Guidelines
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] :
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Disposable equipment use is strictly recommended
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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
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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] :
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Nosebleed risk factors (ie, blood pressure, coagulation factors, ongoing therapies with antithrombotic or anticoagulant drugs) should be controlled
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The patient should be checked for fever, respiratory symptoms, and contacts at risk for COVID-19
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Investigate sudden loss of smell and/or taste
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If allowed, dress patients with a surgical mask
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Promptly assess the nosebleed’s severity
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It is recommended that noninvasive intervention (bidigital compression, administration of antifibrinolytic agents) be employed
Room setting recommendations include the following [18] :
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If conventional operating rooms are unavailable, employ well-demarcated areas within the emergency department complex
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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] :
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Avoid unnecessary interventions
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If noninvasive procedures fail, nasal packing or cautery should be performed
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Resorbable packing, if available, is recommended
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If sphenopalatine artery ligation is needed for posterior epistaxis, the procedure should be postponed until COVID-19 testing has been performed
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Avoid using local anesthetic atomized sprays, employing soaked pledgets instead
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During the procedure, a suction system, within a closed system and employing a viral filter, should be used
Postprocedure recommendations include the following [18] :
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To reduce recurrence risk and optimize outcomes, the patient should receive postprocedural instructions on packing removal or antibiotic prophylaxis
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Carefully execute gowning and degowning procedures
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Standard PPE should be employed by personnel engaged in the decontamination of surgical equipment
Media Gallery
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Posterior epistaxis from the left sphenopalatine artery.
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Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
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Nasal speculum.
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Vaseline gauze packing.
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Expandable (Merocel) packing (dry).
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Nasal vascular anatomy
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Manual Hemostasis
- Humidification and Moisturization
- Cauterization
- Nasal Packing
- Arterial Ligation
- Embolization
- Palliative Therapy for Hereditary Hemorrhagic Telangiectasia
- Complications of Treatment
- Dietary Measures
- Activity Restriction
- Prevention of Epistaxis
- Consultations
- Long-Term Monitoring
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- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- References
