Headlamp

Nasal speculum

Atomizer (for medications not packaged in a spray bottle)

Topical vasoconstrictor, anesthetic, or both (e.g., phenylephrine hydrochloride, ephedrine, epinephrine, oxymetazoline)

Cotton swabs

Tissues

1. Place the patient in semi-Fowler’s position or in a seated position in a dental chair.

2. Have patient blow his or her nose to expel clots and then apply firm, direct pressure by pinching the nares for a full 10 minutes.

1. Place cotton swabs soaked with the topical vasoconstrictor in the nose for 5 to 10 minutes (Kucik & Clenney, 2005). Alternatively, have the patient spray the medication into each naris twice while inhaling through the nose (Van, 2004). The spray application may be repeated if the bleeding does not stop within a few minutes. Do not exceed the maximum safe dose of the medication.

2. ^*Examine both nares using a headlamp and a nasal speculum to verify that the bleeding has stopped.

3. Reassess heart rate and blood pressure after medication administration as indicated, especially for patients with cardiac disease.

1. Anterior nosebleeds are the most common among children. These usually result from cracks in the nasal lining because of exposure to abrupt temperature changes, dry heat, and nose picking.

2. In adults, anterior nosebleeds result from hypertension, coagulopathy, sinus disease, respiratory infections, allergies, and nasal steroid sprays.

1. Dizziness, tachycardia, dysrhythmia, nausea/vomiting, or hypertension

2. Topical therapy may fail to control bleeding and alternative therapies may be required (see Procedures 168 through 172).

3. Continued blood loss may result in hypovolemia and shock.

1. For the next few days, avoid anything that may lead to more bleeding, such as heavy exercise or lifting, alcoholic beverages, hot drinks, aspirin, ibuprofen, blowing your nose, sneezing, or coughing. If you must sneeze, open your mouth to relieve the pressure.

2. Apply petroleum jelly or antibiotic ointment to the nares to decrease drying and scab formation.

3. Use a humidifier at home, especially in your bedroom at night.

4. Sleeping with extra pillows to raise the head may lessen likelihood of recurrence, ease stuffiness, and minimize post-nasal trickle.

5. Return to the emergency department or call your physician for any recurrence of bleeding that does not stop after 10 minutes of firmly pinching your nose. Emphasize that uninterrupted pressure must be held for 10 minutes or more without letting go, peeking, or dabbing; this will nearly always stop bleeding, and will certainly limit it en route to the hospital.

1. Silver nitrate will not cauterize an actively bleeding area; hemostasis must be achieved first.

2. Septal damage or perforation may occur with overly aggressive electrocautery.

3. Silver nitrate reduces the blood supply to the area; bilateral use may cause septal necrosis.

4. If cautery is unsuccessful or rebleeding occurs within 72 hours, anterior packing is usually placed (see Procedures 169 and 171) (Riviello, 2004).

5. Electrocautery may be performed with a small battery-operated cautery unit or a larger electrosurgical unit. If the electrosurgical unit is used, a practitioner appropriately trained in the safe use of this modality should be responsible for ensuring that the patient is grounded and that other necessary safety precautions are taken.

Headlamp

Nasal speculum

Frazier nasal suction tip

Silver nitrate sticks

Electrocautery

Cotton swabs

Antibiotic ointment

Topical or local anesthetic

1. Place the patient in a dental chair or in semi-Fowler’s position on a stretcher.

2. Have the patient blow his or her nose to clear it of clots.

3. Attach grounding pad to the patient and take other appropriate electrical safety precautions if using a large electrosurgery unit.

1. ^* Using headlamp and nasal speculum, locate the bleeding site.

2. Suction the area until the site is visualized and dry. The bleeding site must be dry for silver nitrate sticks to be effective.

3. ^*Anesthetize the nasal mucosa with a topical anesthetic for electrocautery (see Procedure 135).

4. ^*Coagulate the bleeding site with the silver nitrate sticks or electrocautery.

5. ^*After application of silver nitrate, dry the cautery site with cotton swabs to prevent the silver nitrate from spreading.

6. Apply antibiotic ointment to the cautery site to soften the crust formed by the cautery.

1. Anterior nosebleeds are the most common among children. These usually result from cracks in the nasal lining because of exposure to abrupt temperature changes, dry heat, and nose picking.

2. In adults, anterior nosebleeds result from hypertension, coagulopathy, sinus disease, respiratory infections, and allergies.

1. Cauterization can weaken the tissue and make future cauterization more harmful.

2. Burns may occur during cauterization with a large electrosurgery unit if appropriate grounding and other safety measures are not in place.

3. Continued blood loss may result in hypovolemia and shock.

1. Avoid the following activities and substances for the next few days because they may lead to more bleeding: heavy exercise or lifting, alcoholic beverages, hot drinks, aspirin, ibuprofen, blowing your nose, sneezing, or coughing. If you must sneeze, open your mouth to relieve pressure.

2. Apply petroleum jelly or antibiotic ointment to the nares to decrease drying and scab formation.

3. Use a humidifier at home, especially in your bedroom at night.

4. Sleeping with extra pillows to raise the head may lessen likelihood of recurrence, ease stuffiness, and minimize post-nasal trickle.

5. Return to the emergency department or call your physician for any recurrence of bleeding that does not stop after 10 minutes of firmly pinching your nose. Emphasize that uninterrupted pressure must be held for 10 minutes or more without letting go, peeking, or dabbing; this will nearly always stop bleeding, and will certainly limit it en route to the hospital.

1. Nasal packing in sedated patients may lead to hypoxia (Riviello, 2004); monitoring of oxygen saturation is recommended.

2. Antibiotics may be prescribed because of the risk of toxic shock syndrome and sinusitis (Riviello, 2004; Sparacino, 2000).

Headlamp

Swimmer’s nose clip or respiratory nose clip (optional)

Topical anesthetic agent (e.g., lidocaine, pontocaine, cocaine)

Topical vasoconstricting agent (e.g., oxymetazoline, cocaine, phenylephrine)

Silver nitrate sticks

Atomizer (for medications not packaged in a spray bottle)

1-in-wide strips of plain gauze impregnated with antibiotic ointment or petroleum jelly

or

Hemostatic mesh (Gelfoam, Surgicel)

or

Commercially prepared nasal tampon (a variety of sizes and shapes are available)

Frazier nasal suction tip

Long bayonet forceps

Nasal speculum

Pharyngeal mirror

2 × 2 gauze pads

4 × 4 gauze pads

Tape

Cotton-tipped applicators

1. Place the patient in a dental chair or in semi-Fowler’s position on a stretcher.

2. Cover the patient’s clothing with a gown or towel and provide a basin.

3. Administer sedation as prescribed (see Procedure 177).

1. Have the patient blow his or her nose to dislodge clots.

2. Apply swimmer’s nose clip or have the patient pinch the nose for minimum of 5 minutes. If possible, manual pressure by the nurse allows time for calming, teaching, and demonstrates effective self-management by the patient; time the pressure by clock to reinforce unremitting pressure for an effective clotting period.

3. ^* With a headlamp, introduce a nasal speculum into the naris, and suction clotted blood from the nose to assess whether the patient has an anterior or posterior bleed (Figure 169-1).

4. ^*Anesthetize the area with cotton-tipped applicators soaked in a topical anesthetic or vasoconstrictive agent.

5. ^*Apply silver nitrate to cauterize the bleeding site (see Procedure 168).

6. ^*Pack the anterior nose.

Stay updated, free articles. Join our Telegram channel

Join