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Intranasal oxymetazoline to treat epistaxis (bloody noses):

Treatment protocol

Download this protocol as a MS word file (click here 0.55 MB)

Indications: To induce vasoconstriction and stop bleeding in patients with anterior epistaxis

Basic epistaxis tray materials:Epistaxis tray
  1. Tissue for patient to blow nose
  2. Bowl to capture runoff blood
  3. Gloves and mask for provider
  4. Cotton balls
  5. Medication cup
  6. Oxymetazoline bottle
  7. Atomizer (or use the bottle to spray)
  8. Clamp for nose
  1. Provide a gown, tray and tissue to the patient to capture the blood.
  2. Spray oxymetazoline into a cup to soak cotton ballSquirt oxymetazoline (Afrin) spray into a medication cup so it can be easily drawn into a syringe.
  3. Aspirating oxymetazoline into a syringeDraw up 1.0 to 1.5 ml of oxymetazoline (Afrin) into a 3 cc syringe. (Option - Also draw up 0.5 ml of 4% lidocaine into the same syringe for anesthesia if you intend to use cautery).
  4. Connect the syringe to a syringe driven atomizer.
  5. Saok the cotton ball in oxymetazolinePut a cotton ball in the remaining oxymetazoline and soak the cotton ball.  (double the dose and use two cotton balls if both sides are bleeding)
  1. Blow nose to remove clots so the mucosa is bare and the medication can ge effectiveAsk the patient to blow their nose to clear all the blood clots from the nasal passage. This will clear the nasal cavity and expose the nasal mucosa so the medication is more effective.
  2. Position the patient approximately 45 degrees recumbent in the bed.
  3. Atomizing oxymetazoline far into the nostrilPlace atomizer within the affected nostril.
  4. Briskly compress syringe to administer 1-1.5 ml of atomized spray into the affected nostril. Ask them to inhale through their nose during the time you spray.
  5. Allow the patient to capture any runoff blood and solution.
  6. Inserting an oxymetzoline soaked cotton ball into the bleeding nostrilTake the cotton ball soaked with oxymetazoline and roll into cigarette shape.  Place this into the bleeding nostril.
  7. Repeat in other nostril if it is also bleeding.
  8. Tape a folded 4X4 across the nose to hold the cotton ball in place and capture blood.
  9. Sit the patient back up.
  10. Clamp nose for 15 mintues with oxymetazoline spray and soaked cotton ball inside the nostrilAsk the patient to pinch their nostrils firmly with one hand to reduce blood flow to the anterior nose. Alternatively you can clamp their nose with a pre-made nasal clamp.
  11. Wait 15 minutes.
  12. Cautery for epistaxisReturn, remove the gauze and packing, cauterize any anterior vessels that require cautery (usually not needed).
  13. If still oozing or bleeding - repeat procedure again and consider using atomized Thrombin to enhance clotting.
  14. Discharge the patient with instructions to use oxymetazoline spray every 8 hours for the next 48-72 hours to maintain vasoconstriction. Forewarn them to not use the oxymetazoline for a longer period due to rebound edema problems. Instruct them to apply topical Vaseline or other appropriate material to the anterior nose twice a day to keep the mucous membrane from drying and cracking.

Download this protocol as a MS word file (click here 0.55 MB)