Presentation on theme: "Hyperbaric Chamber Overview"— Presentation transcript:
1 Hyperbaric Chamber Overview Michael Natoli, MS, CHTCenter for Hyperbaric Medicine and Environmental PhysiologyDuke University Medical CenterDurham, NC 27710
2 Duke Pilot ChamberIn the late ’50s, Boerema in Amsterdam showed that small pigs could survive with virtually no red blood cells on physically dissolved oxygen at 3 ata. In , he built a clinical chamber large enough to serve as an operating room at pressures up to 5 ata. At Harvard in 1962, the chamber originally used by Behnke was refurbished and used during operations on infants with congenital heart disease. The first hyperbaric chamber designed specifically for clinical studies was installed at Duke beginning in December of 1962 and became operational in June of This chamber was used for clinical research and hyperbaric oxygen therapy until the larger multipurpose complex was completed in 1968.Picture from: Brown IW Jr., Fuson RL, Mauney FM, Smith WW. Hyperbaric oxygenation (hybaroxia): current status, possibilities, and limitations. [Review] Advances in Surgery. 1: , 1965.
3 Duke Chamber ComplexSeven chambers can be operated independently or in combinationGCHDFABEChambers A and B have a total length of 36 ft. with an internal diameter of 10 ft. 6 in. These chambers may be pressurized to 7.8 ATA (225 ft.) but also can be evacuated to a vacuum equivalent altitude of approximately or 1 torr. Chambers D, E, and F are designed for a pressure of 31.3 ATA (1000 ft.) provided by gases such as air, helium-oxygen or helium-nitrogen-oxygen. The D Chamber is a sphere 10 ft. 6 in. diameter with 35 in. access doors to the C and F chambers, and a 30 in. hatch connecting it to the wet chamber (E). The E Chamber has an internal diameter of 6 ft. 6 in., is 10 ft. 6 in. long and is internally insulated to permit simulated diving in cold water. The F chamber is an 18 ft. long cylinder with an internal diameter of 10 ft. 6 in. and is fitted with shower and toilet facilities.A, B, C - ClinicalD, E, F, G – ResearchH – no longer attached
4 Duke Chamber Complex Main Deck Second Deck Golf Golf Foxtrot Delta EchoCharlieBravoAlpha
5 Chamber ConstructionChambers A and B have a total length of 36 ft. with an internal diameter of 10 ft. 6 in. These chambers may be pressurized to 7.8 ATA (225 ft.) but also can be evacuated to a vacuum equivalent altitude of approximately or 1 torr.The C chamber is a large sphere with 20 ft. diameter and a pressurization capability to 7.8 ATA (225 ft). The chamber is equipped for oxygen-helium as well as air, long duration, saturation exposures and is also large enough to support complex investigational procedures, surgery and multiple patient hyperbaric oxygen treatments. The lung lavages carried out on patients with cystic fibrosis, alveolar proteinosis and other diseases also are performed in this chamber.Chambers D, E, and F are designed for a pressure of 31.3 ATA (1000 ft.) provided by gases such as air, helium-oxygen or helium-nitrogen-oxygen. The D Chamber is a sphere 10 ft. 6 in. diameter with 35 in. access doors to the C and F chambers, and a 30 in. hatch connecting it to the wet chamber (E). The E Chamber has an internal diameter of 6 ft. 6 in., is 10 ft. 6 in. long and is internally insulated to permit simulated diving in cold water. The F chamber is an 18 ft. long cylinder with an internal diameter of 10 ft. 6 in. and is fitted with shower and toilet facilities.
6 Chamber FoundationChambers D, E, and F are designed for a pressure of 31.3 ATA (1000 ft.) provided by gases such as air, helium-oxygen or helium-nitrogen-oxygen. The D Chamber is a sphere 10 ft. 6 in. diameter with 35 in. access doors to the C and F chambers, and a 30 in. hatch connecting it to the wet chamber (E). The E Chamber has an internal diameter of 6 ft. 6 in., is 10 ft. 6 in. long and is internally insulated to permit simulated diving in cold water. The F chamber is an 18 ft. long cylinder with an internal diameter of 10 ft. 6 in. and is fitted with shower and toilet facilities.
7 G-Chamber AdditionA short tunnel connects D chamber to G chamber which is 94” diameter and capable of pressures up to 109 ATA (3600 ft.). This chamber was built in 1977, installed in 1978, and became operational in March of The lower section of the G chamber is a 80” deep, 69” diameter wet compartment with access through a hatch on the metal floor.
