The HBO staff had the opportunity to treat a patient who required a Left Ventricular Assist Device (LVAD) to sustain his life. His treatment in the chamber was for a condition that was not primarily related to the LVAD itself but his specific condition could not be treated without acknowledgment and consideration of his dependency upon the LVAD.
Treating any patient with an LVAD in a hyperbaric chamber has only been accomplished once in the history of hyperbaric medicine. However, since that time treating patients who required an LVAD in the unique environment and setting of a hyperbaric chamber has not been approved due to safety concerns and recent changes in NFPA codes surrounding the potential dangers of the lithium ion batteries used to supply power to the LVADs in the past.
We partnered with personnel from a neighboring hospital who are content experts in LVAD usage. Not only did our team of hyperbaric technologists have to consider the safety concerns regarding the LVAD itself in the chamber, the entire medical and nursing team needed to be educated about the functions and physiology on the LVAD. The Hyperbaric Safety Coordinator, Marc Pullis, and technologist team needed to test a new power source that can now power the LVAD and make certain that the LVAD was not going to pose a safety risk (mechanical failure and fire safety) if we were going to treat this patient. Nursing and medical leadership were required to develop an emergency plan on how to deal with a medical emergency if the patient's LVAD stopped functioning once inside the chamber. Therefore, a medical emergency plan needed to be developed and implemented that was specific to this particular patient. In hyperbaric, the nurses are present in the chamber with the patient, providing critical care in the pressurized environment. In the case of this patient, the nurses had to consider another complex layer of planning. This coordination is what they do best.
Several months of direct testing of the LVAD in the HCMC hyperbaric chamber was necessary to ensure that the device was safe to use given our unique hyperbaric environment. Nursing staff needed to have education surrounding the LVAD and the medical emergency response required to treat our patient in the event of LVAD failure. A team approach and collaboration amongst the hyperbaric MDs, nurses, and technologists was required and utilized to successfully treat this patient.
Marc Pullis, Safety Coordinator/CHT presented his data on the usage of the LVAD at the International Undersea and Hyperbaric Medical Society (UHMS) meeting in June 2017 and received an award by the UHMS for his efforts and original research. Providing hyperbaric treatment for our patient is the first reported case of safely treating a patient since the NFPA outlawed the use of lithium ion batteries in hyperbaric chambers. The patient was treated at our chamber, his life-threatening hemorrhagic radiation cystitis resolved, he was able to have his nephrostomy tubes removed and announced that his "quality of life was improved" following hyperbaric oxygen treatment by our team.
Each member of the team played an instrumental role and nursing was there to coordinate and execute the collaborative plan. This team exemplifies many of the HHS annual plan pillars, especially Quality and Safety, as our team has owned a unique patient and safety issue and invested their time into actively finding a sustainable solution to a problem that has transformed our way of proving care to the patient; this project is meaningful work and required peer engagement that truly makes a difference for our patients. We were able to deliver exceptionally safe, effective and efficient care for our patient in a patient-centered manner. In addition, this work by our team exemplifies true team engagement because it required the leadership and participation of the entire team of physicians, nursing, and technologists to reach a safe and effective delivery of patient-centered care.
Team Members recognized with this DAISY Team Award:
Dr. Christopher Logue
Dr. Stephen Hendriksen
Dr. Bjorn Westgaard
Dr. Joe Walter
Dr. Thomas Masters
Marc Pullis, CHT
Joseph Harris, CHT
Eric Brown, CHT
Ryan Wudtke, CHT
Deana Klosterman, CHT
Robert Miller, EMT
Kim Nerling, CHRN
Andrea Jensen, ACHRN
Virginia Nolting, CHRN
Mary Herbon, CHRN
Diane Dullum, CHRN
Jennifer Phelps, RN
Steven Omodt, MSN
Laura Randgaard, RN, MA
Dr. Doug Brunette