Monoplace Delivery System

Monthly Hyperbaric Safety Notice: April 2008

Medication Patches

Background

Medication is manufactured in a variety of administration routes for many reasons; safety, compliance, ease, absorption rate, tolerance, and efficacy. Not all medications respond the same particularly when placed in different environments.

The Issue

Hyperbaric oxygen causes vasoconstriction in normal tissues resulting in up to a 20% reduction in blood flow. It was thought that this same vasoconstriction would also severely impede the normal absorption of drugs injected intramuscularly and subcutaneously. The oral route is not affected, nor is the administration of drugs by inhalation degraded. The intravenous route is probably the best choice for delivering drugs in the chamber¹.

Hyperbaric medicine patients are typically on a daily medication regimen. All patient medications should be carefully screened by the hyperbaric physician prior to initiation of treatment. Patient tolerance levels should be monitored over the course of the treatment series to ensure medication efficacy has not become a problem. HBO patients are showing up with medication patches on their skin. Special considerations should be made regarding the patch. Does the substance include additional fire hazards when placed in a pressurized 100% oxygen environment? If the patch is removed will it interrupt the time-release quality of the medication, thereby making it less effective? Is there an alternative route, such as oral, that may be substituted for the course of treatments? If the patch is deemed fire safe, will the physiologic vasoconstriction delay proper absorption resulting in poor medication coverage?

Bottom Line

All patient medications must be screened daily by staff. Medication patches carry the possibility of being deemed less effective for hyperbaric patients. Consider other options when arranging the patient’s plan of care.

¹Kindwall E, The Use of Drugs Under Pressure, Hyperbaric Medicine Practice, Second Edition-Revised 2004: p 325 Best Publications, Flagstaff, AZ

Stacy Handley, RN, BSN, ACHRN, CWCN, CHT

Stacy Handley Stacy is Vice President of National Baromedical Services. She assumed her present position following several years as nurse manager of the NBS hyperbaric medicine service at Memorial Hospital, in Colorado Springs, Colorado. Stacy oversees the patient care aspects of the NBS network, conducts quality assurance and compliance assessments and preceptors all new NBS nurse managers. Additional responsibilities include marketing and promotion of NBS service lines and generation of monthly safety notices. Stacy is Member at Large for the Undersea and Hyperbaric Medical Society Associates and a board member for the Baromedical Nurses Association. She has trained as a Hyperbaric Safety Director and a UHMS faculty accreditation surveyor, and is a graduate of the Medical University of South Carolina ‘Wound Care Specialty Course’ through which she obtained her wound care certification

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