Renal Unit, Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China.
The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
J Ren Care. 2021 Jun;47(2):103-112. doi: 10.1111/jorc.12358. Epub 2020 Dec 18.
Silver nitrate cauterisation is the conventional treatment for peritoneal dialysis catheter exit-site granulomas. However, it requires to be performed by nurses, patients often experience pain and chemical burns. Therefore, the appropriateness and applicability of using 2% aqueous chlorhexidine swabstick as an alternative was explored in two nephrology centres in Hong Kong.
To examine possibility of conducting full trial using chlorhexidine swabstick compared with silver nitrate.
A pilot study.
Fort-four patients with exit-site granulomas were equally, randomly allocated to receive chlorhexidine swabstick or silver nitrate.
Both groups were followed for 6 weeks to evaluate the time of granuloma subsidence and adverse effects. Pain and treatment satisfaction were assessed using numerical rating scale and self-developed questionnaire, respectively.
Healing rates were 94.4% (17 of 18) using chlorhexidine swabstick,100% (21 of 21) using silver nitrate (p = 0.46). The mean time of granuloma subsidence was significantly longer when using chlorhexidine swabstick (32.8 days) than silver nitrate (12.3 days, p=0.02). The chlorhexidine swabstick group reported significantly fewer adverse effects (11.1%, 2 of 18, p = 0.01) compared with the silver nitrate group (52.4%, 11 of 21). The chlorhexidine swabstick group had lower mean pain score (0.5 of 11) than the silver nitrate group (2.4 of 11, p < 0.01). The satisfaction scores between the two groups had no substantial difference.
Chlorhexidine swabstick took long time to remove granulomas but had similar success rate, less pain, fewer adverse effects than silver nitrate. Additional research is warranted to examine the applicability of chlorhexidine swabstick.
硝酸银烧灼是治疗腹膜透析导管出口部位肉芽肿的传统方法。然而，它需要由护士来进行，患者往往会感到疼痛和化学灼伤。因此，在香港的两个肾病中心探索了使用 2%氯己定拭子棒作为替代方法的适宜性和适用性。
检验使用氯己定拭子棒代替硝酸银进行全面试验的可能性。
一项试点研究。
44 名患有出口部位肉芽肿的患者被平均随机分配到氯己定拭子棒或硝酸银组。
两组均随访 6 周，以评估肉芽肿消退的时间和不良反应。使用数字评分量表和自行设计的问卷分别评估疼痛和治疗满意度。
使用氯己定拭子棒的愈合率为 94.4%（17/18），使用硝酸银的愈合率为 100%（21/21）（p=0.46）。使用氯己定拭子棒的肉芽肿消退时间明显长于使用硝酸银（32.8 天 vs 12.3 天，p=0.02）。氯己定拭子棒组报告的不良反应明显少于硝酸银组（11.1%，2/18 vs 52.4%，11/21，p=0.01）。氯己定拭子棒组的平均疼痛评分（0.5 分，11 分制）低于硝酸银组（2.4 分，11 分制，p<0.01）。两组的满意度评分没有实质性差异。
氯己定拭子棒虽然需要较长时间才能消除肉芽肿，但与硝酸银相比，其成功率相当，疼痛较轻，不良反应较少。需要进一步的研究来检验氯己定拭子棒的适用性。
