From the Guidelines
To prevent nosebleeds, it is essential to eliminate contributing factors, such as digital trauma and vigorous nose blowing, and use proper nasal hygiene, including moistening and lubrication of the nose with nasal saline and gels, as recommended by the 2020 clinical practice guideline on nosebleed (epistaxis) 1. When it comes to preventing nosebleeds, several methods can be employed.
- Keeping the nasal passages moist is crucial, and this can be achieved by using nasal saline and gels, as well as humidifying the environment with a humidifier at the bedside 1.
- Avoiding digital trauma, such as nose picking, and vigorous nose blowing can also help prevent nosebleeds 1.
- Additionally, using nasal saline gel or spray can help moisturize the tissues inside the nose, and oxymetazoline and phenylephrine are nasal spray decongestants that can help slow nosebleeds 1. It is also important to note that if a nosebleed does occur, leaning forward and pinching the soft part of the nose for at least 5 minutes can help stop the bleeding, and nasal saline gel or spray can be used to help moisturize the tissues inside the nose 1. Overall, preventing nosebleeds requires a combination of proper nasal hygiene, avoidance of contributing factors, and use of nasal saline and gels to keep the nasal passages moist, as supported by the 2020 clinical practice guideline on nosebleed (epistaxis) 1.
From the Research
Nose Bleed Prevention Methods
- Compressive therapy is the first step to controlling anterior epistaxis, as stated in the study 2
- Oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1: 1,000 may be useful adjuncts to compressive therapy, according to 2
- Directive nasal cautery, most commonly using silver nitrate, can be used to control localized continued bleeding or prominent vessels that are the suspected bleeding source, as mentioned in 2 and 3
- Topical therapy and nasal packing can be used if other methods are unsuccessful, as stated in 2 and 3
- Inflatable anterior nasal balloon packs reliably control most nosebleeds, and addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis, according to 3
- Topical moisturizing facilitates mucosal healing, and oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment, as mentioned in 3
Effectiveness of Different Methods
- Applying topical agents, such as oxymetazoline, can stop 65-75% of nosebleeds, as stated in 4
- Electrocautery is more effective and has fewer recurrences (14.5% vs. 35.1%) than chemical cauterization, according to 4
- Applying tranexamic acid promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing, as mentioned in 4
- Endoscopic ligation of arteries is more effective than conventional nasal packing (97% vs. 62%), and endoscopic cauterization is more effective than ligation, according to 4
- Embolization can be applied with 80% success rate and comparable efficacy and complications to surgical methods, as stated in 4
Prevention of Recurrent Epistaxis
- Petroleum jelly/Vaseline was found to confer no benefit over simple observation in recurrent childhood epistaxis, as concluded in the study 5