(1) Personnel access
1. Hyperbaric oxygen practitioners, like other clinical professional staff, require good medical ethics. Good health, able to work under high pressure environment.
2. The hyperbaric oxygen department (room) should be staffed strictly in accordance with Table 1
Table 1 Staffing table of hyperbaric oxygen department (room)
Cabin-type medical doctor nurse technician
Oxygen pressurized chamber
(Single cabin) Infant cabin 1 full-time or part-time 1 full-time 1 part-time 1
Adult cabin full-time or part-time 1 full-time 1-2 full-time 1 part-time
Air pressurized cabin
(Multi-occupant cabin) Small multi-occupant cabin Full-time 1-2 full-time 2 full-time 1 full-time
Medium multi-occupant cabin Full-time ≥2 Full-time ≥2 Full-time 1
Large multi-occupant cabin Full-time ≥2 Full-time ≥2 Full-time 1-2
Note: Refer to the 2004 "Medical Hyperbaric Oxygen Chamber Management and Application Specification" of the Chinese Medical Association Hyperbaric Medicine Branch
3. Hospitals in all regions and cities with hyperbaric oxygen chambers with more than 12 people must establish an organizational hyperbaric oxygen department, and deploy medical, nursing, and technical staff according to these requirements.
4. Physicians in the hyperbaric oxygen department (room) require a bachelor's degree or above in clinical medicine from a higher education institution; nurses require a college degree or above in nursing specialty; technicians require a technical secondary school degree or above in mechanical and electrical engineering.
5. Hyperbaric medical staff and technicians must go to the training center of the Shandong Hyperbaric Medical Quality Control Center designated by the Medical Administration Department of the Provincial Health and Family Planning Commission to receive training, and pass the examination and obtain the "Hyperbaric Training Qualification Certificate" before they can work ( (See Ministry of Health document in November 2007).
6. The maintenance and management technicians of the hyperbaric oxygen chamber must be trained and evaluated by an institution recognized by the State Quality and Technical Supervision Bureau, and pass the examination to obtain the "Special Equipment Practitioner Certificate" before they can start their jobs and review them on schedule. (See the 2003 State Council Order of the People's Republic of China, Article 373 <Article 77 of the Regulations on Safety Supervision of Special Equipment>). Units that use medical hyperbaric oxygen chambers without a certificate shall not use oxygen chambers.
(2) Access to equipment and facilities
1. The medical hyperbaric oxygen chamber must be inspected and accepted by the local quality and technical supervision department, and the "Special Equipment Use Permit" can be obtained before the chamber can be opened to admit patients. The unit using the oxygen chamber shall report the use of the oxygen chamber to the provincial and municipal hyperbaric oxygen medical quality control centers as required.
2. The hyperbaric oxygen department (room) should strictly follow the following requirements for house configuration:
(1) Air pressurized cabin:
①Treatment hall (with sufficient cabin area), machine room (including air storage, power distribution, oxygen room, etc.), (the height of the bilge maintenance floor ≥2000mm)
②The office area has independent medical, nursing and technical offices, duty rooms, washrooms, toilets, and warehouses; the diagnosis and treatment area has a waiting room, diagnosis room, rescue room, men's and women's changing rooms, disinfection rooms, and toilets. Departments where conditions permit should set up scientific research sites such as animal laboratories. The internal space and path layout of the department are reasonable, which is convenient for the rescue of critically ill patients and patients who need to be isolated for special infections to enter and exit the oxygen chamber.
③There are emergency passages in the waiting area, and fire passages around it, and the distance from the oxygen supply station, sewage treatment station, morgue, garbage dump, etc. is more than 100 meters.
(2) Oxygen pressurized cabin: ① Including oxygen cabin treatment room and oxygen room. ② The adult oxygen cabin should have a shared medical office, separate dressing room and toilet. ③Oxygen cabins for infants and young children can be implemented with reference to adult oxygen cabins, or only oxygen cabin treatment rooms and oxygen rooms can be provided.
3. The inside and outside of the hyperbaric oxygen chamber shall be equipped with fire-fighting facilities in strict accordance with requirements and have eye-catching fire-fighting signs.
