Download guidelines for nurse practitioners

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
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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
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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.
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Practitioners - Nosebleed.doc
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