9 Design Specifications and Operational Guidelines ASME: BPV sec. VIII & PVHO-1American Society of Mech. Eng.Boiler and Pressure Vessel CodePressure Vessels for Human OccupancyPVHO-2: In service guidelines for PVHO acrylic windowsASME BPV – VIII – Division 1“Boiler and Pressure Vessel Code, Section VIII, Unfired Pressure Vessels”Minimum requirement, originally instituted to protect personnel outside the chamberANSI/ASME - PVHO - 1“Safety Standards for Pressure Vessels for Human Occupancy”NFPA - 99“Standard for Health Care Facilities” (Ch Hyperbaric Facilities)NFPA 70“The U.S. National Electrical Code”NFPA 53M“Fire Hazards in Oxygen-Enriched Atmospheres”CGA - Compressed Gas AssociationAmerican Society of Mechanical Engineers (ASME)United Engineering Center345 East 47th StreetNew York, NY 10017National Fire Protection Association (NFPA)1 Batterymarch ParkPO Box 9101Quincy, MACompressed Gas Association Inc., (CGA)1235 Jefferson Davis HighwayArlington, VA 22202NFPA – 99 and 53 MNational Fire Protection AgencyCGA (multiple)Compressed Gas Association
10 Certifying Agencies US Navy Department of Health and Human Services Inspected every three yearsDepartment of Health and Human ServicesFood and Drug Administration (FDA)Center for Medicare and Medicaid ServicesClinical Laboratory Improvement Amendments (CLIA)Certifying organizationsUS NavySystem Certification of Procedural and Material Adequacy(3 years)Joint Commission on Accreditation of Healthcare Organizations (JCAHO)DUMC Risk Management OfficeDurham Casualty CompanyState Department of LaborBoiler Safety BureauHealth and Human ServicesCenter for Medicaid and Medicare ServicesClinical Laboratory Improvement Amendments (CLIA)U.S. Food and Drug Administration (FDA)The requirements of the Good Manufacturing Practices (GMPs) as defined by CFR 21 Part 820 for Class II medical devicesCollege of American Pathologists (CAP)UHMS - AccreditationState of North CarolinaDepartment of Labor – Boiler Safety Bureau
11 Certifying Agencies (cont.) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)College of American Pathologists (CAP)Undersea and Hyperbaric Medical Society (UHMS)
12 US Navy Pipe Color Coding Originally developed in 1928American Standards Association. (Now ANSI)OxygenNitrogenSpecial GasHeliumAirExhaustVacuumPotable WaterFire Deluge SystemColor codingOxygen - greenNitrogen - grayHelium - buffAir - blackExhaust - silverVacuum - yellowPotable water - blueFire suppression water - redPaintEpoxy paint (zinc containing)Imron (Dupont)Phenoline (Carboline)or other epoxy paintPressurize chamber three times to max. depth for eight hours each timeWait 72 hours, draw gas sample
13 Air Quality Standards US Navy Guidelines O %CO2 < 500 ppmCO < 20 ppmHydrocarbons < 25 ppmParticulate and oil mist < .005 mg/literMoisture < .02 mg/literAir qualityHydrocarbon, oil mist, and other contaminants determined by testing at an independent laboratory (every 6 months)Independent laboratory test every 6 months.
14 Compressors Built by Norwalk 1936 Four stage HP Water cooled 100 cuft/minSynthetic oil lubricated (Anderol 500)Three Norwalk compressors built in 1936, used in the Navy, and surplused after WWII. Each has over 19,000 hrs of operation. Each outputs 100 cuft / min.
15 Compressors and Filters Intake filterRelief valveDew Pt. MonitorCompressorsCO Monitor#1To chambers1200 psigBack Press.ValveCharcoal filter#2DryingtowersCoalescing filterCooling coilTo storageFilters are cleaned or replaced yearlyOiling rate checked yearlyCO monitor calibrated weekly – alarms at 3 and 5 ppmDew Pt monitor calibrated semi-annuallyRoughing filter#3Final filterCyclone separatorDrains
16 Air Storage Banks 24 storage cylinders Primary air source 2x air required to pressurize chamber to max treatment depth + 1 hr ventSecondary air source 1x air required to pressurize chamber to max treatment depth + 1 hr vent42 cu. ft. per cylinder8 cylinders per bank336 cu. ft. per bank64,000 cu. ft. per bank when compressed to 2800 psig190,00 cu. ft total218,000 cu. ft. total at 3000 psig46,000 cu. ft. per bank over operating pressure of psigA chamber = 1200 x 6 ata = 7200B chamber = 760 x 6 ata = 4560C chamber =4188 x 6 ata = 25,128D chamber =600 x 6 ata =3600E chamber =300 x 6 ata =1800F chamber =1430 x 6 ata =8580G chamber = x 6 ata =2343Visually inspected every 5 yrs for dust, rust, and crust24 storage cylinders42 cu. ft. per cylinder water capacity218,000 cu. ft. at 3,000 psi