4. Before opening a hyperbaric oxygen chamber, a medical oxygen chamber certificate, a pressure vessel use certificate, and a medical oxygen chamber use certificate must be obtained.
(3) Management system and job responsibilities
1. Various management systems: including hyperbaric oxygen section (room) safety management system, hyperbaric oxygen section (room) work system, cabin personnel management system, oxygen chamber disinfection and isolation system, computer room management system, oxygen supply room management system, storage Gas tank management system, power distribution panel and power distribution box management system, oxygen cabin equipment maintenance and repair system, infant oxygen cabin safety management system, and employee health protection system (see Appendix 1).
2. Job responsibilities at all levels: including the job responsibilities of the department director, medical technicians, cabin operators, and cabin crew.
Oxygen is one of the three major substances that organismsdepend on for survival. Without one of oxygen, water and food, life stops. Among the three substances, there is only oxygen. The body is the least able to store it. People can live for 6 days without supplementing water. People can live for 6 weeks without food. But if a person’s life stops supplying oxygen, his life can only survive for 6 minutes. Therefore, for the continuation of life, oxygen is the most important of the three substances.
So what is hyperbaric oxygen therapy? Simply put, the process of inhaling high concentrations of oxygen to treat diseases in an environment above one atmosphere is called hyperbaric oxygen therapy. Generally, people need to perform hyperbaric oxygen therapy in the environment of a hyperbaric oxygen chamber.
What is the difference between hyperbaric oxygen and atmospheric oxygen? Under normal circumstances, we inhale oxygen into the lungs, and then the red blood cells in the blood transport the oxygen to all parts of the body. If a patient has 15 grams of hemoglobin per 100 milliliters of arterial blood, experiments have found that every 1 gram of hemoglobin can carry 1.34 milliliters of oxygen, and then every 100 milliliters of arterial blood can carry 20.1 milliliters of oxygen (15×1.34). When all hemoglobin carries oxygen, and then inhale more oxygen, the oxygen content in the blood will not change much. So, what if the patient is still hypoxic at this time? The problem of hypoxia can be solved by increasing the physical dissolved oxygen in the blood. How can we increase the dissolved oxygen in the blood? It is known that the solubility of gas in liquid increases with increasing pressure. Oxygen inhalation under high pressure (in a hyperbaric oxygen chamber) can significantly increase the dissolved oxygen content in the patient's blood. Under certain pressure, if all the hemoglobin in the patient's body is removed, only the dissolved oxygen in the blood can meet the metabolic needs of the patient's body.
What is the effect of hyperbaric oxygen? The effect of hyperbaric oxygen is wide and unique, and there is no other way to replace it. Simply put, hyperbaric oxygen has the following effects:
1. Promote cell aerobic metabolism, correct cell hypoxia, and enable cells to carry out adequate aerobic metabolism.
2. Broad-spectrum antibacterial effect, not only against anaerobic bacteria, but also against aerobic bacteria.
3. It can shrink the arteries at the edema site, reduce local blood volume and reduce edema.
4. Promote the bactericidal effect of white blood cells. Sufficient oxygen supply, increased peroxide substances, and enhanced white blood cell sterilization.
5. Promote the antibacterial effect of certain antibiotics.
6. Increase the permeability of the blood-brain barrier. When there are lesions in the skull (such as infections, tumors), the simultaneous use of hyperbaric oxygen and drugs can increase the concentration of drugs in the skull and increase the efficacy.
7. Promote the discharge of harmful gases, such as coal gas and methylene chloride.
8. Regulate immune function. So far, studies have found that hyperbaric oxygen has a two-way regulatory effect on immune function-allergies can be suppressed, and low ones can be enhanced.
9. Health effect. As the age increases, some cells (such as brain cells) will experience hypoxia, ischemia, insufficient aerobic metabolism, and finally die. For example, before these cells die, adequate oxygen supply is given regularly, which can delay and reduce the speed and number of cell death.
