Hyperbaric Chamber Overview Michael Natoli, MS, CHT Center for Hyperbaric Medicine and Environmental Physiology Duke University Medical Center Durham, NC 27710 Duke Pilot Chamber Duke Chamber Complex G C H D F B A E Seven chambers can be operated independently or in combination A, B, C - Clinical D, E, F, G – Research H – no longer attached Duke Chamber Complex Main Deck Second Deck Golf Foxtrot Golf Delta Echo Charlie Bravo Alpha Chamber Construction Chamber Foundation G-Chamber Addition Main Control Console Don Bordeaux, 2005 Design Specifications and Operational Guidelines • ASME: BPV sec. VIII & PVHO-1 American Society of Mech. Eng. Boiler and Pressure Vessel Code Pressure Vessels for Human Occupancy PVHO-2: In service guidelines for PVHO acrylic windows • NFPA – 99 and 53 M National Fire Protection Agency • CGA (multiple) Compressed Gas Association Certifying Agencies • US Navy Inspected every three years • Department of Health and Human Services Food and Drug Administration (FDA) Center for Medicare and Medicaid Services Clinical Laboratory Improvement Amendments (CLIA) • State of North Carolina Department of Labor – Boiler Safety Bureau Certifying Agencies (cont.) • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) • College of American Pathologists (CAP) • Undersea and Hyperbaric Medical Society (UHMS) US Navy Pipe Color Coding • Originally developed in 1928 American Standards Association. (Now ANSI) Oxygen Nitrogen Special Gas Helium Air Exhaust Vacuum Potable Water Fire Deluge System Air Quality Standards US Navy Guidelines – – – – – – O2 CO2 CO Hydrocarbons Particulate and oil mist Moisture < < < < < 20 - 22 % 500 ppm 20 ppm 25 ppm .005 mg/liter .02 mg/liter • Independent laboratory test every 6 months. Compressors • Built by Norwalk 1936 Four stage HP Water cooled 100 cuft/min Synthetic oil lubricated (Anderol 500) Compressors and Filters Intake filter Relief valve Dew Pt. Monitor Compressors CO Monitor #1 1200 psig Back Press. Valve Charcoal filter To chambers #2 Cooling coil Coalescing filter Drying towers To storage Roughing filter #3 Final filter Cyclone separator Drains Air Storage Banks 24 storage cylinders 42 cu. ft. per cylinder water capacity 218,000 cu. ft. at 3,000 psi To chambers Reference Emergency Air Delivery Control Main Reducing Back-up Emergency storage Bypass Relief valve From Compressors By-pass Bank 1 Bank 2 Electrically Operated Bank 3 Air Delivery Reducing Station Control Console Rate Selector Spray Valve Ventilation Rate Emergency Stop Control Method Reference Control Rate Controlling Valve DP Cell Polarity Gauge DP Cell Isolation Pressurization Control Gauge on console Proportional control valve Muffler Emergency stop valve Chamber wall Manual Manual (back-up) From reducing station 450 psig Decompression Control Manual Proportional control valve To exhaust duct Emergency stop valve Ventilation valve Flow meter Internal Environmental Control Pneumatic valves Muffler Cold water Hot water Heating / Cooling Coils Lubrication level Electric motor Blower Air flow Shaft seal Temperature indicator Thermistor External Environmental Control Blower Thermistor Temperature controller Cold water CO2 absorbent Hot water Breathing Gas Systems • Air Chamber compression, air breaks, emergency facemask, ventilator. • Oxygen Treatment protocols, tender decompression. • Special Gas 50/50 for Table 6A, Nitrox for various studies. Breathing Gas Systems BIBS Panel Oxygen System O2 manifold Liquid level Evaporators O2. reg. 80 psi over bottom High press. reg. 180 psig Main O2 reg. 250 psig Check valves Relief valves High Press. O2 back-up Liquid O2 Tank Fill point Patient Oxygen Delivery Systems Head tent Recirculating Single Pass • Scott Duo-Seal Face mask Single hose Overboard dump • Ventilator / Ambu-bag Oxygen Delivery - Recirculating Head Tent Eduction Oxygen Purge Eduction Line Venturi 20 Purge Line 10 0 Venturi 30 40 50 60 Sample Sample Line Bubbler Sodasorb Canister Ice Bucket Condensate Drain Ice Water Drain Latex Neckseal Oxygen Delivery - Single Pass Head Tent Eduction Oxygen Patient Sample Line Oxygen Dump Regulator Oxygen Supply Regulator Latex Neckseal Oxygen Eduction System Reducing Differential Pressure valve Converter 20 psig Safety Shut Off Flow Fuse Exhaust from patient 5 L Bag Diaphragm 100 psig Signal air Filter Drain Valve O2 Eduction Eduction Manifold Description Outside Building 50 ft Foxtrot Delta Air Amplifier 1” pipe Charlie Bravo 3” pipe Alpha 4 ft2 Chamber Exhaust Duct Manifold Inlet Oxygen Eduction O2 Building Exhaust Duct Air eduction Amplifier manifold Air Amplifier A differential pressure gauge is used to verify suction at the inlet of the O2 eduction manifold Fire Suppression System Relief valve 200 psig reg. check valve Muffler 450 psig air OFF Fire Suppression Tank Pneumatic valve Air mask Overhead sprinklers Manual Pump ON Level sensor Drain Hand-held hose Fire Suppression Water Source Fire Suppression Equipment Inside the Chamber Nitrogen Purge Power and Lighting Canty Light Ground fault interrupter Explosion proof housing low wattage Isolation transformer Doppler 120 volts Ground fault indicator Redundant Communication Systems Plantronics Headset Telex Wireless System Soundpowered Phone Two-way Mic/Speaker Box Closed Circuit Patient Monitoring Breathing Gas Analysis • Vital for fire safety and personnel safety Chamber Atmosphere O2 = 20.5% - 23.5% CO2 < 1.0% SEV • Documents that patients are receiving proper treatment Patients O2 > 98.0% CO2 < 1.0% SEV Breathing Gas Analysis Chamber O2 Servomex 21.0 Patient O2 Patient CO2 Servomex % O2 zero span Oxygen Analyzer 572 Dwyer 98.0 % O2 0.0 5.0 zero span Oxygen Analyzer 572 Dwyer Dwyer 50 50 50 40 40 40 30 30 30 20 20 20 10 10 LPM AIR LPM AIR 10 LPM AIR Patient sample Chamber sample Breathing Gas Analysis Critical Care Monitoring – – – – – EKG Blood pressure Respirations Temperature Cardiac Output and wedge pressure – Oxygen Saturation –Transcutaneous O2 monitors Defibrillator Blood Gas Determination at Pressure Ultrasonic Assessment Doppler ultrasonic venous bubble detector Two-dimensional ultrasonic arterial bubble detector Suction Medical Lock Special Equipment Considerations Patient Stretcher Patient Chair Altitude Controls Chamber Cleaning • Ultraviolet lights UV lights have been used in the past to disinfect a chamber after treating patients with bacterial infections UV light can degrade acrylic viewports • Acceptable agents Sanimaster 3 Benzalkonium choloride swabs Up to 10% Clorox solution • Pressure washing Chambers Here, There, and Everywhere Toronto Canada: Toronto General Hospital Bermuda: King Edward II Hospital Providenciales: Menzies Medical Clinic Panama Canal: ACP Panama Canal Authority ? ? ? ? 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