INDICATIONS OF PROTOCOL IN USING THE TOPICAL OXYGEN THERAPY CHAMBER AND FOR CONTINUING THERAPY ALSO IN THE POST HOSPITALIZATION PHASE
For correct application of this therapy with positive results the following should be considered:
b) Method of treatment
c) Duration of treatment
d) Evaluation of treatment
For all trophic injuries situated in the lower limbs which have solutions of continuity of the skin, the main place is the leg. Injury to the thigh is rare since it has not been taken into consideration. Therapy is applied to injuries with various causes or contributory causes even if with varying results. For the following pathologies:
- Phlebostatic ulcers (frequent and with varying percentages of healing between 60 and 80% depending on contributory causes and associated pathological factors).
- Diabetic ulcers (diabetic foot). These injuries include both trophic injuries of skin and below-skin tissues and those with a relevant exposed bone. These injuries are frequent with percentages of healing which vary from 70% to 90%.
- Ulcers in arteriopaths. Not frequent. Lower results both subjectively and objectively.
- Traumatic injuries. Discreetly frequent with good results but which vary greatly for the associated general and local conditions.
- Iatrogenic injuries and on a neoplastic basis. Rare with results varying greatly from case to case.
Method of treatment
The experience matured over the last few years has seen a modification in approach and the method of treatment of trophic ulcers in the lower limbs since:
- these injuries are chronic (apart from post-traumatic injuries).
- these injuries were treated in the course of their chronicity with various and varying methods depending on the health service operators.
We maintain that on the basis of the experience obtained and the general principles we have shown the therapeutic course these directives can follow
1) Precise indications, as far as possible, for oxygen therapy. These indications must be set by a doctor specializing in therapy, vascular therapy, dermatology, diabetology or by a doctor who has the experience and competence in this pathology and knowledge of the pathologies correlated to the etiology of such injuries.
2) The injury to benefit from the oxygen therapy must be cleansed. The cleansing can be done with simple medical cleansing or with surgical cleansing removing scabs and necrotic tissue in such a way as to bring the oxygen into contact with the tissues with the possibility of granulation.
3) The possibility of the oxygen therapy and the method of administration must be tested and evaluated by medical or paramedical personnel since the sensitivity to the dosage, the time and the humidity are individual.
4) The only substances used by medication are physiological solution for cleansing before and after the application of oxygen. Neither betadine nor Vaseline medications are used nor whatever does not allow the passage of oxygen.
5) If the injury is painful, besides increasing the humidity the injury can be bathed with marcaina or other local anesthetic.
The correct procedure in sequence is the following:
- Bandaging of the injury
- Cleansing with a wet gauze with fisiologic water (do not cover the injury with any medication)
- Introduction of the limb in the oxygen chamber
- Closing the same possibly above the knee
- Supplying the oxygen near the injury in accordance with the sensitivity of the patient with a flow between 3 and 4 LT a minute for 10 minutes and then at 2 LT a minute
- The total duration save for particular cases is one hour
- At the end carry out cleansing with a wet physiological gauze and then cover it with gauze with the same solution or with a local anesthetic if the injury is painful.
Duration of the treatment
The duration of the treatment per day is indicated by the doctor who sets the indication and follows the patient and the progress of the injury; in any case we advise the following directives:
- The treatment must be followed daily
- It is preferable to carry out two applications a day, each for one hour.
Improvement is noted generally after 10-15 days and becomes evident on the third week of application; each case, however, presents individual variables given by the subject who presents etiological factors and accompanying variable pathologies.
There are no side-effects even for the treatment, even for 4 hours per day, from the experience of several cases for which the therapy for this duration was prescribed.
Evaluation of the results
It is useful and should be the case that the injury is photographed at the moment of the first visit and before surgical or medical cleansing.
The injury will then be photographed at regular intervals decided by the medical team.
With the right software the diameters of the injury, the depth, the surface and its circumference can be measured. With the same software one can carry out and register the graphics that show the behaviour of the injury and the effectiveness or otherwise of the therapy.
On one card it is advisable to note the objective variations but also the subjective impressions that refer to the patient.
Taken into consideration are:
– The patient’s data
– The causes
– The contributory factors
– Associated pathologies
– Medicines in use
– The birth and duration of the injury
– Symptoms declared by the patient
– The characteristics of the injury and the granulation tissue
Possibility of treating the patient at home
The peculiarity of oxygen applied locally, are identifiable, in the absence of side-effects, in the low cost, the simplicity of application, but above all in the need for a certain duration and continuity (this therapy produces better results after about three weeks of regular application). The duration of the therapeutic cycle of oxygen applied locally is difficult to match to the period of hospitalization (in other European countries – P.D.L. 4409/2003 chronic ulcers are treated at the patient’s home). For this direct experience a course of therapy is indicated coupled with a brief stay in hospital (5-7 days).
Over the course of the years we have obtained the first certification for our domestic model which was then renewed in accordance with the regulations in force. This model used at the patient’s home for therapies of medium – long duration enables social costs to come down and guarantees the continuity of application required. In this way we have already treated patients with various types of ulcer with excellent results and minimum cost.
At present the cost of hire applied to patients is €160 (VAT 4%) monthly; this charge is generally accepted and also includes assistance by telephone and at home for any problem concerning the therapy. These costs are still not reimbursable by the N.H.S. but the invoice is deductible.
A public or private structure in this way can offer a complete service to various patients, increasing the degree of satisfaction and constantly monitoring the development of the pathology with weekly visits but without rigidly committing the structure and the personnel (guidelines already provided by a proposal of law under discussion in the Chamber and applied in many countries in the European Union).