Is hyperbaric oxygen harmful to normal people? As long as the treatment plan is selected properly, hyperbaric oxygen will not cause harm to people. In clinical work, doctors and family members often enter the cabin to accompany patients for treatment. Although some family members of patients do not take oxygen, under high pressure, some chronic diseases in the cabin are alleviated and even cured unknowingly.
macypanhbot tells you the main technical parameters of the medical hyperbaric oxygen chamber
1. Main technical data
1) Cabin type: one cabin, two rooms and four doors
2) Main technical data and requirements:
Diameter of cabin body: Φ2200mm.
Length of cabin: 6000mm.
Cabin volume: total volume 21m3, main cabin volume 13.8m3, auxiliary cabin volume 7.2m3.
Effective height in the cabin: greater than 1.80m.
Clear ground width: 0.8m.
3) Design pressure: 0.30MPa (4.0ATA).
4) Working pressure: 0.20MPa (3.0ATA).
5) Number of people treated: 6 (4+2).
6) Pressure and pressure control method: manual control.
7) Increasing and decompressing rate:
Minimum compression rate: ≤0.004MPa/min when used as a treatment cabin
When used as a transition chamber ≤0.004MPa/min
Maximum compression rate: when used as a treatment cabin ≥0.050MPa/min
When used as a transition tank ≥0.100MPa/min
Minimum decompression rate: when used as a treatment cabin ≤0.008MPa/min
When used as a transition chamber ≤0.008MPa/min
Maximum decompression rate: when used as a treatment chamber ≥0.050MPa/min
When used as a transition chamber ≥0.080MPa/min
8) Temperature control requirements: Summer: 24-28℃±2℃ Winter: 18-22℃±2℃
9) Cabin noise: When pressurized: ≤65dB (A) When air-conditioned: ≤60dB (A)
The actual noise of the air conditioner is around 55dB(A)
10) In-cabin illuminance: In-cabin illuminance value Ë≥60Lx illuminance unevenness ≤60%.
11) Ambient oxygen concentration in the cabin: ≯21%
12) Oxygen inhalation and discharge resistance: oxygen inhalation resistance≮-50Pa, exhalation resistance≯50Pa
13) Grounding resistance value: ≯2Ω
14) Entry voltage: ≯12V
15) Emergency equipment outside the cabin:
The time from the highest working pressure to 0.01MPa ≤ 2.5 minutes ≥ 1.0 minutes
2. Main supporting equipment
1) 4 sets of cabin airtight doors
Rectangular self-sealing thin shell door
Door clearance size: height 1300mm width 650mm
[Self-sealing thin-shell rectangular door]
The sealed door is processed by a stamping one-step forming process, and the stress distribution of the door panel is uniform. Only a small cabin pressure (0.005MPa) is required to tightly fit the door panel and the fence.
The handle of the cabin door adopts an elastic self-sealing structure, and the handle is gently pulled out, and the handle can step into the self-sealing elastic positioning groove. At this time, the door can be closely attached to the door hole fence. In the process of closing the cabin door, no ancient and complicated mechanical locking device is needed, which is convenient to open and close and has good sealing performance.
2) 6 sets of oxygen inhalation device
Equipped with 6 sets of oxygen breathing machines for hyperbaric oxygen chambers, assembled in a stainless steel plate processing equipment box. Oxygen inhalation and oxygen exhaust devices are assembled into an assembly, which are respectively arranged on the side of the reserved seat, which can be used by patients to inhale and exhaust oxygen in the cabin.
3) 6 sets of seats in the cabin
The cabin seats are designed as fixed luxury seats, arranged in two rows along the bulkhead on both sides of the floor in the cabin. The width and length of the seat are in line with the standard seat size.
4) Observation window
Light transmission size of the observation window: Φ150mm.
There are 4 main cabins, 2 on each side, 2 auxiliary cabins, and 1 on each side.
The observation windows are assembled at the best positions on both sides of the cabin in an even number, and are at the same height; the center elevation of the observation windows is at a suitable height from the ground to facilitate the doctor to observe the patient. Before the formal use, the plexiglass of the observation window is protected by the plastic film. The observation window plexiglass is a transparent, pressure-resistant partition, made of industrial first-class plexiglass, the thickness is 30mm, and the design life is 5000 times of pressure. The medical staff can observe the condition of the patient in any position in the cabin through the observation window while standing on the ground.
