By Lauren Lazarevski, RN, BSN, CWOCN
As summer begins to wind down and we look ahead to Halloween, let’s discuss some “creepy crawlies” we may encounter in wound care that may cause apprehension in even the most seasoned health care staff.
By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS
Many people do not realize that the two most common issues we see in hyperbaric oxygen (HBO) therapy patients are ear/barotraumas and a decrease in their blood glucose level. In general, HBO is very well tolerated and requires little other than a commitment to the treatment series.
If you have ever flown on an airplane, you know the feeling of what it means to have your ears be "blocked." This is the same as what you feel occasionally when in an HBO chamber. This is because of the pressure when diving. In order to clear this, we instruct the patient in ways to "clear" their ears, one of which is a valsalva maneuver. An over-zealous clear/valsalva maneuver can rupture the round window and cause permanent damage. It is important to have the HBO technician watch patients at all times, check in with the patients about their comfort level and any ear pain, and remind the patients on clearing their ears. It is important to monitor the "grading" of the ear and the signs and symptoms of barotraumas. If wax builds up, providers may irrigate as this can eliminate frequent feelings of "being blocked up."
There are only a few side effects from HBO which effect the patient's vision. If the patient has cataracts, it can actually worsen the cataract. If a patient has near vision, during the course of treatment the vision can temporarily improve. However, far vision can worsen.
Glucose metabolism is somehow effected by hyperbaric hyperoxia and tends to be seen more severely in those who are insulin dependent. The research on the mechanism that causes this drop is still not completely understood. However, we do know this happens from a clinical monitoring standpoint. That being said, it is considered best practice to check the finger sticks before and after treatment of HBO. Monitoring of the insulin used and food intake is essential in making sure the patient does have a critical drop in blood sugar while in the chamber. If needed, having the patient's endocrinologist involved can minimize the risk of having the patient be too low due to insulin dosage. Due to the drop in blood sugar levels, it is encouraged to have them be above 120-150 (depending on the research read), as typically the levels drop by 56mg/dL (UHMS, 2003).
On a personal note, I would like to take a moment and recognize Dr. Peter Sheehan for all his wound care contributions during his lifetime. He was an internationally-respected and pioneering force in the field of diabetes. He passed away May 16, 2014.
About the Author
Lindsay (Prussman) Andronaco is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. Her clinical focus is working with Diabetic Limb Salvage/Surgical/Plastic Reconstruction patients, though her interests and experience are varied and include surgical, urological and burn care, biotherapeutics and Kennedy Terminal Ulcer research. Lindsay is the 2011 recipient of the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse' and has been recognized in Case In Point Magazine as being one of the "Top People in Healthcare" for her "passionate leadership and an overall holistic approach to medicine."
Lindsay is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. In 2011, Lindsay was honored with the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse.'
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.