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 Lydia A Meyers RN, MSN, CWCN
I have heard some doctors and a number of other health care professionals talk about Hyperbaric Oxygen Therapy (HBOT) and my sense is not many of them truly understand what it does or how it works. HBOT is not a television station and it is not what Michael Jackson used in an effort to preserve his youth. HBOT is a true way to help wounds heal and create new blood vessels that promote increased circulation. HBOT helps to promote angiogenesis, which is the rebuilding of blood vessels during wound healing. It also promotes increased neutrophils to help fight infection.
My first days of working in the wound healing center were interesting. I can remember learning new things working with the nurses and doctors there. The regional clinical manager came in one of those early days and she was full of new information about HBOT. The patient I remember admitting for treatment that day had an unbelievable diabetic foot complication. He had three toes that were black and had already lost his big toe. I did not think this foot could be saved. In addition to his diabetes, he was a smoker, making this wound condition extremely difficult to heal.
I looked at the regional clinical manager and could not believe what she said next. She directed the clinic doctor to do a workup and to put this patient on the list for HBOT. I had heard some information about this treatment intervention and did not have strong faith it would work. The patient was scheduled for surgical debridement and HBOT prescreening.
Education was provided about how HBOT helped to heal wounds and what the patient was to expect. The patient agreed to the plan of care and the treatments were scheduled. The treatments would be performed five times a week for eight weeks. He would be reassessed weekly during that period. The transcutaneous oxygen measurement (TCOM) performed prior to the surgery showed he did have some blood flow, but would benefit from the therapy.
I learned a great deal about the benefits of HBOT during my early days at the wound healing center. I saw this patient walk out, foot healed, in addition to another patient healed by the same intervention. That was my first exposure to HBOT from beginning to end. In the two years I was at the wound healing center, I witnessed many times over patients healed with HBOT where other treatments had failed.
The other patient that has a place in my heart is a young man that had previously lost a leg to a foot wound that did not heal. This gentleman was diabetic, on dialysis and had the access in his leg with the new foot wound we were to treat. His blood flow was compromised and he was barely able to qualify by doing a TCOM in the HBOT chamber. This patient also had a pacemaker/defibrillator, which caused the treatments to be at a lower oxygen setting than normal. This foot had only a slight chance of healing even with the HBOT.
The doctor and I worked very hard to make this patient’s treatment successful. Even when he was admitted to the hospital for an infection, the doctor fought for him to come back to the wound healing center. The dialysis doctors said amputation was the only option for this patient. The wound clinic doctor I worked with refused to accept this as a treatment solution. This patient would have been unable to stay home with his parents if he had a double amputation. The patient did heal with HBOT and his foot was saved.
Do I believe in HBOT? Yes, I do. With high quality wound care and sound nutritional support, wounds that previously had not been given what they needed to heal will benefit from HBOT.
Chambers, A. &. (2011). Role of oxygen in wound healing: a review of evidence. Journal of Wound Care 20(4), 160-164.
About the Author
Lydia Meyers RN, MSN, CWCN has been a certified wound care nurse for over 15 years with experience working in home healthcare, extended care facilities, hospice care, acute care, LTAC, and wound clinics. Her nursing philosophy to "heal wounds as quickly as possible" is the guiding force behind her educational pursuits, both as a teacher and a student.
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.