Guideline released on management of nosebleeds

A guideline for management of nosebleeds suggests that physicians should perform anterior rhinoscopy to identify a source of bleeding and then perform nasal endoscopy to identify the site, among other recommendations.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation developed the guideline, which defines useful actions for clinicians, identifies quality improvement opportunities, and offers recommendations for clinical practice. The target patient for the guideline is any individual age 3 years or older. The guideline was published Jan. 7 by Otolaryngology–Head and Neck Surgery.

Among the 14 recommendations are the following:

• Active bleeding should be treated with firm, sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for five minutes or longer.
• If bleeding prevents identification of a bleeding site despite nasal compression, nasal packing should be used. Resorbable packing should be used in patients with a suspected bleeding disorder and in those taking anticoagulation or antiplatelet medications.
• Clinicians should perform anterior rhinoscopy to identify a source of bleeding after removing any blood clots.
• Clinicians should perform nasal endoscopy or refer the patient for this procedure to identify the bleeding site and guide further management in cases of recurrent nasal bleeding despite prior treatment with packing or cautery or in patients with recurrent unilateral nasal bleeding.
• Patients with an identified site of bleeding should be treated with an appropriate intervention, such as topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents.
• Patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization should be evaluated for surgical arterial ligation or endovascular embolization or should be referred to a clinician who can perform such an evaluation.
• Clinicians should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care.