Hi Dr. Jacques,
The 2021 NFPA 99 Health Care Facilities Handbook, under section 14.3.2.5, prohibits equipment made from cerium, magnesium, and magnesium alloys in hyperbaric chambers. Annex A14.3.2.2 of the handbook also expresses concerns regarding the potential risk of certain materials such as iron alloys, aluminum, human skin, plastic tubing, and others, as they may not self-extinguish in a hyperbaric environment. However, titanium and titanium alloys are not explicitly prohibited in the hyperbaric chamber according to NFPA 99.
One significant concern regarding titanium in a hyperbaric setting is that, in the presence of 100% oxygen, titanium may potentially combust if it breaks or snaps. Literature often highlights risks related to titanium in products like eyeglass frames or jewelry, where the material could break under stress. However, solid titanium, particularly when used in medical implants like rods, pins, or oral plates, is typically very strong and resistant to breakage, which significantly reduces the risk of combustion and is considered safe in a monoplace chamber.
The Taylor Spatial Fixator (TSF) device you mentioned is external and, as such, warrants a careful assessment of risk versus benefit in the hyperbaric environment. To assist in this decision-making process, I recommend completing a safety risk assessment. You can use the
Go/No-Go Prohibited Item Risk Assessment Tool for guidance. Key factors to consider include:
1. Is the titanium component of the TSF solid titanium or a titanium alloy?
2. What is the likelihood of the titanium part snapping or breaking during treatment?
3. How long will the external fixator remain in place?
4. Is it possible to delay hyperbaric oxygen therapy (HBOT) until the fixator is removed?
Additionally, it would be prudent to contact the manufacturer of the TSF to inquire whether the device has been tested in a hyperbaric environment.
Ultimately, the decision regarding whether this specific device presents a safety risk in the hyperbaric chamber rests with the Medical Director, in collaboration with the Safety Director of the HBOT program.