G/GJ tubes: Using silver nitrate to treat granulation tissue


If your child has issues with persistent granulation tissue​ around the stoma (the opening in the stomach), your health care team may suggest applying silver nitrate to the area. Your first application should be done in a clinic or your doctor’s office, but you can continue the treatment on your own at home.

What are silver nitrate sticks?

Silver nitrate sticks (also called silver nitrate applicators) have rounded tips covered in silver and are used to remove granulation tissue. Once activated, the silver burns the tissue, causing the cells to die and fall off, flattening the tissue. Your child’s skin will be able to better heal after this.

This product should not be used if your child has a sensitivity or allergy to silver.

Where can I get silver nitrate sticks?

You can buy silver nitrate sticks at many pharmacies without a prescription. Call your local pharmacy ahead of time so they can order them for you.

How to apply silver nitrate to a child’s stoma

  1. Always wash your hands with soap and water before touching your child’s skin.
  2. Clean the stoma with soap and water and pat or let air dry.
  3. Protect the healthy skin around the stoma by applying a barrier cream (i.e., zinc oxide, diaper rash cream, petroleum jelly).
  4. Dip the silver nitrate stick into a small amount of sterile or distilled water. The water will activate the silver. Salt water, or saline, will deactivate the silver and stop it from working. Do not use salt water at this stage.
  5. Roll the tip of the stick over the granulation tissue only—avoid healthy skin. One stick is usually enough for each application. The tissue may turn a grayish-black colour—this is normal. This colour will disappear slowly over time.
  6. If you accidentally get silver nitrate on healthy skin, wash that portion of skin with saline solution or salt water right away to stop its effects.
  7. Wash your hands with soap and water.

Topical antibiotic cream or ointments can lessen the effect of silver nitrate, so you should avoid using silver nitrate and antibiotic creams at the same time.

Applying silver nitrate to your child’s stoma may be painful. Providing acetaminophen or ibuprofen before applying silver nitrate can help your child stay comfortable.

Can I still apply hypertonic salt soaks if I’m using silver nitrate?

Because salt water stops silver nitrate from working, you should wait at least 12 hours before applying hypertonic salt soaks​ to your child’s stoma. This means you should apply hypertonic salt soaks to the stoma 3 to 4 times per day, only on the days you are not using silver nitrate. For example, if you apply silver nitrate to the stoma on Monday, Wednesday, and Friday, you can then apply hypertonic salt soaks on Tuesday, Thursday, Saturday, and Sunday to help with inflammation and redness.

How often should I apply silver nitrate to my child’s stoma?

Your first application will be done in a clinic or at your doctor’s office, but afterwards, you can apply the silver nitrate at home. Silver nitrate is not for long-term use unless approved by your care team. Silver nitrate should be applied to your child’s granulation tissue every two days for up to two weeks. Then you should have the G tube specialist or your doctor assess the stoma for improvements. They may decide to continue the silver nitrate for longer than the two weeks.

Key points

  • Silver nitrate sticks are used to help treat and remove granulation tissue around your child’s stoma.
  • Do not use silver nitrate if your child has a sensitivity to silver.
  • Applying silver nitrate may be painful. Giving your child acetaminophen or ibuprofen before application may help your child stay comfortable.
  • Always protect your child’s healthy skin with a barrier cream before applying silver nitrate to the stoma.
  • Water activates the silver nitrate so it will start working.
  • Salt water, or saline, deactivates the silver nitrate so it will stop working. Only apply hypertonic salt soaks to the stoma on days you are not applying silver nitrate.
  • Avoid using antibiotic creams on the stoma if you are applying silver nitrate.
  • Contact your G tube specialist or doctor to assess the stoma after two weeks of applying silver nitrate.

Holly Norgrove, RN, BScN


At SickKids

If you are a SickKids patient, contact the G tube resource nurse at 416-813-7270, extension 4, with any questions or concerns.