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Out of date Phenol?

Discussion in 'General Issues and Discussion Forum' started by Lauren84, Jan 21, 2009.

  1. Lauren84

    Lauren84 Member

    Members do not see these Ads. Sign Up.
    Just wondering the consequences of using out of date phenol for PNA surgery?
  2. Steve Jackson

    Steve Jackson Member

    Other than the fact it would be unproffessional and unethical, the increased risk of regrowth is probably the main problem.
    Last edited: Jan 21, 2009
  3. twirly

    twirly Well-Known Member

    Hi Lauren,

    :welcome: to Podiatry Arena.

    As a provider of professional foot health services it would be totally unacceptable to use out of date medicaments!

    A) Your governing body would take a bleak look at your practices.
    B) You would be unlikely to be insured for treating a patient with OOD stock.

    Would it be acceptable practice for a Pharmacist to provide OOD antibiotics? NO. In my opinion, treat others as you would hope to be treated.

    A previous discussion on the disposal of out of date Phenol is here: http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=10129&highlight=phenol


  4. cornmerchant

    cornmerchant Well-Known Member


    i sense that the reason behind your question is that you may have inadvertantly used an out of date phenol.?

    Obviously, we all know the right and wrong way to do things, but if this has been a genuine mistake, fear not! you cant actually do any harm but you may find some regrowth as a result of the phenol being less effective.


  5. Tree Harris

    Tree Harris Active Member

    Thank you cornmerchant for your response.

    Although it is often not the intention, and is wholely dependant on the readers emotional status at time of reading, as with texting, any letters and these type of forums, there is the potential for judgements and negativity to be broadcast in our responses.

    I for one often rewrite multiple times the same sentance to ensure censure is not represented when it does not exist- except for this occassion when my response flowed naturally, obviously (he he).
    We all make mistakes, and i often think as a profession, Podiatry is very intolerant of flaws. Having said that, my background is nursing, and they are perhaps too tolerant of flaws. Oh well, not a perfect world is it.
  6. twirly

    twirly Well-Known Member

    Hello Tree,

    Professional guidelines in the UK regarding the control of substances hazardous to health are in place to prevent this type of event occurring.


    My question: ' Are regulations in Australia so different than those currently in place in the UK?'

    I would have considered that even as a minimum requirement (if not law) that chemicals used in practice are regularly assessed for date etc. in any country.

    Cornmerchant said:
    Again, to prevent this 'inadvertant' use of an OOD chemical would you not advise always double checking dates prior to its use?

    On the whole I would advise against handing any regulatory body a stick to beat us with :deadhorse:

    Kind regards,

  7. trevor

    trevor Active Member

    Perhaps regrowth and a no charge PNA some time in the future.
  8. twirly

    twirly Well-Known Member

    Hi Trevor,

    I'm no legal boffin but I would imagine that to offer a free PNA in such circumstances you would then explain 'why it is free' to your patient.
    ie. Admit you caused unecessary pain & suffering due to a failure of the clinician to check chemicals.

    Given the current situation RE: litigation I would not envy the individual in question.

    The NHS has paperwork for such instances: Incident reporting forms & Near miss reports.
    Many private practices also utilise similar paperwork to prevent incident.

    Anyone can inadvertantly make an error. To learn from it & change practices accordingly is surely what we would all advise.


  9. heleneaustin

    heleneaustin Active Member

    Apart from the usual professionality behind the use of out of date medicaments the only problem i can see is that the solution becomes weaker thereby increasing the risk of regrowth. Ethically we all know that dates should be checked before use but genuine mistakes such as this do happen to even the best of us.
    Last edited: Jan 22, 2009
  10. Ann Mohler

    Ann Mohler Member

    I have received phenol with no use by date printed on it...what is the shelf life of phenol?

  11. Cameron

    Cameron Well-Known Member


    Go back to the source and ask for a use by date. The legal responsibility lies with the supplier. Obviously you are exercising your professional right to not use the product because you have insuffient information.

