Name of the Procedure:

Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing)
Common Name(s): Complex anterior nasal bleeding control, Extensive anterior nosebleed cautery/packing.

Summary

This procedure is performed to stop severe or recurrent nosebleeds originating from the front part of the nasal cavity. It involves using methods such as cautery (burning the blood vessels) or nasal packing (inserting material to apply pressure) to achieve hemostasis, which is the control of bleeding.

Purpose

This procedure addresses severe or recurrent nosebleeds (epistaxis) coming from the anterior (front) part of the nasal cavity. The goal is to stop the bleeding, prevent recurrence, and maintain nasal function.

Indications

• Severe or uncontrolled anterior nasal bleeding
• Recurrent nosebleeds that do not respond to simple measures
• Patients with underlying conditions predisposing to bleeding, such as blood clotting disorders or high blood pressure

Preparation

• Patients may be advised to avoid eating or drinking a few hours before the procedure.
• Discontinuation or adjustment of certain medications, such as blood thinners, might be necessary.
• Blood tests to assess clotting function or overall health status might be performed.
• Local anesthesia administration plan.

Procedure Description

1. Anesthesia: Local anesthesia is applied to numb the nasal area.
2. Visual Inspection: A nasal speculum is used to widen the nostril, and a light source or endoscope may be used to locate the bleeding site.
3. Cautery or Packing:
   • Cautery: A heated instrument or a chemical agent is applied to the bleeding vessel to cauterize (burn and seal) it.
   • Nasal Packing: Sterile gauze or specialized nasal sponges are inserted into the nasal cavity to apply pressure and stop the bleeding.
4. Hemostasis Confirmation: The bleeding is monitored to ensure it has stopped. Additional applied cautery or packing if necessary.
5. Final Steps: Removal of equipment and application of any additional dressings or instructions for care.

Duration

The procedure typically takes about 30 to 60 minutes depending on the severity of the bleeding.

Setting

This procedure is usually performed in an outpatient clinic, hospital emergency room, or an ENT specialist's office.

Personnel

• ENT specialist or trained physician
• Nurses or medical assistants
• Anesthesiologist if sedation is required

Risks and Complications

• Infection
• Nasal septum perforation
• Recurrence of bleeding
• Pain or discomfort
• Breathing difficulties if packing obstructs nasal passages

Benefits

• Immediate control of severe or recurrent nosebleeds
• Prevention of significant blood loss and related complications
• Relief from the inconvenience and anxiety associated with frequent bleeding

Recovery

• Post-procedure, patients may be advised to rest and avoid strenuous activities.
• Follow-up appointments may be scheduled to ensure proper healing.
• Patients might receive instructions on how to care for the nose and recognize signs of complications.
• Expected recovery time ranges from a few days to a week, with specific restrictions provided by the healthcare provider.

Alternatives

• Simple nasal packing for less severe cases
• Silver nitrate cautery for minor bleeds
• Addressing underlying causes such as blood pressure management or adjusting medications.
• Pros: Less invasive procedures may be effective for milder cases.
• Cons: May not be sufficient for complex or severe nosebleeds.

Patient Experience

During the procedure, patients will feel nasal pressure and might experience minor discomfort despite local anesthesia. Post-procedure, there may be some pain, swelling, and nasal congestion. Pain management options will be provided, and patients should report any severe pain or unusual symptoms to their doctor.