Nephrology

310 Application Of Silver Nitrate to Tenkchoff Catheter Exit Site

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    Indications

    A granuloma (sometimes called proud flesh)  is a growth of healthy cells around the tenckhoff (coming out of the exit site).  The cells can form as a response to the "foreign body" (Catheter) and while they are not harmful when small they can promote breakdown of the exit site (including infection) and potentially cause discomfort and even pressure on the catheter.  Silver nitrate is a product used for reducing granulomas.  It is also commoly used for removing warts.  

    The granuloma will be assessed at your childs outpatient appointment.  It is preferable for the PD coordinator to demonstrate how to apply silver nitrate carefully.

    Precautions

    • Use of silver nitrate requires a medical order
    • Should not be used on a clinically infected exit site
    • Due to the caustic action of silver nitrate, it must not come into contact with the Tenckhoff catheter, or skin as it will cause black discoloration and discomfort.   
    • If this does occur, or in the event of extreme pain or discomfort, rinse area with Normal Saline to cease the caustic action.
    • Vaseline should be used to prevent contact with surrounding skin

    You will need:

    • Silver Nitrate stick x 1
    • Vaseline (single use packet)
    • Sterile sachet of water x 1
    • Sachet of Normal Saline x 1

    Directions

    Day 1:

    • Remove dressing and assess exit site for infection, breakdown etc (do not apply if infection present)
    • Clean exit site thoroughly
    • Cover surrounding skin with sterile vaseline (right up to but not on granuloma)
    • Moisten tip of silver nitrate with minimal amount of sterile water
    • Please ensure the tip is not dripping
    • Carefully apply to granuloma only.  (Patient may complain of slight burning sensation.)
    • Gently wipe vaseline away with a sterile gauze (not touching the treated area)
    • Anchor catheter well and redress with patient's normal daily dressing

    Day 2:

    • Take dressing down and assess exit site, and attend to daily care
    • Do not apply silver nitrate on second day

    Day 3:

    • Clean exit site thoroughly
    • Carefully apply a second dose of silver nitrate 
    • Anchor catheter well and redress with patient's normal daily dressing

    Ongoing Care:

    • Assess exit site daily.  Over a few days the granuloma should darken in colour, form a scab and eventually fall off (five to ten days)
    • If granuloma remains after the scab falls off, a further course of treatment with silver nitrate may be indicated.
    • PD coordinator to access at next outpatient appointment