5) Camera device The light transmission size is Φ100mm. 2 sets
1 set each for main and auxiliary cabins
6) 3 sets of cold light source lighting devices
2 sets in the main cabin
1 set of auxiliary cabin
7) 4 sets of emergency relief valves for cabins
(1) Location: The emergency relief valve outside the cabin is installed near the console;
(2) Marking and valve handle: the valve body is painted with red eye-catching mark, the valve stem is upward, and the valve handle is pressed down;
The emergency relief valve configured in each compartment can release the pressure of the compartment at a working pressure of 0.2MPa within 2 minutes.
8) Cabin delivery tube
(1) Quantity: 2 sets;
(2) The size of the delivery tube: Φ325×400mm (clear space)
(3) Attachment of the delivery barrel: equipped with 1 balance valve and 1 pressure gauge; 1 set of safety interlock device.
Sealing structure: The outer end cover is equipped with a quick-opening swing ring compression sealing device, and the inner end cover is a special opening and closing system.
The delivery barrel is assembled on the back side of the door hole at the outer end of the treatment cabin, and the delivery time of the delivery barrel is not more than 1 minute.
9) Bulkhead outfitting materials
The bulkheads are outfitted with plastic-sprayed panels, which have high strength, do not change color and will not oxidize. The joints are decorated with aluminum alloy battens, and the structural framework for outfitting is welded with square steel.
10) The ceiling and outfitting materials in the cabin are made of high-grade mirror-finished stainless steel plates: the floor in the cabin is laid with imported ceramic tiles.
11) Seat skirt
The apron under the seat and the side guard of the seat are outfitted with electrostatic sprayed steel plate.
12) 2 sets of multifunctional connecting board (including first-level oxygen inhalation device)
1 set each for treatment cabin and transition cabin
The multi-function connecting board is equipped with oxygen supply flow meter, flow control valve, quick-plug oxygen supply nozzle, sputum suction vacuum meter, connection socket and other devices. It can be used for severe patients such as tracheotomy and nasal intubation. It is connected with a balanced oxygen inhalation and exhaustion helmet and a mobile micro-resistance respirator.
Each set of multifunctional connectors can temporarily connect 2 sets of oxygen inhalation and exhaust devices to increase oxygen therapy for two patients.
13) 1 set of balanced oxygen suction and exhaust helmet
It has the functions of supplying oxygen on demand, automatically balancing the pressure inside and outside the hood, and discharging oxygen appropriately. The CO2 concentration in the helmet can be controlled according to the oxygen flow. It can save the oxygen consumed by the human body exponentially, without consuming the gas in the cabin, and will not increase the oxygen concentration in the cabin environment.
14) Supply and exhaust system
Non-asbestos materials are used for the gasket material of the supply and exhaust system. The pipeline from the air filter to the cabin body is made of stainless steel pipes, which meet the requirements of the latest national standards.
15) Console
(1) Quantity: 1 group (combined type).
(2) Structural form
The longitudinal axis of the main console is parallel to the longitudinal axis of the oxygen chamber body. It adopts piano structure, beautiful and coordinated appearance, and the color of the surface paint is the same as that of the cabin. Arranged in the middle of the oxygen cabin body, the console inspection door is 600mm away from the oxygen cabin body. The arrangement of instrumentation fully takes into account the independence of each system and the concentration of each instrument function.
16) Instrumentation
(1) One oxygen source pressure gauge
(2) One oxygen pressure gauge
(3) Two air pressure gauges in the cabin
(4) 2 precision pressure gauges
(5) Air source pressure gauge 1
(6) 2 sets of temperature controller
(7) One intercom monitoring emergency alarm system
(8) 1 set of CD music device
17) Monitoring system
Color monitor 14 inches 1 set
Color lens 2 sets
2 cameras
Switch 1
18) Oxygen supply control device
Single oxygen inhalation flow meter 6 sets
19) Oxygen meter
2 intelligent oxygen measurement and printing integrated machines
20) 2 sets of gas sampling flow meters
Use with oxygen meter
21) Emergency call device 2 sets
Performance: Non-contact proximity switch .
