CHAMBER DOOR OPERATIONS

Opening

1. Chamber pressure must be at 1 psi or less.
2. Turn chamber control knob to the OFF position.
3. Ensure the pressure indicator shows zero pressure (complete black eye).
4. Confirm pressure safety lock has retracted.
5. Slowly Rotate swing arm (clockwise) the full extent of travel.
6. Open door with handle.

NOTE: No attempt should be made to open the chamber door until the pressure indicator eye is completely black.

Closing

1. Ensure the door seal is clear of obstructions, slowly move the door to the closed position.
2. Rotate the swing arm assembly to the closed position.
3. Ensure the swing is in the closed position, then rotate to the locked position.

NOTE: When the chamber is occupied, Immediately turn the control knob to the ON position.

COMMUNICATION SYSTEMS OPERATIONS

The Intercommunication System allows a two-way private conversation between the patient and hyperbaric technician. Auxiliary sound input is accessed thru two standard RCA connections located at the rear of the chamber. The system is comprised of the following components: Intercom Assembly located on the Chamber Control Panel,  Intercom Power Supply/ Battery Charger, Built-in battery back-up.   

Two (2) speakers are provided within the Chamber for an auxiliary audio program source (e.g., television sound or music). Connections to the Speakers are made through two Auxiliary Input Connectors (a standard RCA Jack) located at the Base. 

The chamber (intercom) is equipped with a battery back-up system that is used in case of a power failure. The electrical service is only necessary to power the intercom system and will continue normal operation of the intercom for a minimum of 30 minutes.  An indicator light confirms that the charger is in operation and functioning correctly. [1]

NOTE: Be aware of the potential for excessive noise resulting from the entertainment source. Particular attention should be given when decreasing the external speaker volume to ensure that communication with the patient is not compromised. 

CHAMBER OPERATION

Compression

1. Equipment pre-treatment checks complete and documented.
2. Patient pre-treatment checks complete and documented.
3. Confirm the equipment pre-treatment checks are complete and have been documented.
4. Confirm that the patient is grounded.
5. Confirm patient understanding of the "air mask" function.
6. Ensure door seal area is without obstructions (e.g. sheets, pillow or IV lines).
7. Confirm IV pump(s),  monitoring devices and approved ancillary equipment is functioning properly.
8. Check for IV blanks, secure if IV fluids are not to be administered. 
9. Place patient into chamber
10. Remove gurney, taking care not to strike chamber door.
11. Slowly close door and secure cam assembly.
12. Immediately turn control valve to the ON position.
13. Confirm radio communications with patient and adjust volumes as necessary.
14. Set pressure control to desired psig (or ATA).
    
15. Begin compression - Inform the patient that you have started compression.
16. Document at the time compression has been initiated "left surface" (LS).
17. Confirm the rate of compression is appropriate for patient.  All first time patients are to be compressed a 1-1.5 psi/min. (as tolerated for further treatments).
18. Confirm Safety Pin has engaged (after 2 psi).
19. Communicate with the patient and confirm ear equalization is taking place. If difficulties arise, STOP compression.
20. Observe the infusion tubing closely (when in use) to confirm it remains free of air bubbles. If air is observed, regardless of its volume, stop the pump and remove air. If the air is in the tubing within the chamber, return the patient to 1 ATA. Flush the line and then return to the compression phase.
21. Document at the time the patient arrives at prescribed treatment pressure/ "at pressure" (AP).
22. Set the timer for the prescribed "total bottom time" (TBT).
23. Observe and maintain visual contact with the patient at all times during treatment

NOTES:

The chamber operator should remain near the chamber console with visual contact throughout the compression phase. This is irregardless of the pressure rate set or the experience level of the patient.

In the event you are required to leave the controls during compression (equipment alarm, telephone, attend to another patient, etc.), halt further compression and confirm that the patient is stable. Ensure the volume control is adjusted so the patient can be heard. Resume compression as soon as possible. Audio from the TV or radio is not to be provided to the patient until the chamber has reached treatment pressure and the patient confirms he/she is comfortable.

At Pressure

1. Confirm chamber pressure gauge reads desired pressure and adjust set pressure as indicated.
2. Confirm chamber pressure corresponds with the prescribed treatment pressure.
3. Communicate throughout the treatment to ensure the patient is not experiencing ear pain, shortness of breath or confinement anxiety.
4. Adjust flow rate if necessary for patient comfort. This should be performed in  accordance with institutional policy. 
5. Provide entertainment (TV or audio) as requested. Check chamber audio level does not "drown out" patient's voice communications.
6. Chart patient's progress per institutional policy.
7. Routinely check ancillary equipment during the entire treatment.

NOTE: Under NO circumstances is the chamber room to be left unattended (by hyperbaric trained personnel) during a treatment.

Decompression

• Inform the patient that you are about to begin ascent and will be decreasing the pressure.
• Confirm rate control setting.
• Turn the set pressure gauge (counter-clockwise) below zero. Document time - left pressure (LS).
• Observe the patient during ascent. Communicating throughout to confirm that the ascent is being tolerated well.
• Decrease the volume of entertainment as needed to ensure clear communication with the patient. 
• Remind the patient that ear equalization techniques are not required during ascent.
• Stop and hold ascent if difficulty arises.
• Upon arrival at 1 psi (chamber pressure), confirm safety pin has retracted.
• Inform patient you will be removing them from the chamber.
• Chamber pressure must be at 1 psi or less.
• Ensure the pressure indicator shows zero pressure (complete black eye).
• Turn chamber control knob to the OFF position.
• Confirm pressure safety lock has retracted.
• Slowly Rotate swing arm (clockwise) the full extent of travel.
• Open door with handle.
• Connect gurney and secure wheel lock.
• Tell patient you are about to remove them, ensure patient's arms are clear of monitor cable (if in use).
• Remove stretcher to the lock position on gurney.
• Document the time the patient is "at surface" (AS).

Primary Sources Sechrist Industries Monoplace Hyperbaric Chamber users Manual[1] National Baromedical Services[2]

REFERENCES

1. Sechrist Industries. Sechrist Industries Monoplace Hyperbaric Chamber Users Manual .;.
2. National Baromedical Services. Introduction to Hyperbaric Medicine Primary Training Manual .;.