Care of the infant with an Umbilical Granuloma

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Care of the infant with an Umbilical Granuloma

• New Guidelines for Hospital and Home

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Introduction

• The protocol and clinical guidelines aim to guide
  health professionals when undertaking the care of
  an infant with an umbilical granuloma.
• An Umbilical Granuloma should be diagnosed by an
  appropriately qualified Health Professional i.e.
  Doctor, Specialist Community Practitioner or
  Advanced Nurse Practitioner.

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Purpose and Scope

• The guideline is aimed at all nurses, medical
  staff and doctors assessed as competent to care
  for a child with an umbilical granuloma.
• The purpose being to provide a standard of good
  practice that is evidence based.

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What is an Umbilical Granuloma

• Usually the umbilical cord dries and is separated
  by 8 days in most infants and the separation
  normally heals by 12-15 days. An umbilical
  granuloma occurs when there is a delay in the
  separation of the cord as a result of mild
  superficial skin infection in the umbilical area.
  The inflammatory process at the umbilicus becomes
  florid with excess granulation tissue preventing
  the area from developing epithelia tissue.

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Umbilical Granuloma
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Using Common Salt

• Common salt has shown to be an effective practice
  to treat umbilical granulomas.
• the principle of using this approach is thought
  to be through its desiccant effect and other
  biological properties sodium ion in the area
  draws water out of the cells and results in
  shrinkage and necrosis of the wet granulomatous
  tissues (Derakhsham 1998, pg 3)
• The Health Professional visiting the family
  should give the following instructions to the
  family.

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Use of Salt 1.

• Expose the centre of the umbilicus by pressing on
  the area around the umbilicus.
• Apply a very small pinch of table/cooking salt
  over the umbilical granuloma.
• Cover the area with a gauze dressing and secure
  it in place for 30 minutes.
• It is important not to use too much salt because
  it will damage the normal skin around the
  umbilicus.

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Use of Salt 2.

• Clean the site using a clean gauze swab soaked in
  warm water.
• Repeat the procedure twice a day for at least 3
  days.
• The granuloma should be reviewed at one week by a
  health professional.
• If umbilical granuloma has not responded to
  treatment then the next approach would be to use
  Polyurethane.

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Using Polyurethane e.g. Lyofoam

• The health professional visiting the family
  should give the following instructions to
  parent(s) carers
• Cleanse the area with warm water.
• Use Polyurethane Foam and cut to size to cover
  area.
• Apply polyurethane foam dressing and secure with
  hypo-allergic adhesive tape e.g. micropore.
• NB Tape around the edge of foam leaving the
  centre of the foam exposed to air.
• Change 3 times a week or as exudate dictates.
• Review at one week by health professional who
  will assess and advise. If Granuloma has not
  resolved the use of silver nitrate will be
  utilised.

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Use of Silver Nitrate

• An Umbilical Granuloma should be diagnosed by an
  appropriately qualified Health Professional i.e.
  Doctor, Specialist Community Practitioner or
  Advanced Nurse Practitioner.
• Umbilical Granulomas may be self limiting and
  initially should be treated conservatively. The
  use of silver nitrate is not without risk and can
  cause burns if not applied correctly.

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Silver Nitrate Guidelines

• EQUIPMENT
• Caustic applicators containing 40 sliver nitrate
  60 potassium nitrate. These are to be stored in
  cool dry place out of the light.
• Petroleum jelly or similar product i.e. Epaderm
• Water

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Silver Nitrate Procedure 1.

• Ensure the umbilical area is cleaned and dried of
  any umbilical exudate.
• Protect the surrounding skin with petroleum
  jelly. To ensure there is no leakage of silver
  nitrate onto surrounding healthy tissue.
• The tip of the silver nitrate applicator only
  must be moistened lightly with tap water. Over
  wetting the tip dilutes the activity of the
  caustic applicator.
• The tip of the silver nitrate applicator should
  be rubbed gently not held onto the affected area
  for 1-2 minutes only.

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Silver Nitrate Procedure 2.

• Excessive quantities or incorrect use may cause
  burning of the healthy tissue surrounding the
  umbilical granuloma. The action of applied silver
  nitrate can be stopped by irrigating with sodium
  chloride 0.9 solution
• Following the procedure advise parents to leave
  area exposed for 10 minutes. The area does not
  require covering with any form of dressing.
• The silver nitrate applicator is to be used only
  once and to be disposed of safely.

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CAUTIONS

• If silver nitrate comes into contact with any
  other area of the skin rinse with cold running
  water for least 10 minutes.

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Hazards when using Silver Nitrate

• To yourself

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Hazards of Silver Nitrate

• To the Infant when Silver nitrate when occluded

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Any Questions
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REFERENCES

• BNF for children (2007) London. BMJ publishing
  group
• www.bestbets.org
• www.bristolnorthpct.nhs.uk/publications/policies
• UKMI QA Accessed online through nlh.com
  17/10/2007
• www.gpnotebook.co.uk
• www.healthinaaw.nhs.uk/document.ctm?document23201