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Frequently Asked Questions
Clinical FAQs
What is Hyperbaric Oxygen Therapy (HBOT)?
How does clinical HBOT work?
What are the accepted indications for HBOT?
How does a patient receive HBOT?
How do you prepare the patient for HBOT in a monoplace hyperbaric chamber?
Is Physician supervision of the HBOT treatment required?
Is HBOT covered by insurance?
How does HBOT improve wound healing?
What does a patient experience during treatment?
Technical FAQs
What type of linens & gowns are allowed in the chamber?
What is the recommended service for our chamber?
What are acceptable cleaning and disinfecting agents for the Acrylic Tube?
What size room is needed for one (1) ETC monoplace hyperbaric chamber?
What size room is needed for two (2) ETC monoplace hyperbaric chambers?
What size room is needed for four (4) ETC monoplace hyperbaric chambers?
What is the recommended flooring for the Treatment Room?
What are the pressure and flow requirements for the Air-Break assembly?
Can the air-break be supplied from compressed air cylinders?
What is the maximum patient weight allowed in a BARA-MED® XD monoplace hyperbaric chamber
What is the maximum patient weight allowed in a BARA-MED® monoplace hyperbaric chamber
Can chambers be positioned in direct sunlight?
Clinical FAQ
Q. Hyperbaric Oxygen Therapy (HBOT), what is it?
A. Hyperbaric Oxygen Therapy is a non-invasive therapy. In its clinical applications, the patient breathes 100% oxygen while fully enclosed in a specially designed chamber at ambient pressures up to three times normal atmospheric pressure. HBOT is used to promote and support healing in the management of conditions in which oxygen transport to the tissues has been disrupted by traumatic injury, infection, inflammation, or edema
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Q. How does clinical HBOT work?
A. Inadequate oxygenation occurs in tissue compromised by infection, traumatic injury, hypoxia, inflammation, and edema. At normal atmospheric pressure, the oxygen needed for tissue metabolism is carried in the blood in chemical combination with hemoglobin in the red cells. Only an insignificant amount is physically dissolved in the blood plasma. Because of increased diffusion distances caused by such factors such as circulatory disruption and edema, the pressure-dependent gradient necessary for oxygen to dissociate from hemoglobin and diffuse from the blood plasma into the tissues may be inadequate to deliver sufficient amounts of oxygen to support basic metabolism. If physiologically significant amounts of oxygen are dissolved in the plasma at a pressure far in excess of the normal arterial PO2 of 100 mmHg, however, this will cause the oxygen to diffuse over much greater distances and support both basic tissue metabolism and healing processes left wanting by oxygen carried on hemoglobin.
During an HBO treatment, as ambient pressure in the chamber is increased, the amount of oxygen entering into solution in plasma also increases. At 1 ATA (atmospheres absolute) the volume of oxygen in solution in plasma is 0.3 ml/100ml. When breathing oxygen at 3 ATA, the arterial PO2 is increased to 2200 mmHg and the volume in solution rises 22 times to 6.6 ml/100ml. It has been shown that under these circumstances, oxyhemoglobin passes unchanged through the capillaries since the volume of oxygen physically dissolved in solution at this pressure is sufficient to meet tissue demand without dissociation from hemoglobin.
The primary effect of administering oxygen at greater than normal atmospheric pressure, then, is to dissolve physiologically significant amounts at much increased partial pressures in the blood plasma. The higher plasma oxygen tension increases the rate and distance that oxygen diffuses from patent capillaries across the barriers created by edema and poor perfusion. Thus, oxygen becomes more readily available to tissues affected by disease or traumatic injury even when blood flow to those areas is impaired and red cells are not able to pass through restricted capillary beds. This facilitates healing through enhanced macrophage function, fibroblast proliferation and collagen synthesis, angiogenesis, and epithelialization.
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Q. What are the accepted indications for HBOT?
A. HBO is a primary therapy in only two indications: gas embolism and decompression sickness. In all other cases, it is an adjunctive treatment. The list of accepted indications for HBO as a supporting modality varies widely from country to country. In the United States the accepted indications are those which attract reimbursement. Currently this differs on a state-to-state basis and between third-party payers. The Undersea and Hyperbaric Medical Society (UHMS), a U.S.-based, but international organization, is considered to be pre-eminent in the field of hyperbaric medicine in the U.S. and perhaps, the world. The UHMS periodically publishes a report, assembled by a committee of North American experts in hyperbaric therapy that provides support, justification and guidance on clinical application for a list of indications it considers should be approved for hyperbaric oxygen therapy.
The following indications are approved uses of hyperbaric oxygen therapy as defined by the Hyperbaric Oxygen Therapy Committee. The Committee Report can be purchased directly through the UHMS.
