the discomfort will be eliminated immediately.
10. During the decompression process, gas in the gastrointestinal tract expands, which can cause abdominal distension and abdominal pain. Therefore, before treatment, the patient should be instructed to properly control the diet and choose foods and beverages that do not produce gas.
11. Cabin operators must concentrate and are not allowed to leave the console without authorization. After decompressing and exiting the cabin, the patient should be asked whether they have any discomfort such as skin itching, joint pain, and early detection of symptoms of decompression sickness. For critically ill or unconscious patients, they should notify the physician in charge to take over.
[Cleaning and disinfection of oxygen chamber]
(1) Cleaning the oxygen chamber
1. Strictly implement the disinfection and isolation system and pay attention to aseptic operation.
2. Workers who treat ordinary patients should wear clean clothes and hats, and wear isolation gowns, shoes, and masks when contacting infected patients.
3. In order to keep the environment and air in the hyperbaric oxygen chamber clean, both staff and patients must change their shoes into the chamber.
4. For hyperbaric oxygen offices, treatment rooms, patient rest and waiting rooms, etc., all places that can become a route of infection should use wet mopping, wet cleaning appliances, doors and windows every day.
5. The toilets for the hyperbaric oxygen department are cleaned once a day in the morning and afternoon.
6. The patient's special clothes and shoes are washed once every course of treatment in winter, and replaced at any time according to the situation in summer.
7. Wipe the surface of the hyperbaric oxygen chamber once a week.
8. Spittoons, toilets, and trash cans are rinsed and immersed in 30% Lysol solution for disinfection after use, and washed the next day for use.
9. The hyperbaric oxygen treatment room should be wiped with disinfectant once a day, and common items such as instrument boxes should be autoclaved once a week. Sterilize the foam instrument box once a week and replace the disinfectant.
10. After a course of treatment, the patient’s special clothing and shoe cabinets are cleaned up first, and then wiped with 1:200 "84" disinfectant for use.
(2) Disinfection and isolation in the cabin
1. The compressed air and oxygen filled into the cabin must meet sanitary standards. Conditional units can sprinkle aromatic air disinfectant before each treatment to disinfect the cabin and eliminate bad smells in the cabin.
2. At the end of each treatment, the cabin should be ventilated, cleaned, and disinfected with ultraviolet radiation for 30 minutes.
3. The oxygen mask is specially used, and the patient is instructed to clean it after each use, and to wipe it before use.
4. Before the operation patient enters the cabin, wipe the cabin with 5% peracetic acid or 1:200″8.4″ disinfectant, then smoke with 12ml of lactic acid per 100m3 volume for 30 minutes, ventilate, wipe with clean water, and finally use ultraviolet light Air disinfection for 30 minutes.
5. When a person diagnosed with tetanus, gas gangrene, or anaerobic infection undergoes hyperbaric oxygen treatment, other persons with wounds should be prohibited from entering the cabin at the same time. After the patient leaves the cabin, the cabin shall be strictly disinfected. The disinfection method is as follows.
(1) Wipe the floor, bulkhead and all utensils in the cabin with 0.5% peracetic acid or 1:200″8.4″ disinfectant, once a day, three times in total.
(2) Air disinfection: smoke with 12ml of lactic acid per 100m3 for 30 minutes and ventilate, then disinfect with ultraviolet air for 30 minutes, once a day, three times in total.
(3) After the cabin is closed for three days, perform general cleaning, and then incubate with air for three times to be negative before opening for use.
(4) Soaked in 0.5% peroxyacetic acid or 3% Lysol solution for 120 minutes, send it to the laundry room to boil for 60 minutes, and wash it before use.
(5) All dressings are completely burned.
6. The oxygen suction and exhaust rubber tube and the breathing tee tube in the cabin are disinfected once a week. Soak in 1:200"8.4" disinfectant for 60 minutes, scrub with soapy water, rinse with clean water and let it cool.
7. Each patient in the single-person oxygen chamber should have a fixed linen, change and wash after a treatment, and change the sheet once a week. Use bamboo mats in summer, wipe them with disinfectant once a day in the morning and afternoon.
8. Bacteria culture in the cabin once a month.