Chemical cautery is the process of burning tissue to stop bleeding. This procedure must be supervised by a doctor. Nose bleeds are common and most are controlled with pressure, ice and avoidance of trauma to the area. Cautery can be performed on a small source of bleeding inside the nose. A few simple guidelines help you understand when you need a doctor to care for your nosebleed and what the doctor will do for you.
- Skill level:
Things you need
- Eye protection
- Tissue or towels
- Afrin nasal spray
- Two tongue depressors or Popsicle sticks
- Cloth tape
- Silver nitrate cautery applicators
- Vaseline or topical antibiotic
Sit forward, keep the head leaning forward. The assistant should wear gloves and eye protection when working with blood. Blow the nose into a tissue to remove mucus, blood and clot. Apply ice gently to the nose to constrict the blood vessels.
Apply Afrin nasal spray to the nose to reduce congestion and minimise bleeding.
Using a flashlight, have an assistant look inside the front part of the nose for a small well defined area of bleeding. Cautery only works on small, well defined areas of bleeding. If you cannot find a small well defined source of bleeding or if blood is oozing everywhere, seek the care of a doctor immediately.
Identify the source
Tape two parallel tongue depressors together at the halfway point of only one end in order to form a pressure clamp.
Gently apply the free end of the tongue depressor pressure clamp to the outside of the nose so that it applies gentle, firm pressure to the nose (to stop bleeding) for ten minutes.
Check the nostril again in ten minutes. If the bleeding is controlled, cautery is not necessary.
Attempt pressure control first
Your doctor will only use cautery on the lining of the inside of the nose but never to the outer surface. Your doctor cannot apply cautery to both inner nostrils as this can cause a hole in the nasal septum (the tissue supporting the bridge of the nose). The doctor will not apply cautery more than twice on one site.
Use Afrin and pressure to stop active bleeding. Cautery sticks are inactivated by fresh blood and will not work if there is active bleeding.
The doctor will look for a defined small bleeding site less than five millimetres diameter. The doctor will apply silver nitrate to burn the site for about five seconds moving from top to bottom and from the periphery to the centre to avoid fresh blood.
If cautery and pressure are ineffective, the nose must be packed and antibiotics administered.
Apply vaseline or a topical antibiotic to the inside of the nose to prevent drying out.
Avoid aspirin or other non-steroidal anti-inflammatory medications such as ibuprofen. Tylenol or acetaminophen is fine for pain.
Do not blow or pick the nose, maintain an upright posture and avoid laughing, coughing, or heavy lifting for two days.
If bleeding recurs, pinch the nostrils closed for twenty minutes and lean forward to avoid blood leaking into the back of the throat (which can cause coughing).
Tips and warnings
- Wear gloves and eye protection when working with blood to prevent transmission of infectious disease.
- Silver nitrate cautery should only be performed by a health care professional.
- Never cauterise a site more than twice.
- Never cauterise both nostrils, this may cause a perforation of the septum (the tissue supporting the bridge of the nose).
- Individuals with disorders of blood clotting should not use cautery.
- Silver nitrate is toxic and will burn skin and eyes. It should not be ingested. Seek medical help and call poison control immediately if exposed.
- Control of bleeding in the back part of the nose may require a surgical operation.
- Seek medical attention if pressure does not stop bleeding.
- Do not stuff cotton balls in the nose, this may cause toxic shock syndrome.
- See your doctor if you have persistent nose bleeds.
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