Selected Podcast
Hyperbaric Oxygen Therapy (HBO) for Wound Healing
Hyperbaric Oxygen Therapy (HBO) discussion with Gillian Covert, Regional Nurse Manager with the UPMC Wound & Hyperbaric Centers of Central Pennsylvania.
Featuring:
Gillian Covert, RN, ACHRN
Gillian Covert has been a Registered Nurse with UPMC for approximately 20 years. She is the first Registered Nurse in the entire system to earn the Advanced Certified Hyperbaric Registered Nurse certification credential. She is now still just one of two to hold that certification. Gillian presently serves as the Regional Nurse Manager for the Central Pennsylvania Wound & Hyperbaric Centers. She mentors Safety Directors, a term used for the Safety officers for hyperbaric medicine. She provides clinical oversight to five center locations, three of which are accredited by the Undersea and Hyperbaric Medical Society, two of those which are accredited "With Distinction" - the only two center locations in PA with that level of accreditation. Transcription:
Bill Klaproth (Host): So, what is hyperbaric oxygen therapy for wound healing? I'm sure it's conjuring up images right now in your brain of what that is, but this is really a great way to promote healing. So, we're going to learn more with Gillian Covert, regional nurse manager at UPMC Wound and Hyperbaric Centers of Central Pennsylvania.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Gillian, it is a pleasure to talk with you on such an interesting topic. So, thank you so much for your time. So first off, can you explain to us what exactly is hyperbaric oxygen therapy or HBO?
Gillian Covert: Sure. I would love to talk about that and thank you very much for having me. Hyperbarics or hyperbaric oxygen therapy is the use of oxygen, 100% oxygen as a drug under increased barometric pressure. When we're just wandering around doing everyday normal things, we breathe 21% oxygen. So in order to provide this therapy, we put you in a vessel that is pressurized up to, for our settings, 2.5 or 2 atmospheres. And I'll talk a little bit more about that in a minute, at a 100% oxygen. And when we do this, it helps to heal wounds and heal tissues within the body to I treat a couple of different diagnoses.
The pressure of 2 atmospheres or 2.5 atmospheres is equivalent to approximately 33 to 48 feet of sea water, which you don't feel. It's not something that you feel as if you would, if you were to dive down 33 feet. But it is the equivalent of that amount of pressure.
Bill Klaproth (Host): So, basically oxygen promotes healing. Is that right?
Gillian Covert: Yes. Not directly, but yeah.
Bill Klaproth (Host): Okay.
Gillian Covert: So by hyperoxygenating the tissues, which is done when we put you in a vessel and increase the pressure and utilize a 100% oxygen, we're able to absorb oxygen into the plasma of your blood, Usually, it's just your red blood cells. So by doing that, we can send oxygen to the tissues in the same way we do when we breathe, but more so. And by doing that, we create an environment where a couple of different things can happen. We can promote the release of stem cells. We reduce inflammation. We create an environment where our body can build new blood pathways to increase the oxygenation even more. And all of those things working together to include increased college into formation of wound areas will help with better healing.
Bill Klaproth (Host): Got it. So basically, the oxygen therapy is helping our bodies to do its job better.
Gillian Covert: Perfect. Yes, exactly.
Bill Klaproth (Host): Love that. Okay. So Gillian, who can receive what we're calling HBO or hyperoxygen therapy, who can receive HBO? What are the approved diagnoses for this?
Gillian Covert: So, hyperbarics is monitored or reviewed or indicated by the UHMS, the Undersea and Hyperbaric Medical Society. And they have a list of indications that are approved. And then, we also, as a provider, follow the guidelines of the National Coverage Determination for Medicare and Medicaid. And most of those diagnoses match UP. Some, but not all, are indicated from either party. For UPMC Central Pennsylvania and statewide wound and hyperbaric centers, we primarily deal with diabetic foot ulcers, chronic refractory osteomyelitis, which is a persistent bone infection, if you will. And irradiated tissue damage, failed flaps. We can also do treatment for retinal artery occlusion, which we don't do very frequently because there are some things that have to be met in the short term, and it's a quick turnaround.
When we are watching TV or looking at movies or things like that, we often see a lot of treatments for carbon monoxide poisoning or necrotizing fasciitis, which are pretty impressive issues, but we do not treat those at UPMC with our monoplace chambers. It's usually done in multiplace chambers. And of course in the movies and on TV, treatment of the bends, but we are pretty landlocked here and those treatment protocols are much more extensive than what we do when we're talking about wound healing.
