Each day prior to and following the delivery of hyperbaric oxygen therapy, the following inspections should be performed. The inspections should be performed and documented with the corresponding chamber serial number. Inspections should be completed with each treatment.  Routine Pre & Post treatment inspections are conducted to ensure the proper function of all equipment utilized during hyperbaric oxygen  therapy and necessary safety measures have been taken.

PRE-TREATMENT PROCEDURE: EQUIPMENT CHECKLIST

1. After completion of the Daily Inspection, the chamber can be prepared for patient care.
2. Ensure that clean, 100% cotton linen is in place.
3. Confirm the appropriate air break assembly (non-rebreather, demand valve/mask or trach collar) is in place and functional.
4. For diabetic patients validate blood glucose (BG) machine has been calibrated in accordance with institutional policy.
5. Confirm cardiac monitor is operational.
6. If performing an in-chamber TCOM, connect the internal and external cables and calibrate the TCOM.
7. Align the stretcher, lock the wheels and remove the chamber bed. 

PRE-TREATMENT PROCEDURE: PATIENT

1. Confirm the equipment pre-treatment checks are complete and have been documented.
2. Perform Patient pre-treatment safety checks and document (See Pre-HBOT Safety Check)
3. Attach ancillary equipment as indicated (e.g. cardiac monitor, TCOM, IV pump) to the patient and confirm proper function, delivery and / or alarm limits.
4. Secure the patient ground and confirm that the patient is grounded.
5. Confirm patient understanding of the "air mask" function.
6. Provide the patient with a water bottle.
7. Provide urinal or bedpan as indicated.
8. Ensure door seal area is without obstructions (e.g. sheets, pillow or IV lines).
9. Confirm IV pump (s),  monitoring devices and approved ancillary equipment is functioning properly.
10. Check for IV blanks, secure if IV fluids are not to be administered. 
11. Place patient into chamber
12. Remove gurney, taking care not to strike chamber door.
13. Slowly close door and secure cam assembly.
14. Immediately turn control valve to the ON position.
15. Confirm radio communications with patient and adjust volumes as necessary.
16. Set pressure control to desired PSIG (or ATA).
    
17. Begin compression - Inform the patient that you have begun compression.
18. Document at the time compression has been initiated "left surface" (LS).
19. 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).
20. Confirm Safety Pin has engaged (after 2 psi).
21. Communicate with the patient and confirm ear equalization is taking place. If difficulties arise, STOP compression.
22. 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.
23. Document at the time the patient arrives at prescribed treatment pressure/ "at pressure" (AP).
24. Set the timer for the prescribed "actual bottom time" (ABT).

POST-TREATMENT PROCEDURE: PATIENT AND EQUIPMENT

1. Upon removal from the chamber discuss with the patient how the treatment was tolerated.
2. Visualize tympanic membranes on all first time patients and in any case of patient difficulty or complaint. If barotrauma is observed, notify the hyperbaric physician.
3. Ensure all treatment related documentation is completed in the patient record.
4. Remove sheets, blanket and pillowcase.
5. Clean the internal and external chamber acrylic, footplate chamber door,  mattress, mattress support and pillow with manufacturer approved cleanser.  Ensure that the cleaner is used in compliance with the necessary "kill time" and institutional infection control policy.
6. Replace IV through-port blank if IV tubing was in use.