    For all practical purposes 80% phenol solution has probably got an indefinate shelf life (albeit that would not be acceptable in the current H&S regulations anywhere) - so some pharmacies will not put a date on the supply (naughty naughty). Prior to the introduction of O H&S legislation it would be fare to assume alcohol and phenol procedures were undertaken with phenol of an indefinate age and remarkably the outcomes were no different to today. Not to be recommended but thise were the days when these things happened.

    Also a cuastic is a caustic is a caustic and should be treated with respect the chances are a solution will become stronger (not weaker) with age which would be a very good reason in this case not to use an out of date supply.

  12. Cameron

    Cameron Well-Known Member


    Just checked with an informed source - the rule of thumb is the active shelf live of the drug is 14 days after the cap has been removed.

    This can create a problem for low users who would find it very expensive to have such small qualities made to order. Consequently most people order a 100 mls solution then rely on a shelf life date. Technically however this is not really appropriate as the solution may only have 14 days in which the product is consider active for the appropriate use. Because caustics are likely to strenthen with age these present less of a problem than other medicaments.

    From memory, the phenol solution should be saturated solution and once crystals start to form within the solution then the preparation in no longer saturated. To the best of my knowledge this is not covered in the shelf date of the drug.

    Interesting topic :morning:
  13. Ann Mohler

    Ann Mohler Member

    Thanks for that. 14 days! I know a collegue that gets fresh phenol at each P&A...I think I will be following suit.
  14. cornmerchant

    cornmerchant Well-Known Member


    Historically, is that really necessary? If we have used phenol successfully up to its shelf life, why would you want to renew it each time and leave a surplus of unused phenol to be disposed of?

    Shouldnt common sense and the environment prevail here?

  15. Ann Mohler

    Ann Mohler Member

    Hi cornmerchant

    The colleague would get some fresh phenol from the chemist (small amount - enough for a P&A) so there would not be alot to dispose of...this was a few years back. As many of the chemists are chains, and not stand alone, I am not sure if the one in my building is able to do it.

  16. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Yes, and I wonder how long the big bottle that the pharmacist has in storage has been sitting on the shelf.

    Given how little phenol is used in healthcare, I suspect it has been sittin there for years...

    In note a lot of people hold grevious opinions about phenol being 'carcinogenic' - but phenol is virtually a naturally occuring compound is found throughout nature. SOme believe it (carbolic acid) was one of the fundamental building blocks of life on this planet - which would be a paradox.

    Like any acid, a saturated solution is not generally a good thing to have on your skin, or to ingest. In real terms, the Australian Government considers the health and safety of this compound to be at 1.7 on a scale of 1-3 (http://www.npi.gov.au/database/substance-info/profiles/70.html).

    No mention of carcinogenicity...

    Rememebr phenol is widely used via percutaneus injection by vascular surgeons and interventional radiologists for the treatment of peripheral arterial disease via chemical lumbar sympathectomy. If it is safe to use next to the spinal cord, I think we can relax a little about its use in a toenail...I'm yet to meet a vascular surgeon who was concerned with its use. :rolleyes:

  17. efuller

    efuller MVP

    This is a fun academic one. It can really get you thinking.

    How does phenol work? Chemical burn
    Is the expiration date based on anything valid? I couldn't find anything in a brief search.
    (Wikipedia led down some interesting paths)

    What chemically changes when phenol sits on a shelf in a bottle that has been opened?

    In my brief reading of Wikipedia and recalling organic chemistry from 25 years ago I did not see much reason for concern for loss of effectiveness to exposure to air. Maybe evaporation or oxidation. If you start with 85% phenol and the phenol evaporates faster than whatever the other 15% is then you would still have to leave the lid off a while to loose a significant amount of phenol. It's boiling point is 181 C so it should evaporate slower than water.