Bill Klaproth (Host): Right. So then, what is expected during therapy? This conjures up all kinds of images of somebody laying in the big chamber. Maybe that's what it is. I'm not sure. So, how does this work? How does the therapy happen?
Gillian Covert: So when we treat patients, the expectation for the scenario is you come into my center and there are a lot of pieces that a lot of T's to cross and I's to dot in order to make sure that it's safe for therapy. But you will come into the center five days a week, upwards of six weeks, maybe longer, depending on what the diagnosis is. And we get you ready for therapy by giving you our scrubs at a 100% cotton or more than 55% cotton at the very least. And we check your lungs and we check your ears and we get vital signs and we put a ground wire on you. And we do a couple more things to maintain a safe environment because, at a hundred percent oxygen, we have a risk for fire safety and issues. And then, you are slid into the chamber and the oxygen is disseminated throughout the body by breathing in the 100% oxygen. So when you see things like an arm inside a plastic bubble and it's having oxygen thrown out at it, that may be beneficial for something, I don't know, but it's not hyperbaric oxygen therapy.
Bill Klaproth (Host): So, the whole body then is in the chamber. Is that right, Gillian?
Gillian Covert: Yes, that's correct. And the reason for that is because we need to pressurize the vessel. The whole body is at 2.5 atmospheres and breathing in that pressurized oxygen at a 100%.
Bill Klaproth (Host): Right. And the value is that breathing in, so that's why you have to be in the vessel because you have to intake this oxygen, which is going to promote the healing.
Gillian Covert: Correct. And we need the pressure in order to dissolve that oxygen into the plasma to be disseminated throughout the entire body. We are again using it almost as if it were a drug. So, you take penicillin because you have an infection of some kind. And, you know, it goes into your stomach and it is disseminated throughout the whole body, even though maybe you just have an abscess on your arm.
Bill Klaproth (Host): Right. That makes sense. So, who is a good candidate for this? What needs to be done to receive therapy?
Gillian Covert: So, we do a lot of things to clear patients for therapy to include, but not necessarily always limited to, an echocardiogram to check the ejection fraction for your heart, to make sure that you can withstand those pressures medically. And we have a long form that checks off different medications that can interact with therapy. And we get a chest x-ray to make sure that there's no partial lung collapse or scar tissue that might inhibit your ability to withstand the treatment again.
The only contra-indication that absolutely indicates that you may not receive hyperbaric oxygen therapy is a collapsed lung, an active collapsed lung. If you had one 20 years ago, that doesn't mean that you can't receive therapy now, but that's why we get the chest x-ray to make sure that your lungs are in good shape to receive therapy. And of course, we go over lots of safety forms and make sure that you don't have any implants of any kind or other medical issues that might decrease the safety to the therapy.
Bill Klaproth (Host): So, how long generally does a session last?
Gillian Covert: From the time you go into the chamber until you come out is anywhere between one hour and 50 minutes to two hours and 10 minutes, again depending on the protocol, which is indicated by the diagnosis. And sometimes, it can take a little longer because you have to pop your ears. It's much like going up over the mountain or up in a plane. So, you need to equalize. And sometimes our patients have problems equalizing their ears. So, we slow down the ascent or the descent, so that they have time to pop their ears, and that can add a couple of minutes. But the therapy itself is 90 minutes at a 100% oxygen.
Bill Klaproth (Host): Wow. That's really interesting. So as we wrap up, Gillian, is there anything else you want to add? Anything else we need to know about hyperbaric oxygen therapy for wound healing?
Gillian Covert: Well, probably a whole lot, Bill. No, I think we've got to basically covered.
Bill Klaproth (Host): Right. We've touched the surface.
Gillian Covert: Yes.
Bill Klaproth (Host): We've touched the surface. Is there anything just in closing that you want to mention about this type of therapy?
Gillian Covert: I encourage people to pursue it as needed. And I am excited about the future of hyperbarics. They are doing clinical trials all the time to open up new diagnoses. And it is such an important thing in reference to non-healing wounds and it's a pretty exciting field.
Bill Klaproth (Host): Yeah, it is. And where can you receive treatments?
Gillian Covert: There are centers all throughout Pennsylvania and all throughout the world. UPMC has five central Pennsylvania locations in Lititz, Hanover, Carlyle, Harrisburg and Mechanicsburg.
