I've a question for those of you who have used silver nitrate sticks to burn off granulation tissue build-up. Do you do it yourself? My last visit to my surgeon, I asked him if he could give me the sticks and I could apply it myself at home (my surgeon is 30 miles from where I live; I simply can't get there 5 days in a row for the surgeon to apply it). He told me that he couldn't do that because it's a federally controlled substance first and foremost, and has to be applied by a doctor or nurse. However, I was able to easily order the sticks through my local pharmacy. A prescription is not required; it just had to be ordered since my pharmacist doesn't stock it routinely. I'm puzzled why my surgeon told me it's federally controlled, since that obviously isn't the case. So my question is, have any of you applied this yourself? Is it easy to do? My surgeon did it once (which wasn't enough to do any real good because it was only one treatment), so I think I could do it myself. If not, I have a nurse cousin who is willing to apply it for me.
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Silver nitrate application - do it yourself?
- By Woeful
- Posted June 28, 2009 at 1:34 pm · 17 replies
- In Home IV feeding (HPN, parenteral nutrition)
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- By Vicik
- Posted June 29, 2009 at 1:02 pm
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i do it myself. my surgeon gave me a presciption and i had no problems filling it. Not sure why yours said that.
only advice is wears gloves. if not it stains your fingers brown. obviously be careful to get it only on the intended area.
but its worked for me with no regrets in doing it myself.
john
- By Jesana
- Posted June 29, 2009 at 5:31 pm
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hi
I asked my dr if i could have some she quickly said no . she said it was a chemical
she applied the silver nitrate only to the granulation tissue and was careful not to let it hurt too much. but when I went to the gastoenterology clinic the nurse dabbed it all around the stoma completely even as i yelled ow ow That was painful
How does your dr apply it ?
- By Vicik
- Posted June 29, 2009 at 6:06 pm
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it should be put only on the granulated tissue. each swap about 10 seconds.
- By Novagrad
- Posted June 29, 2009 at 8:28 pm
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Woeful:
That's silly - I don't think these sticks are federally controlled! I've had many doctors give me the sticks and I've been able to burn off the granulation tissue myself at home. Sometimes it's hard to do these things to yourself, but this one is not bad.
Good luck!
Mimi
- By JenD
- Posted June 30, 2009 at 8:09 am
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I've had several doctors and nurses just give me a handful of these sticks to apply it at home. I'm sure you could also order them on the internet if you want. They are not a "controlled" substance. I don't know where he came up with that. I personally no longer use them because they are so painful. I use tea tree oil with the same effect and no pain. You just have to be carfeul to not to use too much and to get it only on the granular tissue not on good skin.
-Jen
- By Woeful
- Posted July 1, 2009 at 11:31 am
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What is tree oil? Does it require a script? My pharmacist ordered the silver nitrate sticks and my mom picked them up for me last week (they didn't require a script; he just had to order them from his supplier). Exactly how do you apply the sticks though? I did a google and didn't find any step by step instructions of how to apply it. I do recall reading somewhere on this site that if you apply 2% lidocaine ointment first, let it set a few minutes, then wipe it off, and then apply the sticks, you don't get the burning. Is that true?
- By Lynee
- Posted July 1, 2009 at 4:23 pm
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I have done this myself, but it is pretty painful for me. My enteral nurse just handed these to me at an appointment because I asked if I could do it myself. Just recently they prescribed a steroid cream though that isn't painful at all and it prevents the granulation tissue from forming. I put it on at night whenever I notice that there is new tissue. It's really cool. I don't have it with me or I'd tell you exactly what it is. I would definitely look into the cream though.
- By MarieTwinTubes
- Posted July 2, 2009 at 9:38 pm
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Hi, Woeful. I too have used it myself. To prevent the painful event beyond the granulation, I put zinc oxide on the skin around it to create a barrier and prevent damage to halthy skin. Here's to healthy pain free skin! :) Marie
- By Woeful
- Posted July 3, 2009 at 1:39 pm
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Marie,
Exactly how do you apply the sticks? What is the step by step process?
- By MarieTwinTubes
- Posted July 3, 2009 at 2:50 pm
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Hi, Woeful.
First, be sure the area around the stoma is clean (I use a mix of water and a little hydrogen peroxide.) and dry.
Apply the zinc oxide to the skin around the stoma. (Zinc is both protective and healing.)
Then I just take the silver nitrate stick and rub it right on the granulation. It just kind of eats the granulation away (gradually). Like others have said, in addition to hurting, it does discolor. The zinc helps prevent that where you don't need it, because it will eat up the skin as well as the granulation.
I haven't had to use it in quite a while. It's hard to tell how and when I crossed over the line from constant skin problems to being more manageable. I do think it is really imortant to keep the area dry. After cleaning the area (and using Nystop powder (for fungus folly) if the area itches), lastly I place a piece of gauze under the flange.
I hope I have said something that will be helpful to you. Best wishes in getting rid of the granulation.
Marie
- By LizAA
- Posted July 3, 2009 at 3:51 pm
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Hi Woeful, your doctor probably is leary about giving you the nitrate sticks, because you need to be very careful not to burn more than you should. Very quick, light taps are all that's needed to do the work. Do not apply prolonged pressure as it will burn deeper into the tissue.
I know many doctors that are afraid to give these because of the fear of the patient burning too much healthy tissue.
