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How to Use Silver Nitrate for Recurrent Epistaxis

August 17, 2021

Written by Vivian Lei

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This video and summary article describes how to perform silver nitrate cauterization for recurrent epistaxis at the bedside.

Why does this matter?
Recurrent epistaxis is a common reason for seeking medical care. After the bleeding is controlled, consider performing silver nitrate cauterization, as it is an effective and simple procedure to treat this condition.

No more nosebleeds
Obtain a focused history of the patient’s epistaxis, including a personal and family history of bleeding disorders. Thoroughly examine the head and neck in addition to the nasal cavity. A nasal speculum can aid in anterior rhinoscopy, noting any prominent blood vessels in the mucosa. Active or recurrent anterior epistaxis that interferes with quality of life is an indication for nasal cauterization.

Prepare the equipment:

  • Nasal speculum, if available

  • Light source

  • Cotton balls with forceps to apply topical anesthetic agent (e.g. 4% lidocaine +/-  topical vasoconstrictor)

  • Topical silver nitrate, several applicators

  • Back-up equipment for possible bleeding (i.e. topical vasoconstrictors, packing materials, suction)

Place the cotton ball soaked in topical anesthetic in the anterior nasal cavity for approximately 10 minutes, then remove. Apply silver nitrate to the prominent blood vessel and surrounding mucosa, making sure to address the entire course of the vessel.

After the procedure, topical saline gel can be applied to protect the area as it heals. Advise use of topical vasoconstrictors in addition to compression for recurrent bleeding. Bedside humidifiers will reduce the risk of recurrence.

Nasal Cauterization with Silver Nitrate for Recurrent Epistaxis. N Engl J Med. 2021 Jun 24;384(25):e101. doi: 10.1056/NEJMvcm2020073.
Full video available at: https://www.nejm.org/doi/full/10.1056/NEJMvcm2020073

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