Cleaning and dressing ulcerated haemangiomas

Equipment and supplies 

• non-adherent silicone dressing of appropriate size

• two alginate dressings of appropriate size

• two gauze packs

• bandage, tube bandage or low adherent tape to secure dressing

• potassium permanganate crystals

• prescribed antimicrobial ointment

• large bottle or jug of cooled, boiled water

Important

Always have the dressing and cleaning solution prepared before removing the old dressing.

When removing a dressing, do not remove forcibly but soak off gradually.

If bleeding occurs at any time during a dressing change, apply pressure using gauze for five minutes without looking, and secure in place. If blood soaks through the gauze, do not remove but add another gauze pad on top. Do not replace dressing for 48 hours.

If at all concerned, take your child to the nearest Accident and Emergency (A&E) department.

Preparing the dressing

1. Wash your hands.

2. On a clean surface, such as a tray or other container only used for preparing dressings, open the gauze squares. You should have enough to cover an area twice the size of the haemangioma and two to three gauzes in thickness.

3. Open the outer packets of nonadherent silicone dressing and alginate dressing, but do not remove the inner packaging for the moment.

4. Remove cardboard from alginate dressing and place one piece on top of the gauze.

5. Moisten remaining piece of alginate dressing with a little of the cooled, boiled water and place onto top of the dry alginate dressing and gauze.

6. Remove one side of the non-adherent silicone dressing inner packaging and apply antimicrobial ointment to the surface.

7. Remove other side of the non-adherent silicone dressing inner packaging and place ointment side uppermost to the top of the alginate dressing and gauze 'sandwich'.

Preparing the cleaning solution

1. Put a very small amount of potassium permanganate crystals into a small bowl and add a little of the cooled, boiled water. Note: if you have been supplied with potassium permanganate tablets, crush one tablet in a tablet crusher or between two teaspoons, and use a small amount of the resulting powder. The resulting solution will be purple in colour.
2. Add enough of this solution to the bottle or jug of cooled, boiled water to turn it a pale pink colour.
3. Keep a small amount of the purple solution to add directly to the bath water if required.

Haemangioma in the nappy area

1. Fill a baby bath with warm water so that it is deep enough for the affected area to be covered, without your baby sitting on the bottom of the bath.
2. Add enough of the purple solution to turn the water pale pink.
3. Put your baby in the bath for three minutes to soak.
4. Lift your baby out of the bath and dry rest of body as usual.
5. Use a hairdryer on a cool setting to dry the haemangioma. Do not wipe or rub.
6. Apply the sandwich of dressings, ointment side uppermost to the area. Do not apply tape to secure the dressing as it will be held in place by your baby’s nappy.

7. Repeat this procedure twice a day. However, at nappy changes, you may need to apply a new dressing if it is wet or soiled. At this time, pour cooled, boiled water over the area and replace the antibiotic ointment with petroleum jelly.

Haemangioma on an arm, leg or body

If your child's haemangioma is on their arm, leg or body:

1. Fill a baby bath with warm water and put your baby in the bath as usual. 

2. Pour the bottle of pink solution gently over the haemangioma.

3. Lift your baby out of the bath and dry rest of body as usual.

4. Use a hairdryer on a cool setting to dry the haemangioma. Do not wipe or rub.

5. Apply the sandwich of dressings ointment side uppermost to the area.

6. Secure using a bandage (on limbs) or a tube bandage vest (on body).

Haemangioma on the head or face

If your child's haemangioma is on their head or face:

1. Soak a piece of gauze in pink solution.
2. Place directly onto the haemangioma. Do not wipe or rub.
3. Leave for 30 seconds.
4. Repeat the above steps six times.
5. If possible, dry the area with a hairdryer on a cool setting or leave to dry naturally for five to ten minutes.
6. Apply the sandwich of dressings ointment side uppermost to the area.

7. Secure using a stretchy tubular bandage balaclava if possible or use a small amount of low adherent tape.

Last reviewed by Great Ormond Street Hospital: September 2012
Ref: 2012F0336 September 2012
Compiled by the Birthmark Unit in collaboration with the Child and Family Information Group.

This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.