Perhaps they can demonstrate the first few times in the office, and you can take over from there?
God Bless!
liz
- By Lynee
- Posted July 4, 2009 at 10:29 am
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Woeful, Here is the cream I was talking about above. Honestly, I haven't had to have granulation removed since I started using it. You just apply it around the stoma each night (at first I did it morning and night )and no granulation tissue forms. It actually makes what is there go away too. I can't imagine going back to the silver nitrate because I hated it. It always hurts no matter what you do and it is easy to burn yourself with them. It is called: Triamcinolone Acetonide Cream USP, 0.1%. Really awesome stuff. Lynee
- By shan789
- Posted July 5, 2009 at 3:41 pm
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My sons surgeon n his GI give me plenty of them out of the office. Our pharmacy won't order them, due to we are the only one in our small town that uses them. So they gladly give them to us. His doctors are 3 hours away. I use them on his granulation around his cecostomy site.
Shannon
- By Woeful
- Posted July 5, 2009 at 6:07 pm
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Marie,
A couple questions.
I don't have any zinc oxide, but I'm wondering if Vaseline will work equally well? I did a quick google and a few sites said to just apply Vaseline all the way 'round the edges of the granulation tissue on the healthy skin part. That the Vaseline works as barrier as well (as zinc, I'm guessing?).
You said then just take the stick and rub it right onto the granulation. Sites I've read said to first dip the stick in water (to activate the silver, or something to that effect). Do you do that? As for "rub it right on the granulation," do you mean just stroke it back and forth across the tissue (like say if you're using a paintbrush and making strokes)? How many times do you do this?
Afterward, do you then wipe off the silver nitrate? (One site I went to said to wipe it off after application. But doesn't that just defeat the purpose?) As for keeping the area dry, I try to, but it's hard because of the constant leakage. I try and change the dressing (I wear a dressing 24/7) as soon as I feel it's leaking, but that's not always an option (changing the dressing immediately).
I hope this works. For some reason, the lidocaine isn't working anymore. Where before it kept the area wonderfully numb for at least 3-4 hours, now sometimes the numbness wears off in 2 hours. I don't know if it's because perhaps there's slow leakage (too slow and light for me to 'feel' but enough that it 'washes off' the lidocaine). My pharmacist said you don't build tolerance to lidocaine, so tolerance can't be the cause.
I left the house willingly for the first time in 8 months yesterday. Went to a cousin's 4th of July cookout (she's the one who is a nurse). It indeed felt great to feel sunlight on my face, just to breathe fresh air for that matter. I even put on mascara, which I haven't done in almost a year, lol. I gooped on half a tube of lidocaine before we left the house, but I still had to go change the dressing/apply more lidocaine about 2 hours after we got there. I again changed the dressing and applied fresh lidocaine right before we left to come home, and it was already hurting like the dickens by the time we pulled up in our driveway (and my cousin only lives 10 minutes away). So I've GOT to get this tissue under control somehow. My mother found me two dresses that fit so that I can actually get out of pajamas and, more importantly, out of the house occasionally. But that's all moot if I can't get the danged tissue under control because the pain drives me right back onto the sofa again once the burning starts. So I think if I can just get this damned granulation tissue under control, maybe, just maybe, I can actually get off the sofa.
- By Woeful
- Posted July 5, 2009 at 6:12 pm
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Lynee,
You said how the silver nitrate always hurt afterward no matter what. Did your surgeon apply lidocaine to the tissue first? I've read that supposedly cuts back drastically (if not eliminating entirely) the burning afterward. I only ever had one treatment. That evening it did indeed burn, but nothing to the extent the granulation tissue itself burns. And it seemed to work some. I did notice the yucky grey/black tissue (which sloughed off) and where he applied it, the tissue did seem to shrink a little. But I only had that one treatment. (My doc is 35 miles away, so I can't get down to his office often because I have to call around to find someone willing to drive me to the city.)
You mentioned Triamcinolone Acetonide Cream USP, 0.1%. I've read about that elsewhere on here (but it seemed to get mixed results). But I'm willing to give it a try. Maybe I'll too be one of the lucky ones it works for. Does it require a prescription?
- By Lynee
- Posted July 5, 2009 at 6:24 pm
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woeful, yes it does require a presription. I am amazed because I was having to in about every 6 weeks to have the granulation treated. I have "overactive" nerves in my stomach that are perpetually ticked off and the granulation tissue seemed to be more painful for me than others. Now, with the cream, I apply it myself once daily and the granulation doesn't form. My stoma is much more comfortable than it was before. I'd say it's worth a try. In answer to your other question, they did use lidocaine and also gave me lidocaine to use at home, but it had little effect for me. Nerve pain doesn't always react the same way and mine is definitely a "medical mystery". I get so darned tired of that.
I'm thinking your doc might even just call it in for you without a visit - I hope it works for you!
Lynee
- By JRE
- Posted yesterday at 2:50 pm
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Has anyone had a pyogenic granuloma? I seem to be at a dead end as far as help. I have had it cut off twice and it has grown back both times. I believe that I now have it under control. I am currently using silver nitrate but it is very painful and I develop a lot of drainage from it. Has anyone had one successfully go away by using silver nitrate? How did you use it? How do you know when to stop using it? The pyogenic granuloma is on the tip of my left thumb.
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