From the Guidelines
To stop a nosebleed, a person should sit with their head slightly forward and pinch the soft part of their nose for 10 to 15 minutes, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. This approach is supported by the most recent and highest quality evidence, which emphasizes the importance of continuous manual pressure to control bleeding. Key steps to follow include:
- Sitting upright and leaning slightly forward to prevent blood from flowing down the throat
- Pinching the soft part of the nose firmly between the thumb and index finger for 10-15 minutes without releasing pressure
- Breathing through the mouth during this time
- If bleeding does not stop after 15 minutes of continuous manual pressure, or if the person becomes lightheaded, seeking medical attention is advised 1 Additional measures such as applying an ice pack or cold compress to the bridge of the nose, or using nasal decongestants like oxymetazoline (Afrin), may be helpful but are not universally recommended in the guidelines. It is also important to avoid strenuous activity, hot showers, bending over, picking the nose, or blowing the nose forcefully for 24 hours after the bleeding stops to prevent recurrence. Applying petroleum jelly inside the nostrils with a cotton swab can help keep the nasal passages moist if dryness is causing repeated nosebleeds. If bleeding continues beyond 20-30 minutes, is extremely heavy, or occurs frequently, seeking medical attention is necessary as it may require cauterization or packing by a healthcare provider.
From the Research
Stopping a Nosebleed: Methods and Treatments
- 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
Medical Management of Epistaxis
- The use of an intranasal vasoconstrictor (oxymetazoline) can be used to effectively treat epistaxis, avoiding nasal packing, as found in the study 3
- 65% of patients were successfully managed with oxymetazoline as their sole therapy, and an additional 18% were managed successfully with silver nitrate cautery in combination with oxymetazoline, according to 3
Inpatient Management of Epistaxis
- Nonpacking interventions (cauterization, embolization, and ligation) were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges, as reported in the study 4
- Nonpacking interventions were associated with an increased rate of blood transfusion, but no significant differences in rates of stroke, blindness, aspiration pneumonia, and other complications, according to 4