Bill Klaproth (Host): Well, that's good to know. So, you've got the area covered for hyperbaric oxygen therapy. Well, I know there is a lot more to learn about this, but this certainly has created awareness and given us information and education on hyperbaric oxygen therapy and how it certainly can promote and help wound healing. Gillian, thank you so much for your time. This has really been interesting.
Gillian Covert: My pleasure. Thank you.
Bill Klaproth (Host): And once again, that's Gillian Covert. And for more information, please visit UPMC.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So, what is hyperbaric oxygen therapy for wound healing? I'm sure it's conjuring up images right now in your brain of what that is, but this is really a great way to promote healing. So, we're going to learn more with Gillian Covert, regional nurse manager at UPMC Wound and Hyperbaric Centers of Central Pennsylvania.
This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Gillian, it is a pleasure to talk with you on such an interesting topic. So, thank you so much for your time. So first off, can you explain to us what exactly is hyperbaric oxygen therapy or HBO?
Gillian Covert: Sure. I would love to talk about that and thank you very much for having me. Hyperbarics or hyperbaric oxygen therapy is the use of oxygen, 100% oxygen as a drug under increased barometric pressure. When we're just wandering around doing everyday normal things, we breathe 21% oxygen. So in order to provide this therapy, we put you in a vessel that is pressurized up to, for our settings, 2.5 or 2 atmospheres. And I'll talk a little bit more about that in a minute, at a 100% oxygen. And when we do this, it helps to heal wounds and heal tissues within the body to I treat a couple of different diagnoses.
The pressure of 2 atmospheres or 2.5 atmospheres is equivalent to approximately 33 to 48 feet of sea water, which you don't feel. It's not something that you feel as if you would, if you were to dive down 33 feet. But it is the equivalent of that amount of pressure.
Bill Klaproth (Host): So, basically oxygen promotes healing. Is that right?
Gillian Covert: Yes. Not directly, but yeah.
Bill Klaproth (Host): Okay.
Gillian Covert: So by hyperoxygenating the tissues, which is done when we put you in a vessel and increase the pressure and utilize a 100% oxygen, we're able to absorb oxygen into the plasma of your blood, Usually, it's just your red blood cells. So by doing that, we can send oxygen to the tissues in the same way we do when we breathe, but more so. And by doing that, we create an environment where a couple of different things can happen. We can promote the release of stem cells. We reduce inflammation. We create an environment where our body can build new blood pathways to increase the oxygenation even more. And all of those things working together to include increased college into formation of wound areas will help with better healing.
Bill Klaproth (Host): Got it. So basically, the oxygen therapy is helping our bodies to do its job better.
Gillian Covert: Perfect. Yes, exactly.
Bill Klaproth (Host): Love that. Okay. So Gillian, who can receive what we're calling HBO or hyperoxygen therapy, who can receive HBO? What are the approved diagnoses for this?
Gillian Covert: So, hyperbarics is monitored or reviewed or indicated by the UHMS, the Undersea and Hyperbaric Medical Society. And they have a list of indications that are approved. And then, we also, as a provider, follow the guidelines of the National Coverage Determination for Medicare and Medicaid. And most of those diagnoses match UP. Some, but not all, are indicated from either party. For UPMC Central Pennsylvania and statewide wound and hyperbaric centers, we primarily deal with diabetic foot ulcers, chronic refractory osteomyelitis, which is a persistent bone infection, if you will. And irradiated tissue damage, failed flaps. We can also do treatment for retinal artery occlusion, which we don't do very frequently because there are some things that have to be met in the short term, and it's a quick turnaround.
When we are watching TV or looking at movies or things like that, we often see a lot of treatments for carbon monoxide poisoning or necrotizing fasciitis, which are pretty impressive issues, but we do not treat those at UPMC with our monoplace chambers. It's usually done in multiplace chambers. And of course in the movies and on TV, treatment of the bends, but we are pretty landlocked here and those treatment protocols are much more extensive than what we do when we're talking about wound healing.
Bill Klaproth (Host): Right. So then, what is expected during therapy? This conjures up all kinds of images of somebody laying in the big chamber. Maybe that's what it is. I'm not sure. So, how does this work? How does the therapy happen?