22) Split type air-conditioning system (external magnetic driving device) 2 sets
[Air conditioner magnetic drive device]
All the electrical components and electrical parts on the original air conditioner were moved out of the cabin, and the motor on the original air conditioner fan was removed and replaced with a magnetic drive device installed outside the cabin. The air-conditioning magnetic drive device can drive the air-conditioning fan in the cabin through the cabin, its power is greater than the actual power of the original air-conditioning motor, and the combined noise of the operation with the air-conditioning fan is less than 55dB(A). During the operation of the device, the personnel in the cabin basically cannot hear the noise, and the gas in the cabin will not leak out under any conditions, and the service life can reach at least a ten-year continuous operation period.
23) Air supply system
(1) 2 sets of oil-free air compressor
0.7m3/min 1.4MPa
(2) 2 sets of gas storage tanks of 5 cubic meters and 1.4MPa
(3) 1 air filter
(4) 1 air cooler
(5) 1 oil-water separator
(6) 4 silencers
24) Oxygen cabin power distribution cabinet
(1) One isolation transformer
(2) Emergency power supply 1 set
(3) 1 air compressor distribution box
(4) 1 set of electrical components and facilities
(5) Cabinet shell 1
25) Water sprinkler system
(1) 2 sets of mechanical manual control valves
(2) 6 sets of deluge valves
(3) 1 set of fire water tank
Main technical parameters of pulse vacuum sterilizer
1. Technical parameters of pulsating vacuum steam sterilizer:
1) Specifications: 1.0 cubic motor double door
2) Interior size: 1790*610*915 (mm)
3) Design pressure: 0.25(-0.1)Mpa
4) Design temperature: 138℃
5) Working pressure: 0.23Mpa
6) Working temperature: 136℃
7) Total power of equipment: ≤35KW/380V
8) Equipment net weight: ≥2000Kg
9) Stroke cycle: about 45min
10) Cooling water consumption: ≤260 Kg /time
11) Dimensions: 2136*1264*1823 (mm)
2. Description of functional requirements: motorized double doors, color touch screen control, Chinese number, curve printer, built-in steam generator.
1) Door and door rubber strips: The door rubber strips are installed on the back of the door, not on the cylinder body to avoid long-term heating of the door rubber strips and prolong the service life.
2) Vacuum pump: bipolar split water ring vacuum pump, belt drive.
3) Pneumatic valve: Imported pneumatic valve, no trouble-free operation for more than 4 million times.
4) Main control system: imported brand programmable controller (PLC).
5) Software program: There are six programs for dressing, equipment, BD, lower exhaust steam, two free settings, set in minutes (0-999 minutes), easy to understand, minimum display value Is 0.1 seconds.
6) Touch screen: 5.0-inch color touch screen, Chinese and digital dynamic display, self-test function, automatic alarm and fault printing record when failure occurs, and can display the temperature and pressure of the jacket and interior at the same time (convenient for timely inspection to ensure safety ).
7) Micro printer: imported printer, Chinese number, curve printing.
8) Door motor: high temperature silent door motor.
9) Pressure sensor: imported pressure sensor.
10) Safety: Double doors are automatically interlocked, pressure and temperature are over-high alarm, dual control, safer, the thickness of the cylinder is 8mm, and the service life of the equipment is guaranteed to be more than 10 years.
11) The programmable controller of the main control system and the original electrical control are separated from the cylinder and installed on the panel side of the equipment, which can be repaired and monitored from the front; avoid long-term heating of the programmable controller of the main control system and the original electrical control , Reduce the failure rate.
12) Vacuum pumps, pipes, electrical appliances and all accessories that need to be repaired must be installed on one side of the equipment, independently suspended to reduce vibration, facilitate maintenance, reduce vibration, and extend the service life of the equipment.
13) The equipment comes standard with 1 sterilization vehicle and 2 loading vehicles.
Main technical parameters of fully computerized multifunctional steam therapy machine
1. A treatment bed with massage function can perform multi-mode and multi-part treatment at the same time.
2. The treatment bed is equipped with two sets of medicine boxes, which can choose multiple medicines for steam bath therapy at the same time.
