How is cauterization of the bleeding source performed in anterior nasal packing for epistaxis?

Updated: May 09, 2018
  • Author: Eric Goralnick, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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A clear view of the bleeding source is mandatory for the use of cauterization methods. Cauterize to cease unilateral septal bleeding only. Bilateral cauterization, whether chemical or electrical, increases the risk of septal perforation.

For chemical cauterization, apply a silver nitrate stick to the red dot or oozing vessel for 5-10 seconds, then roll it over the surrounding area (1 cm) for 5-10 seconds to cauterize feeding vessels. Apply antibiotic ointment over cauterized area. This provides prophylaxis against infection and serves as a topical barrier to prevent desiccation and restart of bleeding.

Patient with a history of significant left-sided epistaxis. Packing was performed in the emergency department with continued bleeding. After packing removal, small vessel arterial bleeding was noted on the anterior septum. Silver nitrate cautery is applied and dressed with dissolvable microfibrillar collagen. Video courtesy of Vijay Ramakrishnan, MD.

Electrical cauterization is typically used by an otolaryngologist in the context of endoscopic visualization.

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