Cryotherapy

Policy

Category:  Clinical Services
Subject:  Cryotherapy
Division:  Community Health and Wellness
Policy Number:  CA.72.01.407
Effective Date:  October 26, 2017

POLICY STATEMENT

Cryotherapy has been identified as a form of best practice treatment for genital warts as per current federal STI guidelines. A public health nurse (PHN) can provide this type of treatment to clients of Wellington-Dufferin-Guelph Public Health (WDGPH); given the PHN has the added skill set. These clients may be clients of the sexual health clinic, or a community physician or nurse practitioner referred to WDGPH for genital wart treatment.

Cryotherapy is a controlled act and requires a direct order on file for nurses to perform this treatment.

Provided the following conditions are met:

  1. Initial diagnosis of genital warts has been made by the clinic physician, a community physician or a nurse practitioner and a direct order outlining an individual treatment plan has been established.
  1. The client has no visible signs of infection in the area to be treated with liquid nitrogen, including redness, swelling, or purulent drainage.
  1. Verbal consent has been obtained by the client for the PHN to apply liquid nitrogen to the affected area.
     
  2. The client will be reassessed by physician or nurse practitioner after a maximum of five Cryotherapy sessions, for further direction and a continued treatment plan.
     
  3. The client will not exceed one Cryotherapy treatment weekly.

CRITERIA FOR REFERRAL:

Client exhibiting signs of infection in the area to be treated as well as clients that are pregnant or trying to conceive require referral to a physician or nurse practitioner.

SCOPE

This policy applies to all nurses assigned to Clinical Services with the added skill set and appropriate Agency training.

DEFINITIONS

Cryotherapy – a technique that uses an extremely cold liquid or instrument to freeze and destroy abnormal skin cells that require removal.

Direct order – is client specific.  It is an order for a procedure, treatment, drug or intervention for an individual client. It is written by an individual practitioner for a specific intervention to be administered at a specific time(s).

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure:  CA.72.02.407 Cryotherapy

Compendium of Pharmaceuticals and Specialties

Canadian Guidelines on Sexually Transmitted Infections, January 2010.

Potter, P.A. & Perry, AG. (2006). Fundamentals of Nursing, St. Louis:  Mosby.

CONTACT FOR INQUIRIES

Manager, Clinical Services

APPROVED BY

Director, Community Health and Wellness


Procedure

Category:  Clinical Services
Subject:  Cryotherapy
Division:  Community Health and Wellness
Procedure Number:  CA.72.02.407
Effective Date:  Ocgtober 26, 2017

PROCEDURE

Nurses will:

  1. Asses client and order/policy/treatment plan to ensure all conditions are met for a nurse to administer Cryotherapy.
  2. Obtain consent to provide treatment to the client.
  3. Collect required supplies: Liquid Nitrogen (spray nozzle or cotton tipped swab), gloves, cotton tipped swab.
  4. Complete an assessment of the site for redness, swelling or purulent drainage and assess for contraindications.
  5. Provide health teaching to the client in regards to the process of Cryotherapy. Explain to the client that Cryotherapy is the process of freezing tissue with an extremely cold gas (liquid nitrogen). After treatment, the outer layer of tissue forms a blister and eventually breaks away from the deeper layers, taking most of the affected tissue with it.
  6.  Discuss with the client the protocol for weekly treatment of areas if required and the need for follow-up assessment by a physician or nurse practitioner post three Cryotherapy session.
  7.  Apply liquid nitrogen to the affected area(s) approximately three times ensuring the specific area remains white throughout treatment.
  8. Advise the client of schedule for subsequent treatment and discuss after care of treatment area(s) receiving Cryotherapy as it may cause some discomfort. Recommend saltwater baths to help soothe and heal the genital area during treatment. Two handfuls of plain salt per bath, preferably twice daily.
  9. Notify physician or nurse practitioner if no improvement is noted, unexpected reactions occur or any concerns arise requiring further direction or clarification.
  10. Document treatment according to agency policy and program guidelines.

After visible genital warts have cleared, a follow-up evaluation is not necessary but may be useful to ensure that there are no persistent or new warts

RESPONSIBILITIES

Managers/Supervisors are responsible to:

  • Train program employees on Cryotherapy policy and procedure as well as the safe handling and use of liquid nitrogen;
  • Ensure staff are aware of the safe handling and use of liquid nitrogen as well as the risks and protocols associated with its use; and
  • Assist employees in interpreting and applying Cryotherapy policy and procedure to their practice.

Clinical Services Nurses are responsible to:

  • Participate in training for Cryotherapy policy, procedure and guideline;
  • Follow safe handling and use of liquid nitrogen guidelines;
  • Notify manager of any safety concerns as soon as they arise regarding the safe handling and use of liquid nitrogen; and
  • Consult with manager if clarification or interpretation is required

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy: CA.72.01.407 Cryotherapy

Compendium of Pharmaceuticals and Specialties

Canadian Guidelines on Sexually Transmitted Infections, January 2010.

Potter, P.A. & Perry, AG. (2006). Fundamentals of Nursing, St. Louis: Mosby.

CONTACT FOR INQUIRIES

Manager, Clinical Services

APPROVED BY

Director, Community Health and Wellness