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Controlled Document Ref: G15A Issue 1 Approved Date: Oct 03 Review Date: Oct 05 GUIDELINES FOR NURSE PRACTITIONERS - NOSEBLEED (EPISTAXIS) Bleeding occurs with rupture of nasal blood vessels, or damage to nasal membrane occurs. The commonest site is anterior, i.e. upper end of the nasal septum where there are many blood vessels and blood flows out through the nostrils. Posterior bleeding is less common, bleeding concentrates around the upper part of the nose. Blood tends to backflow towards the back of the mouth & throat. Children are more vulnerable to nosebleeds than adults. Majority of nosebleeds are not serious. HISTORY • • • • • • • • • • • • • • • Duration Amount of blood loss Trauma – including nose picking Cold, hayfever or sinus symptoms Foreign body – offensive discharge may indicate foreign body especially in children Previous episodes of bleeding Medications : nasal spray / anticoagulants / NSAIDs Anaemias or leukaemia Broken nose Head injury Cocaine use Uncontrolled hypertension Liver disease Haemophilia or other clotting disorder Tumours EXAMINATION • • • • One or both nostrils ? Look for signs of infection in nostrils or congestion Check BP in adults. Consider FBC if recurrent / severe TREATMENT Sit in an upright position & pinch middle third of nose (the soft fleshy part) against the bone for 5 to 15 minutes without releasing. When the bleeding has stopped, breathe through the mouth. Don't blow or clear clots for the next 4 hours. If infection is present prescribe fusidic acid cream / ointment for 1 week If sinusitis treat with doxycyline REFERRAL: To A&E if bleeding does not stop within 20 mins. If patient is on anticoagulants or has known or suspected bleeding disorder. http://www.nhsdirect.nhs.uk Johnson G et al (2000) The Minor Illness Manual 2nd edition p19 Radcliffe Press . Oxon. \\Hal\Central Derby PCT\PCG Data\Zoe Boyes\Clinical Governance\Clinical Policy Folders\Guidelines\G15A - Guildelines for Nurse Practitioners - Nosebleed.doc Page 1 of 1