Monoplace Delivery System

Monthly Hyperbaric Safety Notice: December 2006

Use of Compression Dressings during Hyperbaric Treatments

In order to comply with fire hazard safety standards in the hyperbaric chamber, the following notice discusses how to handle the patient that presents with a compression dressing on their lower extremity.

Background

Some hyperbaric patients may have compression dressings on their lower extremity for treatment of edema secondary to venous stasis ulcers, thrombosis of deep venous system, incompetent valves, post phlebitis syndrome, or congestive heart failure. There are many different kinds of dressings, and providing a range 10 to 45 mmHg of gradient pressure to the legs. Some of the most common dressings include the 3 or 4 layer Profore, Surepress, Unna boot, or Ace/Elastic Bandages. Removable compression stockings are also used to control lower extremity edema. Compression dressings are contraindicated for macrocirculatory arterial insufficiency or in patients whose Ankle-Brachial Index (ABI) is less than 0.8.

The Issue

In addition to providing compression for the edema, these dressings are often used by physicians after application of a graft or Oasis dressing to maintain a moist environment. Compression allows constant contact of the graft with the wound and may include an absorbent topical dressing for excessive exudates. Disturbing the wound area by removing the compression dressing before every treatment could adversely affect the patient’s healing. Another reason for not removing the compression wrap is that most hyperbaric facilities may not have another dressing to reapply once the patient is out of the chamber. Correct application of the dressing is also essential and some staff may not be qualified to perform this task.

If a hyperbaric patient presents with a compression dressing, it is important to leave it on. However, before the patient enters the chamber, safety precautions must be taken to reduce the potential fire hazard. If there is any Velcro, it must be taped over, secured with a safety pin then covered with plastic tape. Next, wrap the elastic (Ace) bandage in a 100% cotton towel. If the patient presents with an Unna boot, compression stockings or a Profore dressing, wrapping the leg with the 100% cotton towel is all that is required. This

will be the best option to maintain the prescribed compression and reduce the associated fire hazard. Finally, when preparing the patient to enter the chamber, elevate the affected leg(s) on a pillow or towel to assist in reducing edema.

Bottom Line

If a patient presents with a compression dressing, which is maintained during treatment, a Prohibited Items form must be completed to address the use of this dressing type in the hyperbaric chamber. If in order to maintain weekly wound photo-documentation with these patients ask for assistance from the primary wound care provider at the time that they change the dressing.

Contributing Author: Dick Clarke, CHT

Dick Clarke Dick is President of National Baromedical Services, which he founded in 1986. His previous background included service in the British Royal Navy, diving instructor and underwater photographer, assistant director of the seabed habitat 'HydroLab' and several years in the offshore commercial diving industry. Dick heads the Baromedical Research Foundation where he serves as Principal Investigator for several international clinical trials. He is course director for 'Primary Training in Hyperbaric Medicine' and the 'HBO 2000' series of advanced hyperbaric symposia. Dick has been a NOAA Diving Medical Officer Training Course faculty member since 1983. He pioneered the Certification in Hyperbaric Technology (CHT) program, is a past president of the National Board of Diving and Hyperbaric Medical Technology and remains active at the committee level within the Undersea and Hyperbaric Medical Society.

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