Epistaxis Guidelines

Updated: May 08, 2020
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Guidelines Summary

Guidelines on coronavirus disease 2019 (COVID-19)

In May 2020, clinical recommendations out of Italy were published regarding the management of epistaxis during the coronavirus disease 2019 (COVID-19) pandemic. [18]

Personal protection recommendations include the following [18] :

  • Disposable equipment use is strictly recommended
  • FFP3 (Europe) or N99 (United States) masks are preferred, but if FFP3 masks are unavailable, FFP2 or N95 masks, covered by a surgical mask, can be used
  • It is strongly recommended that health-care personnel employ cap and shoe covers, goggles, gowns, and double nitrile gloves

Clinical assessment recommendations include the following [18] :

  • Nosebleed risk factors (ie, blood pressure, coagulation factors, ongoing therapies with antithrombotic or anticoagulant drugs) should be controlled
  • The patient should be checked for fever, respiratory symptoms, and contacts at risk for COVID-19
  • Investigate sudden loss of smell and/or taste
  • If allowed, dress patients with a surgical mask
  • Promptly assess the nosebleed’s severity
  • It is recommended that noninvasive intervention (bidigital compression, administration of antifibrinolytic agents) be employed

Room setting recommendations include the following [18] :

  • If conventional operating rooms are unavailable, employ well-demarcated areas within the emergency department complex
  • The patient should be treated by a reduced and experienced clinical staff, including a surgeon and a scrub nurse, with proper personal protective equipment (PPE)

Treatment recommendations include the following [18] :

  • Avoid unnecessary interventions
  • If noninvasive procedures fail, nasal packing or cautery should be performed
  • Resorbable packing, if available, is recommended
  • If sphenopalatine artery ligation is needed for posterior epistaxis, the procedure should be postponed until COVID-19 testing has been performed
  • Avoid using local anesthetic atomized sprays, employing soaked pledgets instead
  • During the procedure, a suction system, within a closed system and employing a viral filter, should be used

Postprocedure recommendations include the following [18] :

  • To reduce recurrence risk and optimize outcomes, the patient should receive postprocedural instructions on packing removal or antibiotic prophylaxis
  • Carefully execute gowning and degowning procedures
  • Standard PPE should be employed by personnel engaged in the decontamination of surgical equipment