Used in patients with epistaxis refractory to first aid methods (1).
Prior to cautery, ask the patient to blow the nose to clear out any clots and the nasal cavity should be sprayed with local anaesthetics which should ideally include a vasoconstrictor.
There are two main methods
- chemical cautery with silver nitrate
- silver nitrate stick is applied to the bleeding point with firm pressure for 5-10 seconds.
- used for mild active bleeding or after active bleeding has been stopped and prominent vessels have been identified
- avoid touching other areas like facial skin, nasal alae, or other nasal mucosae
- excess chemical is removed to avoid staining of the vestibule or upper lip
Note - 75% silver nitrate has been shown to be more effective than 95% silver nitrate at two weeks following application (2)
- electrocautery
- done by otolaryngologists under local anaesthetic
- used in severe nose bleeds not controlled by chemical cautery
- uses radiation to seal the bleeding vessels (rather than direct contact)
- damage to the anterior nares and inferior turbinate can occur as complications
The risk of iatrogenic septal perforation is minimized by cauterizing one side of the septum at a time.
The interval between cautery treatments should be four to six weeks
Reference
- National ENT Trainee Research Network. The British Rhinological Society multidisciplinary consensus recommendations on the hospital management of epistaxis. J Laryngol Otol. 2017 Dec;131(12):1142-56.
- Qureishi A, Burton MJ; Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev. 2012 Sep 12;9:CD004461.