Who should read this document 2 Key points 2 Background/ Scope 3 Policy/Procedure/Guideline 4

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1 Stoma and peristomal granulomas using local anaesthetic and curette and cauterisation the assessment and treatment of Classification: Policy/Procedure Lead Author: Zoe Yarwood Stoma Specialist Nurse Additional author(s): Amanda Smith Stoma Specialist Nurse Dr Calum Lyon Consultant Dermatologist Authors Division: General Surgery Unique ID: TWCG23(14) Issue number: 2 Expiry Date: December 2018 Contents Section Page Who should read this document 2 Key points 2 Background/ Scope 3 Policy/Procedure/Guideline 4 Explanation of terms and definitions References and Supporting Documents 5 Document control information (Published as separate document) Document Control 6 Policy Implementation Plan 6 Monitoring and Review 7 Endorsement 7 Equality analysis 8 Page 1 of 5

2 Who should read this document? The provision of the policy will apply to: Stoma Specialist Nurses Dermatology Consultant Dr Calum Lyon Dermatology OP Theatre Dermatology unit staff Key Messages To practitioner is able to assess the patients stoma/peristomal granulomas and treat with infiltration of local anaesthetic, removal of granuloma by curette and cauterisation. Department Aims: To deliver and maintain high quality patient care To benefit patients and reduce the risk of harm as much as possible To use resources as effectively as possible To reliably collect data about aspects of care to provide assurance that care is safe and effective Page 2 of 5

3 Background & Scope The definition of a Granuloma is characterised by papular, benign tumors appearing around stomas. The lesions are composed of granulation tissue, acanthomatous epidermis and islands of bowel metaplasia (Lyon and Smith 2010). Granulomas have a cauliflower appearance, are friable and bleed easily (Burch 2008). They occur usually at the mucocutaneous junction and often precipitate stoma bags leaks. Faecal irritation is cited as the main cause for their growth (Lyon and Smith 2010). A leaking appliance causes embarrassment, lowering of self esteem, loss of confidence and poor adaptation to life with a stoma. Skin problems are further increased thus leading to a vicious cycle (Myers 1996). Skin integrity is essential and patients suffering with leakage caused by granulomas seek help from various health professionals, various treatments and appliance modifications are tried. Collaboration between the departments of stoma care and dermatology involves a monthly dermatology stoma care theatre/clinic at Salford Royal NHS. The practitioner has completed a Masterclass on the treatment of granulomas at the Post Graduation Centre, York Hospital ran by Dr Calum Lyon - Consultant Dermatologist. Achieved competency for this treatment with regular training and reflection at SRFT. Completed and had approved a PGD for injection of local anaesthetic (Lidocaine Hydrochloride Ph Eur 1% with Adrenaline 1:200,000) into peristomal skin prior to the removal of granulomas. Developed patient leaflets before and aftercare leaflets. Developed treatment policy. Page 3 of 5

4 Policy/ Guideline/ Protocol Process of Assessment and Treatment of Granulomas Referral Patient may be a self referral GP referral Local stoma nurse specialist referral Other Patient reviewed and assessed Assess Granuloma Assess size of granuloma Painful Bleeding Appliance leakage Effecting patients quality of life Alternative treatments tried? i.e Silver Nitrate Suspicious Assess Stoma/mucosal Granuloma Bleeding Appliance leakage Suspicious Patient added to Stoma/Dermatology Theatre Information leaflets given/posted to patient Treatment Attend Dermatology/stoma theatre for removal of granuloma Injection of local anaesthetic Curette remove granuloma Cauterisation to stop bleeding Biopsy Send for histology Follow up Aftercare advice leaflet given FU in clinic if needed. Page 4 of 5

5 Explanation of terms & Definitions Mucocutaneous Junction Bowel mucosa joins skin tissue. Silver Nitrate 75% or 90% application, sticks coated with silver nitrate, pressed onto the lesions for a few seconds, resulting in chemical destruction of the tissue. Curette - Surgical instrument designed for scraping or debriding tissue Histology - Study of the microscopic anatomy of cells and tissues References and Supporting Documents Burch J (2008) Stoma Care. WileyBlackwell. London Lyon C.C, Smith A J (2010) Second edition. CRC press Abdominal stomas and their skin disorders. Myers C (1996) Stoma Care Nursing. A Patient Centered Approach. Arnold. London Stoma Care Nursing Standards and Audit Tool (2013) Page 5 of 5