By Susan Kreimer, MS, contributor
Hyperbaric medicine, also known as hyperbaric oxygen therapy (HBO), could use more nurses. The treatment best known for wound healing with other off-label uses is now offered in between 750 and 1,000 U.S. hospitals.
Stacy Handley, vice president of National Baromedical Services, Inc., provides hyperbaric consulting and training to hospitals worldwide.
“This service, in conjunction with outpatient wound care centers, has been rapidly growing over the past five years,” said Stacy Handley, BSN, RN, CWCN, ACHRN, CHT, vice president of National Baromedical Services Inc., with headquarters in Columbia, South Carolina, which provides hyperbaric consulting and training to hospitals worldwide.
The reason HBO has grown so rapidly is that hyperbaric chambers treats illnesses where the body needs more oxygen than it would normally metabolize. This can help diabetic foot ulcers, compromised skin flaps and other wounds.
To operate the chambers you need a crew of health professionals, including registered nurses. Hyperbaric units also may be staffed by certified hyperbaric technicians, respiratory therapists, physical therapists or emergency medical technicians.
Nurses perform daily assessments, operate chambers and monitor patients during treatments. They also inform patients about fire safety restrictions and key interventions, such as ear-clearing techniques to reduce trauma risks and air-breathing breaks to lower the incidence of oxygen toxicity seizures.
Nurses with experience in these chambers can earn certifications. Completing an approved course allows a nurse to take an exam after one year of experience and become a Certified Hyperbaric Registered Nurse (CHRN).
Three years of HBO practice, continuing education, national presentations and leadership experience are necessary for an Advanced Certified Hyperbaric Registered Nurse (ACHRN). Master’s prepared hyperbaric nurses with five years’ experience can apply for a Certified Hyperbaric Registered Nurse Clinician (CHRNC).
“Certified hyperbaric nurses can certainly work in both hospital and outpatient centers. Being certified makes more opportunities available to us,” said Constance L. Waltz, RN, BSN, ACHRN, director of nursing at the Robert M. Lombard Hyperbaric Oxygenation Medical Center Inc., an outpatient facility in Columbia, Pennsylvania, that her father founded in 1978.
Hospitals tend to treat conditions covered by insurance, such as gas embolism, carbon monoxide poisoning, radiation tissue injury and refractory osteomyelitis (bone infection).
According to Claude Wexford-Brown, RN, ACHRN, clinical manager for the Center of Hyperbaric Medicine at Virginia Mason Medical Center in Seattle, Washington, it is difficult to find registered nurses who are experienced and certified in hyperbaric medicine.
Freestanding facilities also may consider hyperbaric medicine for various off-label uses – multiple sclerosis, Lyme disease, cerebral palsy, stroke, migraines and lupus, to name a few.
It is difficult to find registered nurses who are experienced and certified in hyperbaric medicine, said Claude Wreford-Brown, ACHRN, clinical manager of the Center for Hyperbaric Medicine at Virginia Mason Medical Center in Seattle, Washington.
The center, which mainly treats radiation tissue injury, usually hires critical care RNs and puts them through a 40-hour approved course. Then the center sponsors the nurses as they obtain their certifications.
“Nationally, there is an increase in chambers, but quite often the staffing is by certified hyperbaric technicians,” Wreford-Brown said. “We have a mix.”
The primary location for hyperbaric units is still in hospitals, said Harry G. Vincent, BSN, RN, CHT, MHA, chief operating officer of Hyperbaric Departments Inc., which contracts with CHRISTUS to operate its Santa Rosa Wound Care & Hyperbaric Center in San Antonio, Texas. “For any federal funding (Medicare/Medicaid), you must bill for HBO under a hospital provider number.”
Vincent has observed a transformation in the field. Facilities that used to provide only hyperbaric oxygenation have become comprehensive wound centers that offer this modality along with other services because good wound care is not always available in every location.
“It doesn’t make sense to provide expensive HBO treatments and then apply something to the wound that may not help, and in some instances, may retard healing,” he said.
A hyperbaric and wound care nurse for 22 years, Vincent estimated that good results occur at least 80 percent of the time with this therapy.
“We don’t win them all,” he said. “I have learned to appreciate the human body and what it can do, and patients who really buy into their disease and work with you to get well.”
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