POLICIES AND PROCEDURES
EPISTAXIS CONTROL – OFFICE PROCEDURE
NASAL CAUTERY
OBJECTIVE:To ensure staff understands what epistaxis entails and is able to prepare patient and exam room for immediate urgent treatment.
RESPONSIBLE PARTIES:Clinical Support Personnel
POLICY:All clinical support personnel are to be familiar with epistaxis control procedures. This procedure may or may not be used in conjunction with the epistaxis control – non-nasal cautery procedure.
PROCEDURES:
I.WHAT IS EPISTAXIS?
Epistaxis is a severe nose bleed that can only be controlled in a professional healthcare setting such as a hospital or physician (ENT) office. Any patient who is actively bleeding is considered to be “an urgent” patient and is to be worked into the schedule to be seen immediately. There are two types of nosebleeds, anterior and posterior.
A.Anterior – An anterior nosebleed is the most common in patients. It is from the superficial blood vessels on the anterior nasal septum. Anterior nosebleeds are very common and are usually caused by dry climates or during winter months due to indoor heating. The dry air dehydrates the nasal membranes which may result in crusting, cracking, and bleeding. Most anterior nosebleeds can be controlled easily.
B.Posterior – A posterior nosebleed is the most dangerous and difficult to control. The bleeding is often related to blood vessels entering the nose through the spheopalatine forearm. This type of nosebleed is controlled with posterior nose packing or endoscopic vessel ligation. Most of the time these nosebleeds can be controlled in the office; however there are times when the patient must go to the operating room.
III.PATIENT INTAKE
A.Procedure:
1.Place the Epistaxis kit on SMR unit
2.Place a bib on the patient
3.Check their blood pressure
4.Take a thorough history.
5.Have patient read and sign consent form. Physician is to acknowledge patient signed the consent form and ask the patient if they have any questions regarding the procedure before the procedure begins. If patient is unable to do this prior to treatment, a verbal acknowledgement is to be documented until the patient is able to formally sign consent. Patient is not to leave without formally signing consent.
B.Patient Preparation Questions – The following questions are to be asked and documented for the physician.
- Are you taking any blood thinners? Remember to ask about OTC meds and herbs.
- How long has the nose been bleeding?
- When did symptoms begin?
- Have you had problems with nose bleeds in the past?
- Do you have high blood pressure, if so; are you on medications for the HBP?
- Do you have a pacemaker?
III.EXAM/PROCEDURE ROOM SET UP
A.Supplies Needed:
1.Epistaxis Kit(Hint: A plastic fishing tackle box can be used to keep all of these supplies in one place. Items in the kit are to be replaced immediately after use.)
2.Supplies/Procedure Mayo Set Up:
a.1 1/2cc Lidocaine with Epinephrine
b.Non-Sterile 4x4’s.
c.Syringe – to inflate pack.
d.0.9% Sodium Chloride inside small basin (to soak pack prior to doc placing inside nose.)
e.Basins (2) – one for patient to spit blood in and 1 for sodium chloride.
f.Medical Tape
g.Mask with shield (2)
h.Gown
3.Blood pressure cuff
4.Cautery Machine
a.Plug in appropriate cords, do not plug into outlet until the patient has been grounded.
b.Place grounding plate under patient’s shirt on his/her back.
c.Connect handle (with suction) and cautery tip.
d.Gown the patient.
e.Ask the patient if they have false teeth; if so have them remove them.
f.Do Not use electric cautery machine on patients with a pacemaker.
Epistaxis Control – Office Procedure
Nasal Cautery