bleeding

New Nosebleed Treatment Guidelines Released

The American Academy of Otolaryngology—Head and Neck Surgery Foundation has released new, multidisciplinary guidelines on the diagnosis, treatment, and prevention of epistaxis (nosebleeds).

The guidelines specifically address patients aged 3 years and older with severe, persistent, or recurrent epistaxis or those for whom epistaxis affects their quality of life. The intended audience for the guidelines includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners, as well as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists.

Among the guidelines:

  • Clinicians should distinguish patients who require prompt management from those who do not at initial contact.
  • Active bleeding in patients who require prompt management should be treated with firm sustained compression of the lower third of the nose for 5 minutes or longer.
  • Ongoing bleeding should be treated with nasal packing in patients for whom bleeding precludes identification of the bleeding site. Patients should be educated about the removal, postprocedure care, and the need for reassessment following nasal packing.
  • Factors that increase the frequency or severity of bleeding, including history of bleeding disorders, anticoagulant use, or intranasal drug use, should be documented.
  • Anterior rhinoscopy should be used to identify the source of bleeding following the removal of any blood clot.
  • Nasal endoscopy should be used to identify the bleeding site and guide further management in patients with recurrent bleeding.
  • Topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents should be used for the treatment of patients with identified bleeding sites.
  • The bleeding site should be anesthetized when nasal cautery is chosen for treatment.
  • Patients should be educated about preventive measures and home treatment for nosebleeds.

The full guidelines are published in Otolaryngology—Head & Neck Surgery.

—Michael Potts

Reference:

Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis) executive summary [published online January 7, 2020]. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599819889955.