From the Guidelines
Silver nitrate cauterization is a recommended procedure for treating recurrent or persistent nosebleeds, and it should be performed with caution and proper technique to minimize complications and promote effective healing. To perform this procedure, first ensure the patient is seated comfortably with their head tilted slightly forward. Apply a topical anesthetic such as lidocaine to the bleeding site and wait 5-10 minutes for it to take effect, as recommended by the French guidelines 1. Identify the bleeding point using good lighting and suction if necessary. Once located, take a silver nitrate stick (typically 75% silver nitrate/25% potassium nitrate) and activate it by moistening the tip slightly with sterile water or saline.
- Apply the silver nitrate stick directly to the bleeding vessel for approximately 5-10 seconds, creating a small chemical burn that cauterizes the vessel.
- Avoid touching surrounding tissue to prevent unnecessary damage, as excessively vigorous or extensive cautery may damage the nasal lining and septum 1. After application, observe the area for a few minutes to ensure bleeding has stopped - the cauterized area will appear as a small gray or black eschar.
- Instruct the patient to avoid nose picking, strenuous activity, and hot showers for 24-48 hours.
- Also recommend applying petroleum jelly to the inside of the nostril twice daily for 1-2 weeks to keep the area moist during healing. Silver nitrate works by causing a chemical reaction that denatures proteins and coagulates tissue, effectively sealing the bleeding vessel through a controlled chemical burn. It is essential to note that cautery may be performed with topical administration of chemically active agents, such as silver nitrate, or through the application of heat or electrical energy, typically electrocautery or "hot wire" thermal cautery 1.
From the Research
Procedure Steps for Silver Nitrate Cauterization
- The procedure typically starts with the application of a local anesthetic, such as 5% lidocaine hydrochloride and 0.5% phenylephrine hydrochloride spray, to the nasal area 2.
- The nasal area is then decongested and anesthetized to prepare for the cauterization process.
- Visible vessels in Little's areas are cauterized using two silver nitrate sticks on each side of the nasal septum 2.
- The silver nitrate cautery is applied for a contact time of less than 30 seconds to avoid causing a full thickness burn 3.
- After the procedure, patients are typically prescribed a nasal cream, such as naseptin cream, to promote healing and prevent infection 2.
- Patients are also advised to use topical moisturizing agents to facilitate mucosal healing and oxymetazoline 0.05% nasal spray to address rebleeding after discharge from treatment 4.
Post-Procedure Care
- Patients are usually followed up after the procedure to assess the effectiveness of the treatment and to monitor for any complications 2.
- The follow-up care may include evaluating the patient for signs of rebleeding, crusting, or other complications 2, 5.
- Patients are also advised to avoid blowing their nose, bending, or lifting heavy objects for a few days after the procedure to prevent rebleeding 4.
Effectiveness and Complications
- Silver nitrate cautery has been shown to be an effective method for treating recurrent epistaxis, with significant improvement seen in 93% of patients in one study 2.
- However, the addition of silver nitrate cautery to antiseptic nasal cream has not been shown to be superior to the use of antiseptic cream alone in pediatric patients with recurrent epistaxis 5.
- The procedure is generally considered safe, with few complications reported, such as crusting at the sites of cautery 2 or treatment-related complications like necrosis or septal perforation 6.