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Monoplace Delivery System

Monthly Hyperbaric Safety Notice: April  2007

Nebulizer Safety

Background

Provision of nebulized medications for patients with bronchospastic and other pulmonary diseases is an important safety component of monoplace hyperbaric chamber operations. Having a nebulizer inside the chamber can be particularly valuable should such a patient begin to wheeze during decompression.

The Issue

There have been several case reports (not involving hyperbaric medicine) in which oxygen tubing has been inadvertently connected to intravenous catheters. This has produced in cerebral arterial gas embolism in some of the cases, several of which resulted in death. This connection error is particularly concerning during monoplace operations, when intravenous lines may exit the chamber door, and are identical to the tubing used to provide in-chamber nebulized medications.

Bottom Line

To prevent a potential catastrophic injury the following procedures must be followed when providing an in-chamber nebulizer:

  1. Tubing utilized for nebulizer therapy exiting the chamber door should be placarded with red tape with the annotation “nebulizer.”
  2. Oxygen supply tubing must be connected only to that tubing identified as in #1, above.
  3. All staff should trace the tubing in question to its source within the chamber as a further precaution prior to connecting the oxygen line.
  4. All staff should undergo appropriate training and periodic in-servicing on the proper use of a nebulizer set up within the chamber.

A ‘Nebulizer Safety’ policy has been introduced to the NBS Policy and Procedure Manual, and identified as F-10.

Contributing Author: Dick Clarke, CHT

Dick ClarkeDick 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.

Full Panel of Safety and Technical Correspondents

Previous Monoplace Safety Notices: