Number
106-EN
Section
General Section
Use
Sector
Health services
Function
No technical function
Process
Manual activities involving hand contact
Product category
Pharmaceuticals
Application
Cauterization
Abstract
Chromium trioxide is used to stop bleeding, especially in heavy nosebleeds in a process known as cauterisation. It was found that silver nitrate in the form of lunar caustic sticks can replace chromium trioxide as a cauterisation agent. The use of silver nitrate is associated with some drawbacks, but it is still advantageous compared to chromium trioxide which is highly toxic and carcinogenic.
Substituted substances
Chromium trioxide
CAS No. 1333-82-0 EC No. 215-607-8 Index No. 024-001-00-0
Chemical group
Chromium compounds; metal oxides
Classification: hazard statements
H271 May cause fire or explosion; strong oxidiser
H350 May cause cancer
H340 May cause genetic defects
H361f Suspected of damaging fertility
H330 Fatal if inhaled
H311 Toxic in contact with skin
H301 Toxic if swallowed
H372 Causes damage to organs through prolonged or repeated exposure
H314 Causes severe skin burns and eye damage
H334 May cause allergy or asthma symptoms or breathing difficulties if inhaled
H317 May cause an allergic skin reaction
H400 Very toxic to aquatic life
H410 Very toxic to aquatic life with long lasting effects
Other adverse effects
The substance is: 1 carcinogen (IARC: chromium VI compounds), as listed in the Substance Database according to SUBSPORT Screening Criteria (SDSC).
Alternative Substances
Silver nitrate
CAS No. 7761-88-8 EC No. 231-853-9 Index No. 047-001-00-2
Chemical group
Silver compounds; nitrates
Classification: hazard statements
H272 May intensify fire; oxidiser
H314 Causes severe skin burns and eye damage
H400 Very toxic to aquatic life
H410 Very toxic to aquatic life with long lasting effects
Reliability of information
Evidence of implementation: there is evidence that the solution was implemented and in use at time of publication
Reason substitution
CMR
skin/respiratory sensitizing
other toxic effects
ecotoxicity
physical hazards
Hazard Assessment
Substance to be substituted: Chromium trioxide is however on the SUBSPORTplus screening criteria list and holds many more hazards for human health including: is fatal if inhaled, is toxic if swallowed, is toxic in contact with skin, causes severe skin burns and eye damage, may cause genetic defects, may cause cancer, causes damage to organs through prolonged or repeated exposure, is very toxic to aquatic life with long lasting effects, it may cause fire or explosion (strong oxidiser), is suspected of damaging fertility, it may cause an allergic skin reaction and may cause allergy or asthma symptoms or breathing difficulties if inhaled. Alternative substance: Silver nitrate is not in the database of hazardous substances according to SUBSPORTplus screening criteria (SDSC): However, it causes severe skin burns and eye damage, is very toxic to aquatic life, is very toxic to aquatic life with long lasting effects and may intensify fire (oxidiser).
Description of Substitution
In severe cases of bleeding, a process called cauterisation may be applied to prevent further blood loss. Cauterisation implies burning the tissue around the bleeding with some kind of chemical agent. One such agent is chromium trioxide. Chromium trioxide is however associated with several drawbacks. It is highly toxic, carcinogenic and may impair fertility. A suitable alternative might be silver nitrate, also a hazardous compound but less so than chromium trioxide. The advantages with using silver nitrate are mainly decreased occupational exposure during preparation as well as decreased patient exposure. Chromium trioxide is also very corrosive and might damage equipment and material. In order to use chromium trioxide, records of what personnel are allowed to perform the procedure need to be kept at the workplace due to Swedish occupational legislation. No such records are needed for silver nitrate. The limitation of silver nitrate is mainly that lunar caustic sticks might be too large for children´s noses.
Case/substitution evaluation
Chromium trioxide is very hazardous for human health and thus very inappropriate for the application. Silver nitrate is therefore a preferable substitute. Considering especially the ability of the substitute to cause burns and the toxicity to aquatic organisms, it should be handled carefully, including waste treatment. This substance should also be replaced in further steps.
State of implementation
Full capacity
Date and place of implementation
2006, Sweden
Enterprise using the alternative
www.akademiska.se/">http://www.akademiska.se/ www.akademiska.se/
Availability of Alternative
On the market
Type of information supplier
User
Contact
Environmental Chemist Environment and Chemistry Unit, Uppsala County Council.
Date, reviewed
December 11, 2020