    Oxidation is unlikely because an alcohol is pretty far along the oxidation chain.
    Disclaimer, the above is armchair chemistry by someone who got C's in O chem.

    This brings up another question. Is the chemical burn caused by the benzene ring or by the acidity of the alcohol group attached to the benzene ring?

    The real interesting question is how does a chemical burn kill the matrix of the nail. How thick is the matrix? How long do you have to leave the phenol in contact with the matrix to get a 99% kill rate?

    There might be someone who knows the answers to these questions. However, on the practical side the comment about the fact phenol has been used for a long time for matrixectomies and you wonder how often it was fresh and how long it has been sitting on the pharmacist's shelf in a bottle exposed to air.

    Who first thought to put phenol on a matrix anyway? So many questions

  18. Cameron

    Cameron Well-Known Member


    From memory Colin Dagnall (UK pod and historian) did write a potted history of the procedure which was published in the UK and the US (I think). I believe he was given an award for his endevours. Must go to the shed and look it out.

    Back in the 70s a common technique (UK) seemed to be electro-surgery. It was certainly taught by the Croydon Post Graduate Group who were the proactive group of chiros who started the UK Podiatry movement influenced by the US. Later there was a move to use cryo techniques to destroy the matrix but overall alcohol and phenolisation seems to be popular.

  19. Paul Bowles

    Paul Bowles Well-Known Member

    Its not the use on subjects that is of concern, its the inhalation by practitioners whilst it is sitting around in open space that is!
  20. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Its never been a concern wherever I have practiced over 15 years.

    My technique: draw up about 0.3cc of phenol via drawing-up needle/syringe at the time of the procedure, dispense this into a small 20mm galley pot just prior to application, then apply liberally to target tissue with 1mm dermal curette for requisite time.

    Remaining (0.15cc approx) of phenol cleaned out of galley pot with some gauze and into waste disposal.

    I barely ever smell it, let alone note any of the potential hazardous effects. I tend to get more skin and eye irritation walking next to a main road.

    Maybe we just need to develop some more sensible guidelines for its use?

    I have seen some practitioners leave open bottles lying around and pour horrendous amounts of the stuff onto the surgical field, when just a fraction of this amount is enough to phenolise 100 toes.

  21. Paul Bowles

    Paul Bowles Well-Known Member

    I don't disagree Tony, however OH and S is and remains exactly that - OH and S. Regardless of the fact you barely smell it, in the form we use it in (liquefied phenol) it is a known carcinogen upon inhalation.

    Regardless of individuals beliefs and things being developed - practitioners need to know the potential risks - dismissing them is negligent. Whether they choose to ignore these or dismiss them then that is up to personal opinion.

    A good deal more research needs to be done into this area before we start going around touting the safety of liquefied phenol (as we have been doing for years!). Development of sensible guidelines for its use is the first sensible step though!
  22. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    ?? is it?

    Its not a known carcinogen according to the University of California Berkeley Carcinogenic Potency Project (http://potency.berkeley.edu/chempages/PHENOL.html).

    According to the International Agency for Research on Cancer (IARC):
    Most of the carcinogenicity studies focus on gastrointestinal and skin absorption on phenol. So, I can't imagine small amounts of inhalation are of concern, relative to the many other known air pollutants in major cities. Certainly no mention of carcinogenicity on inhalation in the database searches I did.

    I remain unconvinced this is a major OH&S issue...perhaps you can cite some studies?

  23. Paul Bowles

    Paul Bowles Well-Known Member

    Tony I will get back to this with references shortly - am just getting some of this data ready for a paper we are writing and some of the references are at work.

    The major tag line that is of concern is that "There is inadequate evidence in humans for the carcinogenicity of phenol." "Phenol is not classifiable as to its carcinogenicity to humans"....when that reads "is not harmful to humans" I will be satisfied that breathing it in or exposing patients to it is of no concern.

    It's not the devil you do know, its the devil you don't!

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