Nasal Cautery: Procedure

After obtaining verbal consent:

1. The anterior nose should be cleared with gentle suction. A cut-down flexible suction catheter may be less traumatic than a rigid catheter. [22]
2. The site of bleeding should be identified and a combination local anaesthetic vasoconstrictor agent applied to the anterior nose by either a spray or cotton wool pledget.
3. After waiting for the anaesthetic vasoconstrictor agent to take effect, further visualisation should reveal a clearer view of the anterior nasal cavity. If a visible vessel or localised area of bleeding is seen, it should be cauterised, either by:

• Direct application for no more than 30 seconds in any one spot [23] or, if bleeding is too brisk for the cautery to be effective
• Cauterising the four quadrants immediately around it (‘doughnutting’ the bleeding site)

4. Excess silver nitrate can be removed by application of a saline soaked pledget to the area, which neutralises the silver nitrate, preventing staining and unwanted areas of burning. [24]
5. Observe the patient for 15 minutes after the procedure to ensure bleeding is controlled, prior to discharge.