Bleeding or Hemorrhage from the Nose is called Epistaxis. It can be spontaneous or due to an injury.
There are two types.
- Anterior (most common, Bleeding arises from the Kiesselbach’s plexus of little’s area)
- Posterior (less common, Bleeding arises from the Woodruff’s plexus, a venous plexus situated in the posterior part of inferior meatus)
Causes & Risk Factors
- Local infections (vestibulitis, rhinitis, sinusitis)
- Tumor (sinus or nasopharynx)
- Side effects of drugs (E.g.Aspirin)
- Liver disease
- Systemic infections (scarlet fever, malaria)
- Drying of nasal mucous membranes
- Nasal inhalation of illicit drugs (E.g, cocaine)
- Trauma (digital trauma as in picking the nose; blunt trauma; fracture; forceful nose blowing)
- Redu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia)
|1||– ABC (Airway Breathing Circulation)
– Monitor vital signs
|Assess whether the Airway is patent, breathing is normal and spontaneous, circulation is normal & adequate (monitoring Pulse)||ABC is rapid assessment of deteriorating /critically ill patients.|
|Monitor Temperature, Pulse, Respiration, Blood Pressure||Helps to know the basic condition of the patient|
|2||Applying Direct pressure to the nose||Help the Patient to sit upright with the head tilt forward
|Reduces the risk of Aspiration & swallowing of blood which may cause irritation to the stomach ending nausea and vomiting|
|Explain how to apply direct pressure with the use of thumb and index finger over the soft portion of the nose for 10 to 15 minutes
|Direct application of pressure helps to arrest the bleeding and promotes clotting|
|3||Use of Nasal Decongestants
e.g. Phenylephrine, oxymetazoline
|Administer nasal decongestants with proper documentations.||Phenylephrine, oxymetazoline causes vasoconstriction to reduce the bleed|
|4||Use of 4% Topical Cocaine||Administer the drug with proper documentations.||4% Topical cocaine acts as a vasoconstrictor and topical anesthetic that helps to reduce the bleeding and pain|
Visible bleeding can be cauterized with silver nitrate or electro cautery (high frequency electric current)
|Explain the procedure to the patient||Explaining the procedure in a calm way will reduce the fear and anxiety of the patient and encourage to give cooperation during procedure|
If nasal bleeding is not controlled by above measures, nasal packing.
Material used for nasal packing are Ribbon gauze, merocel, gauze impregnated in petrolatum gelly or antibiotics, balloon catheters etc.
The pack is usually left is place for 48 hours to 5 days
|Explain the procedure to the patient
|Explaining the procedure in a calm way will reduce the fear and anxiety of the patient and encourage to give cooperation during procedure|
|Monitor the position of nasal pack periodically||Sometime pack may be slip into oropharynx and can cause airway obstruction.|
|Observe the patient for frequent swallowing||Indicates posterior bleeding and the doctor should be notified.|
|Apply cold compress||Reduces pain and causes vasoconstriction that reduces bleeding.|
|Provide oral hygiene periodically||To improve comfort|
|Provide rest, psychological support and reassurance||To alleviate anxiety and fear.|
1. Once the bleeding is controlled, advice the patient to avoid hot spicy foods tobacco
|These may cause vasodilation and increase the risk of bleeding.|
|2. Advise the patient to avoid vigorous exercise, nasal blowing, nasal pricking, and straining.||These factors increase the risk of bleeding.
|3. Explain how to apply direct pressure with the use of thumb and index finger over the soft portion of the nose for 10 to 15 minutes.
|To control recurrent nasal bleeding.
(if bleeding is not controlled, patient is instructed to seek medical attention)