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Nasal Cautery

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See related Epistaxis article.

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 anterior epistaxis²

If other methods such as direct pressure are unsuccessful cautery is then performed to stop bleeding and prevent reoccurrence:

Equipment needed:
- Nasal speculum
- Headlight or torch (or otoscope)
- Suction
- Lidocaine and phenylephrine spray
- Silver nitrate cautery sticks
Explain the procedure to the patient.
Inspect the area and suck out any blood clots - look for any bleeding points usually on the nasal septum.
Spray the area with lidocaine and phenylephrine spray.
Cauterise each area with silver nitrate stick for about 10 seconds. Start on the edge of any bleeding/oozing area and move radially into the centre.
Never cauterise both sides of the septum at the same time.
Consider 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 is easier and more practical,¹ particulaly 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 occur.
Itching is common, which can lead to increased nose picking, especially 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 and tattooing of the septal mucosa can occur.
Local anaesthetic may produce adverse effects.

Document references

Burton MJ, Doree CJ; Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev. 2004;(1):CD004461. [abstract]
Leong SC, Roe RJ, Karkanevatos A; No frills management of epistaxis. Emerg Med J. 2005 Jul;22(7):470-2. [abstract]

Acknowledgements EMIS is grateful to Dr Huw Thomas for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 2490
Document Version: 20
DocRef: bgp24553
Last Updated: 1 Nov 2007
Review Date: 31 Oct 2009

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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