3. 11 sets of waterproof mattresses can be freely combined to adjust the fumigation position.
4. The treatment bed has multiple steam spray holes and unique steam spray hoods, and can perform up and down front and back, whole body or local moving positioning treatment at the same time.
5. One machine with multiple functions, in addition to steam therapy, it also has bath therapy and massage functions.
6. Adopting the most advanced secondary cycle temperature adjustment technology, the temperature can be adjusted from 38-60℃, the steam volume is large, and the temperature adjustment is accurate.
7. Full computer control, touch buttons, LCD screen, and display of human body treatment diagram.
8. Adopting the most advanced PLD digital control technology, automatic decoction, automatic time control, automatic temperature control, automatic heat preservation and other functions.
9. The equipment has the functions of low water level automatic alarm and shutdown, automatic alarm and shutdown when the time is reached, automatic shutdown with anti-leakage protection, heat preservation in standby state, and high temperature and ultra low temperature control.
10. The bed body is made of high-strength anti-corrosion materials, and the interior is all stainless steel, which is durable, elegant and beautiful.
11. Five groups of ten major acupoints, multi-site and multi-way massage, effectively stimulate acupoints and accelerate drug penetration.
(Massage parts: neck, shoulders, waist, legs and feet, body parts; massage methods: acupressure, flapping, pounding, pounding, slow kneading, circulation mode; massage five levels of intensity (strong, medium, weak).
12. Equipped with patient temperature controller, which is convenient for patients to adjust the treatment temperature by themselves.
13. Free ozone sterilization device, safe and reliable to use.
14. Voltage: 220V/50HZ; power single bed 2000W.
15. Size: Bed: 2000×700×1250mm.
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.
What is the working system of hyperbaric oxygen chamber
1. Medical staff should be neatly dressed, dignified, rigorous, careful, and meticulous to ensure the safety of hyperbaric chamber treatment.
2. People who are not in this room are not allowed to enter at will. Visitors must ask for permission before receiving. Smoking is strictly prohibited in the room.
3. Familiar with the hyperbaric chamber environment and the performance of various facilities, master the operation and use methods, and ensure that the components are in good working condition.
4. Except for the cabin crew, all instruments, switches, and communication systems on the console are not allowed to be touched casually. During the opening of the cabin, it is not allowed to use the private line contact number inside and outside the cabin. Chatting, listening to music, etc. are not allowed.
5. All kinds of rescue items, equipment and conventional supplies should be prepared in the cabin, and a dedicated person should be responsible for regular inspection, supplementation, positioning and placement, and maintaining a standing state.
6. Before entering the cabin, the patient must change cotton clothes, trousers, socks and slippers. It is strictly forbidden to bring flammable, explosive, and pressure-sensitive items into the cabin, such as chemical fiber clothes (cotton, nylon, polyester, cyan), ethanol , Lighters, matches, pens, watches, tape recorders, pagers, mobile phones, etc. Strictly supervise and inspect each time before entering the cabin to avoid accidents.
Seven, do a good job of explaining the patient, introduce in detail the precautions for entering the cabin, eliminate tension, and obtain the cooperation of the patient.
8. It is forbidden to play around in the cabin, walk back and forth and make loud noises, spit on the ground, littering peels and other debris, not to disturb the cabin equipment and hit the bulkhead with heavy objects to avoid accidents.
9. Operators must strictly guard their jobs and are not allowed to go out without permission. Always keep in touch with the cabin, inquire about changes in the condition, report to the doctor immediately in case of special circumstances, and make emergency treatment.
X. Strict operating procedures, carefully keep operating records, and are not allowed to change the treatment plan without asking for instructions.
11. After exiting the cabin, clean up the cabin, irradiate it with ultraviolet rays for 30 minutes, and ventilate for 30 minutes in time, mopping the ground with 0.2% peroxyacetic acid, cleaning once a week, and air cultivation once a month. Keep the cabin clean, tidy, and orderly placed.
12. Bacillus infections or infectious diseases should be thoroughly disinfected after leaving the cabin. The cabin should be closed for 3 days and the bacteria culture should be negative for 3 consecutive days before it can be activated.
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