1. Air or Gas Embolism
2. Carbon Monoxide Poisoning, Carbon Monoxide Poisoning Complicated by Cyanide Poisoning
3. Clostridal Myositis and Myonecrosis (Gas Gangrene)
4. Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias
5. Decompression Sickness
6. Enhancement of Healing in Selected Problem Wounds
7. Exceptional Blood Loss (Anemia)
8. Intracranial Abscess
9. Necrotizing Soft Tissue Infections
10. Osteomyelitis (Refractory)
11. Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
12. Skin Grafts & Flaps (Compromised)
13. Thermal Burns
For more information, please visit the UHMS website or CMS website
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Q.How does a patient receive HBOT?
A. Hyperbaric oxygen therapy is administered to a patient in a pressurized chamber. The hyperbaric chamber can be made of steel, aluminum, and/or clear acrylic. In this chamber the gas can be compressed to a pressure that is greater than sea level (1 ATA). There are in essence two types of hyperbaric chambers, monoplace hyperbaric and multiplace.
Monoplace Hyperbaric Chambers:
A monoplace hyperbaric chamber is a system that accommodates one patient at a time. This chamber is typically pressurized with 100% oxygen so that the patient receives by breathing the chamber atmosphere. A mask or a hood is not needed. A monoplace hyperbaric chamber can be pressurized to 3 ATA. Critically ill patients requiring extensive life support equipment can be treated in a BARA-MED® or BARA-MED® XD monoplace hyperbaric chamber.
Multiplace Hyperbaric Chambers:
A multiplace hyperbaric chamber is a system that can accommodate two or more occupants. An attendant usually remains inside with the patients. The chamber is pressurized with compressed air through a dedicated supply system, and the oxygen is delivered to the patient via a mask or a hood. Multiplace hyperbaric chambers often have a working pressure of 6 ATA
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Q. How do you prepare the patient for HBOT in a monoplace hyperbaric chamber?
A. The patient can't take anything into the chamber that is not given to them by the facility staff or cleared by the facility staff.
- Explain to the patient what sensations could be experienced during their treatment (e.g. - ear pressure sensation, warmth, cooling, etc.).
- Remove all extraneous objects from patient. Extraneous objects include: loose jewelry, hand warmers, pens, cigarettes, lighters, children's toys, hearing aids, etc. Finger rings could be covered with cotton or paper surgical tape as an alternative to removal.
- Electrical appliances, any alcohol or petroleum based products are not allowed in the chamber
- Ensure the patient is dressed in cotton scrubs or other appropriate garments.
- Ensure the patient is not wearing any nylon or other spark-producing clothing. This includes wigs and other manufactured hairpieces.
- Do not allow the patient to chew gum or eat candy during treatment.
- Have the patient remove any hearing aids, non-fenestrated hard contact lenses, false teeth, or dental plates.
- Ensure the patient, if conscious, understands the planned treatment procedure.
- Assist the patient to lie down and assume a comfortable position on the Patient Transfer System.
- Prohibit, under all circumstances, the use of equipment or jewelry made of cerium, magnesium, titanium, and magnesium alloys in the chamber.
Please refer to your user's manual for all other precautions.
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Q. Is Physician supervision of the HBOT treatment required?
A. According to Center for Medicare & Medicaid Services (CMS), Supervision requirements for outpatient services — In order to ensure that hospital outpatient services are appropriately supervised by qualified practitioners while not impeding beneficiary access to these services, and in response to concerns raised by the hospital community, CMS is revising or further defining several current policies for the supervision of outpatient services. First, in CY 2010, CMS will allow certain nonphysician practitioners specifically physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and licensed clinical social workers to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to their state scope of practice rules and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.
For purposes of on-campus hospital outpatient therapeutic services, CMS is defining "direct supervision" to mean that the physician or nonphysician practitioner must be present anywhere on the hospital campus and immediately available to furnish assistance and direction throughout the performance of the procedure. For services furnished in an off-campus provider-based department, "direct supervision" would continue to mean that the physician or nonphysician practitioner must be present in the off-campus provider-based department and immediately available to furnish assistance and direction throughout the performance of the procedure.
CMS will also require that all hospital outpatient diagnostic services furnished directly or under arrangement, whether provided in the hospital, in a provider-based department, or at a nonhospital location, follow the MPFS physician supervision requirements for individual tests.
This policy is effective January 1, 2010. For more information, please visit the CMS website
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Q. Is HBOT covered by insurance?
A. Most health care plans/third party payers including Medicare reimburse for HBOT treatments performed on currently accepted indications by CMS.
