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Nasal Cautery

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

See related separate article Nosebleeds (Epistaxis).

Nasal cautery is a common treatment of small lesions and epistaxis. A caustic agent such as silver nitrate (chemical cautery), or an electrically charged wire such as platinum (electrocautery) is used to stop bleeding in the nasal mucous membrane. Chemical cautery of the visible blood vessels on the anterior part of the nasal septum is the most popular treatment method for idiopathic recurrent nosebleeds.1

Nasal cautery for epistaxis2

If other methods such as direct pressure are unsuccessful, cautery is then performed to stop bleeding and prevent reoccurrence. Cautery of blood vessels visible anteriorly is much easier than those which bleed posteriorly. A device which combines suction, a cautery stick and a protective sheath has been devised for this use.3

  1. Equipment needed:
    • Nasal speculum
    • Headlight or torch (or otoscope)
    • Suction
    • Lidocaine and phenylephrine spray
    • Silver nitrate cautery sticks
  2. Explain the procedure to the patient.
  3. Inspect the area and suck out any blood clots - look for any bleeding points - usually on the nasal septum.
  4. Spray the area with lidocaine and phenylephrine spray.
  5. Cauterise each area with a silver nitrate stick for about 10 seconds. Start on the edge of any bleeding/oozing area and move radially into the centre.
  6. Never cauterise both sides of the septum at the same time.
  7. Consider the patient for discharge if bleeding has stopped (see epistaxis management) - however, older patients or patients with coagulopathies may require hospital admission and careful monitoring.

Cautery and cream (Naseptin®) are equally effective for the treatment of epistaxis. However the application of a cream-based treatment may initially be easier and more practical,1 particularly in children.

Complications1

  • Serious adverse effects are rare.
  • Silver nitrate cautery may be painful.
  • Cautery often proves ineffective (telangiectatic vessels may reappear at the edges of the cauterised area).
  • Sclerosis of blood vessels may occur.
  • Thickening of mucosa can be a complication.
  • Itching is common, which can lead to increased nose picking, especially in children.
  • Nose picking may delay healing, enable bacteria to colonise and cause further bleeding.
  • Atrophy of nasal mucosa, septal crusting and perforation can occur.
  • There may be a mucocutaneous reaction resulting in tattooing of the septal mucosa.
  • Local anaesthetic may produce adverse effects.

Document references

  1. Burton MJ, Doree CJ; Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev. 2004;(1):CD004461. [abstract]
  2. Leong SC, Roe RJ, Karkanevatos A; No frills management of epistaxis. Emerg Med J. 2005 Jul;22(7):470-2. [abstract]
  3. Judd O; Novel method for safe cauterisation of posterior epistaxis. J Laryngol Otol. 2009 Aug;123(8):910-1. Epub 2009 Feb 16. [abstract]

Acknowledgements

EMIS is grateful to Dr Laurence Knott for writing this article and to Dr Huw Thomas for earlier versions. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2010.
Document ID: 2490
Document Version: 21
Document Reference: bgp24553
Last Updated: 8 Apr 2010
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