What are the methods for preventing epistaxis (nose bleeds)?

From the Guidelines

To prevent nosebleeds, it is essential to keep the inside of your nose moist by using saline nasal sprays or gels, and humidify your home, especially during dry months, as recommended by the most recent clinical practice guideline on nosebleeds 1. The guideline suggests that moistening and lubrication of the nose with nasal saline and gels can be helpful in reducing or preventing nosebleeds. Some key measures to prevent nosebleeds include:

• Using nasal saline gel or spray to moisturize the tissues inside the nose
• Humidifying the home, especially during winter months when indoor air is dry
• Avoiding digital trauma, such as nose picking, and vigorous nose blowing
• Limiting the use of blood-thinning medications like aspirin and NSAIDs if possible
• Managing allergies with appropriate medications to reduce nasal inflammation
• Staying hydrated by drinking plenty of water daily
• Avoiding inserting objects into the nostrils and blowing forcefully These measures can help maintain the delicate blood vessels in the nasal passages, reducing the risk of rupture and subsequent bleeding, as supported by the clinical practice guideline 1. It is also important to note that over-the-counter nasal sprays like oxymetazoline (Afrin) can be used sparingly to help slow nosebleeds, but should not be used for more than 3 days in a row to avoid rebound congestion, as mentioned in the guideline 1. Overall, preventing nosebleeds requires a combination of good nasal hygiene, avoidance of irritants, and management of underlying conditions, as outlined in the clinical practice guideline 1.

From the Research

Prevention and Treatment of Nose Bleeds

• Nose bleeds, also known as epistaxis, can be prevented and treated with various methods, including first aid measures, topical agents, and medical interventions 2.
• Applying external pressure and ice packing, as well as using topical agents such as oxymetazoline, can be effective in stopping nose bleeds 2, 3.
• Oxymetazoline has been shown to be effective in treating epistaxis, with a success rate of 65-75% in stopping nose bleeds 2, 3.
• Other treatment options include electrocautery, chemical cauterization, and nasal packing with non-absorbable or absorbable materials 2.
• Newer hemostatic agents, such as hemostatic gauzes and thrombin matrix, have been shown to be more effective and have fewer complications than traditional methods 2.
• Endoscopic ligation of arteries and endoscopic cauterization are also effective treatment options for epistaxis, with success rates of 97% and higher 2.
• For intractable cases, embolization using gelatin sponge, foam, PVA, and coils has been shown to be effective with an 80% success rate 2.

Use of Nasal Saline Gel

• A nasal saline gel has been shown to be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients 4.
• The use of a nasal saline gel as monotherapy has been shown to be effective in stopping epistaxis in 93.2% of patients 4.
• This simple and painless technique has considerable value as a treatment option for patients with recurrent epistaxis 4.

Outpatient Management

• Epistaxis can be managed in the outpatient setting, with compressive therapy, oxymetazoline nasal spray, and directive nasal cautery being effective treatment options 5.
• Topical therapy and nasal packing can be used if other methods are unsuccessful, but posterior epistaxis is more likely to require hospitalization and nasal packing 5.
• Oxymetazoline has also been shown to be effective in treating posterior epistaxis, with a success rate of 75% in stopping epistaxis 6.