This is a demonstration of a wound care physician using silver nitrate as a chemical cauterization agent to achieve hemostasis in a wound and to decrease hypergranulation tissue in a wound. Japa Volchok, DO demonstrates correct cauterization techniques and discusses the uses of cauterization in promoting wound healing. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home.
Understand Wound Care:
Chemical Cauterization in Wounds
Commentary: Japa Volchok, DO
In this particular demonstration we will be using a chemical cauterization agent to achieve hemostasis in a wound that is bleeding after debridement. Additionally, we will also demonstrate how to apply a topical medication in this particular instance, a chemical cauterization agent to decrease hypergranulation tissue that has occurred in a wound to promote correct wound healing.
Chemical cauterization for hemostasis or treatment of hypergranulation tissue is commonly performed with a prescription medication known as silver nitrate. Silver nitrate is a caustic agent. You can see on the tip, this is the silver nitrate, the small dark area that is on the tip of this applicator. It is important that this be kept in a dark and cool, dry location. If it is not, the medication will degrade and be ineffective.
This model will demonstrate how to correctly apply silver nitrate to achieve hemostasis in a wound that has recently been debrided and has a small amount of vascular bleeding that is ongoing. Silver nitrate is a chemical caustic agent and can sting slightly when applied. It is important to have adequate anesthesia present in the wound. This can most commonly be achieved with a topical anesthetic.
Silver nitrate is a medication that is available by prescription and is one that when is applied to the wound, the area where it has been applied will turn black. This can create staining on the skin. If used in areas of visibility such as the face, this should be taken into consideration. Silver nitrate when applied, will achieve its hemostatic effect by creating chemical cauterization or sealing of the vessels.
In this wound model, you can see that at the depth of the wound there is this area of red. This demonstrates a vessel that is oozing. When silver nitrate is applied it works best when the wound is maximumly dry. Initially, what you will want to do is to use a gauze and apply pressure and dry the wound bed. Once this has achieved, remove the gauze and quickly apply the silver nitrate to the area of maximum bleeding. This silver nitrate stick should be rotated gently. As you rotate it, the silver nitrate will be removed from the tip of the applicator. You will see now, that the wound bed has a small gray to black discoloration. This is the silver nitrate that has been left behind. You can also see that the hemostasis has been achieved and that there is no ongoing hemorrhage.
Silver nitrate is distinctly separate from other wound products that contain silver. It is not a product that it used for achieving bactericidal or bacteriostatic wound healing. It is only a medication that is used topically for the treatment of bleeding or hypergranulation.
Hypergranulation commonly occurs in a wound such as this. The bright red, beefy granulation tissue has overgrown the edges of the wound and is now above the level of the skin or the epithelium. Hypergranulation commonly occurs in a variety of wounds and ulcers, as well as around such surgical wounds as abdominal wounds and feeding tube sites.
Without destruction of a portion of the hypergranulation tissue, reepithelialization cannot occur across the wound. For epithelialization to occur, the epithelial cells from one side of the wound must have contact with the other side of the wound. If granulation tissue is mounded between these two edges of the epithelial cells, they will not cross and contact achieving closure of the wound. Silver nitrate as is seen on the end of this applicator, is commonly used to destroy a portion of the hypergranulation and allow successful wound healing and closure.
Silver nitrate is applied after being prescribed by a licensed physician. It is then applied to the area of hypergranulation as being demonstrated here. The silver nitrate is this portion that you see on the tip of the applicator. It can be applied to the area of hypergranulation by rolling the applicator throughout the course of it. You will see that as it is applied, the tissue starts to turn gray to black.
Once the silver nitrate has been applied, a wound dressing can then be applied over the wound. The application of silver nitrate as a chemical caustic cauterization agent for treatment of hypergranulation may be required on more than one occasion.