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Q. How does HBOT improve wound healing?
A. All bone and soft-tissue healing process, with the exception, perhaps, of wound contraction, are oxygen dependent. Thus, so long as the local dose of oxygen is not too great, causing adverse toxic effects, hyperbaric oxygen stimulates the body's natural healing processes.
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Q. What does a patient experience during treatment?
A. The first stage of the HBOT treatment is compression, in which the pressure inside the system is gradually increased. Patients at this time may feel a bit warmer because gas compression increases chamber temperature, during decompression the opposite happens and the patient may feel cooler,. Patient may also experience a sensation of fullness in the ears, similar to the feeling encountered during the landing of an airplane. Prior to treatment, the patient will be taught a few easy methods to "clear" his or her ears to avoid discomfort. Other then these possible minor discomforts a patient in an ETC monoplace hyperbaric chamber should be able to sleep, watch the TV, or DVD located outside the chamber, or just relax.
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Technical FAQ
Q. What type of linens & gowns are allowed in the chamber?
A. According to NFPA 99 2005 Edition, section 20.3.1.5.4.2 states" Garments fabricated of 100 percent cotton or a blend of cotton and polyester fabric shall be permitted in a Class A chambers equipped with fire protection as specified in 20.2.5 and in Class B chambers.
Class A chamber is defined as: Human, multiplace occupancy
Class B chamber is defined as: Human, single occupancy.
For further information please refer to our user's manual provided with your chamber or NFPA-99
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Q. What is the recommended service for our chamber?
A. Annual preventative maintenance is the most effective way to guarantee the proper function of your chamber and reduce the possibility of non-scheduled maintenance and down time later on. Once a year is usually appropriate, however depending on the use of the semi-annual preventative maintenance may be necessary. For further information on servicing your chamber please contact our Product and Customer Support Team.
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Q. What are acceptable cleaning and disinfecting agents for the Acrylic Tube?
A. Please refer to the user's manual for your hyperbaric chamber for a list of acceptable cleaning and disinfecting agents which came with your chamber.
The disinfection of acrylic monoplace chambers has proven to be problematic due to the fact that many commercial biohazard-cleaning agents contain alcohol. While alcohol is adequate to kill many pathogens, it is destructive to acrylic. Therefore, the procedure recommended here uses sodium hypochlorite (bleach) for high-level disinfection.
Or you may contact our Product and Customer Support Team for further information
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Q. What size room is needed for one (1) ETC monoplace hyperbaric chamber?
A. Without concern for gurney storage when it is not in use, an absolute minimum space of 17' x 7' 8" (5182mm x 2337mm) is required for a single ETC Monoplace hyperbaric chamber and patient-transfer gurney. For optimal use, a somewhat larger space than the minimum is recommended (e.g. 20' x 9' (6096mm x 2744mm)).
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Q. What size room is needed for two (2) ETC monoplace hyperbaric chambers?
A. Without concern for gurney storage, space of 20' x 18' is recommended
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Q. What size room is needed for four (4) ETC monoplace hyperbaric chambers?
A. Without concern for gurney storage, space of 20' X 29' is recommended
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Q. What is the recommended flooring for the Treatment Room?
A. Flooring in the chamber space should be of non-static hard tile (e.g., computer tile) or other non-static hard surface. Waxing, unless with a non-static product, is not recommended. Carpeting is unacceptable due to its propensity to generate static electricity.
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Q. What are the pressure and flow requirements for the Air-Break assembly?
A. For Medical Grade Air used for Air Breaks,
By Demand Mask - The system must deliver at least 1.3 scfm (36 slpm).
- By Flow-through Mask - The system must deliver at least 3.2 scfm (90 slpm).
- By Changing Chamber Ventilation from Oxygen to Air - The system must deliver at least 3.2 scfm (90 slpm), and delivery of a flow between 7.1-14.2 scfm (200-400 slpm) would be much preferable.
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Q. Can the air-break be supplied from compressed air cylinders?
A. Yes, if using a mask system. If flushing the entire hyperbaric chamber with air, a central or dedicated medical air system is required
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Q. What is the maximum patient weight allowed in a BARA-MED® XD monoplace hyperbaric chamber?
A. The BARA-MED® XD patient's weight capacity is 700 lbs
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Q. What is the maximum patient weight allowed in a BARA-MED® monoplace hyperbaric chamber?
A. The BARA-MED® patient's weight capacity is 500 lbs
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Q. Can chambers be positioned in direct sunlight?
A. Sunlight can degrade the acrylic chamber making it unacceptable for service. External Windows should be covered with drapes, blinds or filter to shield the acrylic cylinder of the hyperbaric chamber from direct sunlight.
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