17 Air Delivery To chambers Reference Control From Compressors Bank 1 ElectricallyOperatedBy-passBank 3EmergencyMain ReducingBack-upMain Air regulator shifted annuallyControl air is 100 psiEmergency air is 200 psiReference air is 200 psiMain Air 450 psiHigh pressure relief = 3000 psiLow pressure relief =BypassEmergency storageRelief valve
19 Control Console Rate Selector Spray Valve Ventilation Rate Emergency StopControl MethodGauges checked with dead weight tester annuallyClock checked quarterly (not shown)Three modes of operationManualSemi-automaticAutomaticControl RateReferenceControlling ValveDP Cell PolarityGaugeDP Cell Isolation
20 Pressurization Control Gauge on consoleProportional control valveMuffler in place to minimize noise as per OSHA requirementsMufflerFromreducingstation450 psigEmergencystop valveManualChamber wallManual (back-up)
21 Decompression Control ManualProportional control valveTo exhaustductEmergencystop valveVentilationvalveFlow meter
22 Internal Environmental Control PneumaticvalvesMufflerCold waterHeating / CoolingCoilsHot waterLubricationlevelBlowerInternal systemWater-filled heat exchanger beneath flooringBlower motor is outside the chamberReduces noiseEliminates heat and spark potential of the electric motorPenetrates the chamber hull through a water cooled shaft sealElectric motorAir flowShaft sealTemperatureindicatorThermistor
23 External Environmental Control BlowerThermistorTemperaturecontrollerExternal systemWater-filled heat exchangers, CO2 absorbent.The tubing is rated to an equivalent pressure to that of the chamber.The CO2 absorbent canister may be isolated in order to change the absorbent when it is exhausted.Cold waterCO2 absorbentHot water
24 Breathing Gas Systems Air Oxygen Special Gas Chamber compression, air breaks, emergency facemask, ventilator.OxygenTreatment protocols, tender decompression.Air used for emergency facemask, ventilator, air breaksSpecial Gas for Table 6A, NITROX,Special Gas50/50 for Table 6A, Nitrox for various studies.
25 Breathing Gas Systems BIBS Panel Built in Breathing SystemInline micron filters from high pressure sources cleaned annually
26 Oxygen System Liquid O2 Tank Liquid level O2 manifold Evaporators O2. reg.80 psiover bottomFillpointMain O2 reg.250 psigHigh press. reg.180 psigNo ball valves in systems of > 125 psiLiquid tank contains 900 gallons ~ 100,000 scuftLasts about two monthsPiping must be O2 cleanedUse non-hydrocarbon based lubricants such as fluorocarbons or halocarbon or krytoxSoft goods need to be replaced more often than in air systems – viton is used as opposed to BUNA N or rubberAviator grade > USP medical > IndustrialLiquid N2Contains 3600 cu ft at 200 psiReduced to 120 psiCheck valvesRelief valvesHigh Press. O2 back-up
27 Patient Oxygen Delivery Systems Head tentRecirculatingSingle PassScott Duo-Seal Face maskSingle hoseOverboard dumpOxygen deliveryPlastic disposable face masks are loose fitting and should not be used at pressureT-pieces are used for patients with endotracheal tubesAmbu-bags are used during compression and decompressionVentilator / Ambu-bag
28 Oxygen Delivery - Recirculating Head Tent EductionOxygenPurgeVenturiEductionLine302040Purge Line1050Sample60VenturiSampleLineBubblerRecirculating head tent systemEmploys a venturi to increase flow and create a suctionUses a Sodasorb canister to absorb exhaled CO2An ice bucket with a hollow jacket cools the gas after leaving the Sodasorb canisterA bubbler provides back pressure to keep the plastic tent blown upThe venturi is supplied with ~ 30 psi by an oxygen regulatorA purge line allows a high flow of oxygen to blow up the tent initiallyUses less oxygenMore upkeep involvedFlow through a Mark V hardhat venturi has a 20:1 flow ratioSodasorbCanisterIceBucketCondensateDrainIce WaterDrainLatexNeckseal
29 Oxygen Delivery - Single Pass Head Tent EductionOxygenPatientSample LineOxygen SupplyRegulatorOxygen DumpRegulatorSingle pass head tent systemEmploys an oxygen supply regulator to administer ~ 40 lpm of oxygen into the head tentA dump regulator connected to the overboard dump line exhausts exhaled gas outside the chamberSimple operationUses more oxygenOverboard dump line set to 10 in H2O all depthsLatexNeckseal
30 Oxygen Eduction System Differential Pressure ConverterReducing valve20 psigSafety Shut Off Flow FuseDiaphragmExhaust frompatient100 psigSignal airFlow fuse set at 1 cm H2OFilter5 L BagDrain Valve
32 Eduction Manifold Description Outside Building50 ftFoxtrotDeltaAir AmplifierCharlie1” pipeBravoEach dump system was connected outside the chamber via 2.5 cm (1 in) internal diameter (ID) pipe to a 5.1 cm (2 in) ID eduction manifold. The manifold was configured as a “Y”, open to room air at its origins and connected to the building exhaust at its termination. The fan was placed between the manifold termination and the building exhaust, a 61 cm2 (4 ft2) exhaust duct.3” pipeAlpha4 ft2 Chamber Exhaust DuctManifoldInlet
