CRYOTHERAPY FOR VERRUCA VULGARIS AND/OR PLANTAR WARTS - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Sun, 12/01/2002
Reviewed: 
Sat, 08/27/2011
Revised: 
Tue, 09/12/2017

Successful eradication of plantar warts and some common warts frequently requires repetitive treatments. Benign small and usually painless growths, warts are typically raised, rounded, rough and may have significant surrounding callous. This procedure gives the RN authority to use liquid nitrogen to treat plantar warts and common warts after diagnosis and referral from a UCSC clinician. This procedure does not allow treatment of genital or periungal warts.

Procedure
 Clinician diagnoses verruca. Clinician reviews treatment options. Students who choose liquid nitrogen treatment may be referred to RN for treatment.
 Patient is scheduled for a Nurse appointment for wart treatment.
 The RN practices universal precautions throughout this procedure.
 If necessary, pare the calloused lesions with a #15 blade.
 Apply liquid nitrogen until 1 to 2 mm of whitening extends past the borders of the wart.
 Hold the applicator to the wart or repeat applications until the wart has been frozen for 10 to 30 seconds as tolerated.After thawing, refreeze a second time for 10-30 seconds as tolerated.
 Apply a band aid or corn pad to site for comfort, if patient wishes.
 Explain to the patient that the treatment may not be sufficient and repeat treatments should be scheduled every 2 to 4 weeks.
 If the wart has been treated 4 times without complete resolution, the patient should be referred back to the primary care clinician for re-evaluation.
 Review signs and symptoms of infection. Instruct patient to return to the office should any of these develop.
 Recommend that the student soak the affected area for 5 minutes daily and gently rub the surface of the wart with a pumice stone to speed resolution.
 Provide and review available educational materials for patient.

Experience, Training and/or Education
 Current CA RN license
 Completion of UCSC Student Health Center orientation specific to this procedure
Evaluation of Competency

Initial Competency

  • Observes experienced RN implementing this procedure.
  • Demonstrates successful use of this procedure under direct RN supervision at least three times.
  • Submits a minimum of 5 chart notes demonstrating use of the procedure to the Clinic Director for review.

On-going Competency
Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student Health Center

Scope of Supervision
 No direct supervision required.
 Clinician available for immediate consultation as needed.

Criteria for Provider Consultation & Referral
Patients should be referred for clinician evaluation if:
 The treatment is unexpectedly painful.
 Wart has not resolved after the 4th treatment. RN may generate appropriate outside referral to dermatology or podiatry.
 Patient has an unexpected response to treatment.
 Patient is not satisfied with treatment plan.

Documentation
RN documents according to the standards delineated in the UCSC Student Health Center Policy on Documentation of Care.