Gillian Covert: So when we treat patients, the expectation for the scenario is you come into my center and there are a lot of pieces that a lot of T's to cross and I's to dot in order to make sure that it's safe for therapy. But you will come into the center five days a week, upwards of six weeks, maybe longer, depending on what the diagnosis is. And we get you ready for therapy by giving you our scrubs at a 100% cotton or more than 55% cotton at the very least. And we check your lungs and we check your ears and we get vital signs and we put a ground wire on you. And we do a couple more things to maintain a safe environment because, at a hundred percent oxygen, we have a risk for fire safety and issues. And then, you are slid into the chamber and the oxygen is disseminated throughout the body by breathing in the 100% oxygen. So when you see things like an arm inside a plastic bubble and it's having oxygen thrown out at it, that may be beneficial for something, I don't know, but it's not hyperbaric oxygen therapy.
Bill Klaproth (Host): So, the whole body then is in the chamber. Is that right, Gillian?
Gillian Covert: Yes, that's correct. And the reason for that is because we need to pressurize the vessel. The whole body is at 2.5 atmospheres and breathing in that pressurized oxygen at a 100%.
Bill Klaproth (Host): Right. And the value is that breathing in, so that's why you have to be in the vessel because you have to intake this oxygen, which is going to promote the healing.
Gillian Covert: Correct. And we need the pressure in order to dissolve that oxygen into the plasma to be disseminated throughout the entire body. We are again using it almost as if it were a drug. So, you take penicillin because you have an infection of some kind. And, you know, it goes into your stomach and it is disseminated throughout the whole body, even though maybe you just have an abscess on your arm.
Bill Klaproth (Host): Right. That makes sense. So, who is a good candidate for this? What needs to be done to receive therapy?
Gillian Covert: So, we do a lot of things to clear patients for therapy to include, but not necessarily always limited to, an echocardiogram to check the ejection fraction for your heart, to make sure that you can withstand those pressures medically. And we have a long form that checks off different medications that can interact with therapy. And we get a chest x-ray to make sure that there's no partial lung collapse or scar tissue that might inhibit your ability to withstand the treatment again.
The only contra-indication that absolutely indicates that you may not receive hyperbaric oxygen therapy is a collapsed lung, an active collapsed lung. If you had one 20 years ago, that doesn't mean that you can't receive therapy now, but that's why we get the chest x-ray to make sure that your lungs are in good shape to receive therapy. And of course, we go over lots of safety forms and make sure that you don't have any implants of any kind or other medical issues that might decrease the safety to the therapy.
Bill Klaproth (Host): So, how long generally does a session last?
Gillian Covert: From the time you go into the chamber until you come out is anywhere between one hour and 50 minutes to two hours and 10 minutes, again depending on the protocol, which is indicated by the diagnosis. And sometimes, it can take a little longer because you have to pop your ears. It's much like going up over the mountain or up in a plane. So, you need to equalize. And sometimes our patients have problems equalizing their ears. So, we slow down the ascent or the descent, so that they have time to pop their ears, and that can add a couple of minutes. But the therapy itself is 90 minutes at a 100% oxygen.
Bill Klaproth (Host): Wow. That's really interesting. So as we wrap up, Gillian, is there anything else you want to add? Anything else we need to know about hyperbaric oxygen therapy for wound healing?
Gillian Covert: Well, probably a whole lot, Bill. No, I think we've got to basically covered.
Bill Klaproth (Host): Right. We've touched the surface.
Gillian Covert: Yes.
Bill Klaproth (Host): We've touched the surface. Is there anything just in closing that you want to mention about this type of therapy?
Gillian Covert: I encourage people to pursue it as needed. And I am excited about the future of hyperbarics. They are doing clinical trials all the time to open up new diagnoses. And it is such an important thing in reference to non-healing wounds and it's a pretty exciting field.
Bill Klaproth (Host): Yeah, it is. And where can you receive treatments?
Gillian Covert: There are centers all throughout Pennsylvania and all throughout the world. UPMC has five central Pennsylvania locations in Lititz, Hanover, Carlyle, Harrisburg and Mechanicsburg.
Bill Klaproth (Host): Well, that's good to know. So, you've got the area covered for hyperbaric oxygen therapy. Well, I know there is a lot more to learn about this, but this certainly has created awareness and given us information and education on hyperbaric oxygen therapy and how it certainly can promote and help wound healing. Gillian, thank you so much for your time. This has really been interesting.
Gillian Covert: My pleasure. Thank you.
Bill Klaproth (Host): And once again, that's Gillian Covert. And for more information, please visit UPMC.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Healthier You, a podcast from UPMC. I'm Bill Klaproth. Thanks for listening.