33 Oxygen Eduction Air Amplifier manifoldBuilding Exhaust DuctAir AmplifierDry compressed air is connected to the inlet of the annular ring. The 2” inlet of the air amplifier is connected to the termination of the manifold and the outlet of the air amplifier is connected to the building exhaust duct.A differential pressure gauge is used to verify suction at the inlet of the O2 eduction manifold
34 Fire Suppression System Reliefvalve200 psig reg.checkvalve450 psig airMufflerOFFFireSuppressionTankPneumatic valveAir maskOverhead sprinklersAn oxygen-enriched atmosphere is defined as an environment where the surface equivalent oxygen concentration exceeds 23.45% (the NFPA lists this as 23.5%). The reason why this number has been chosen, is that the only survivable fires in hyperbaric chambers occurred where the oxygen percentage was below 23,5%.ManualPumpONLevelsensorHand-held hoseDrain
38 Explosion proof housing low wattage Power and LightingExplosion proof housing low wattageCanty LightGroundfaultinterrupterIsolationtransformerPowerIsolation transformersGround faultsIndicatorsInterruptersEmergency backupLightingCanty lightsEliminates heat source in chamberExplosion proof casingLow wattage - 35 wattsOR lightsDoppler120 voltsGroundfaultindicator
39 Redundant Communication Systems Plantronics HeadsetTelex Wireless SystemAudio communicationsREDUNDANCYHeadsetsProvide better communication during compression, ventilation, and decompressionProvide privacy and clear communication in emergenciesNo switches inside chamberCross connectionallows clear communication during lock in / out proceduresTwo-way speakersOpen microphone inside the chamber allows audible monitoringEMERGENCYSound powered phonesVisual communicationsViewportsClosed-circuit TelevisionTwo-way Mic/Speaker BoxSound-powered Phone
41 Breathing Gas Analysis Vital for fire safety and personnel safetyChamber AtmosphereO2 = 20.5% %CO2 < 1.0% SEVBreathing gas analysisDocuments that patients are receiving proper treatmentVital for fire safety and personnel safetyHelps identify problems with gas delivery equipmentAn oxygen-enriched atmosphere is defined as an environment where the surface equivalent oxygen concentration exceeds 23.45% (the NFPA lists this as 23.5%). The reason why this number has been chosen, is that the only survivable fires in hyperbaric chambers occurred where the oxygen percentage was below 23,5%.Documents that patients are receiving proper treatmentPatientsO2 > 98.0%CO2 < 1.0% SEV
42 Breathing Gas Analysis ChamberO2PatientO2PatientCO2ServomexServomex21.098.00.05.0% O2% O2zerospanzerospanOxygen Analyzer 572Oxygen Analyzer 572Chamber atmosphereMaintained via ventilation of the chamber, oxygen addition, and CO2 scrubbingPatientsBreathing gas analysis performed at least every 30 minOxygen and carbon dioxide levels checked to ensure oxygen delivery equipment is performing properlyPatient sampleChamber sample
43 Breathing Gas Analysis Chamber atmosphereMaintained via ventilation of the chamber, oxygen addition, and CO2 scrubbingPatientsBreathing gas analysis performed at least every 30 minOxygen and carbon dioxide levels checked to ensure oxygen delivery equipment is performing properly
44 Critical Care Monitoring EKGBlood pressureRespirationsTemperatureCardiac Output and wedge pressureOxygen SaturationTranscutaneous O2 monitors
52 Chamber Cleaning Ultraviolet lights UV lights have been used in the past to disinfect a chamber after treating patients with bacterial infectionsUV light can degrade acrylic viewportsUltraviolet lightsUV lights have been used in the past to disinfect a chamber after treating patients with bacterial infectionsUV light degrade acrylic viewportsCleaning agentsAlcohol and acetone based products should not be usedAcceptable cleaning solutions for inside chambersSanimaster 3Benzalkonium choloride swabsUp to 10% Clorox solutionAcceptable agentsSanimaster 3Benzalkonium choloride swabsUp to 10% Clorox solutionPressure washing
59 References US Navy Diving Manual Revision 5 15 August 2005 National Fire Protection AssociationNFPA 99NFPA 53Safety Standards for Pressure Vessels for Human OccupancyASME PVHO – 1 – 1997Compressed Gas Association
60 Outline Duke Chamber Complex Design Specifications and Operational GuidelinesCertifying AgenciesChamber OperationsBreathing Gas SystemsFire Suppression SystemsCommunicationsPatient care equipmentReferences