Vascular obliteration with nosebleeds

definition

The nosebleed (Epistaxis) can occur for various reasons and is harmless but also unpleasant for many patients, as many patients do not tolerate the taste and smell of blood well. Therefore, as with a very heavy nosebleed, the top priority is to stop the bleeding as quickly as possible.

In addition to the classic nasal packing, there is another modern way of reducing bleeding. This involves sclerosing one or more bleeding vessels by means of an electric current. This procedure is known as electrocoagulation. The method is often carried out in the hospital as part of an operation or on an outpatient basis in the case of very heavy nosebleeds on a ward.

Read more on the topic: Nosebleeds while sleeping

Desolation process

The obliteration of vessels during a nosebleed is usually carried out by a qualified doctor, in this case one Ear, nose and throat specialist. The desolation of vessels can if you have very severe nosebleeds or recurrent nosebleeds.

Also at Patients with a Bleeding disorder Sclerotherapy for the bleeding vessels is a quick and easy way to correct the problem. Since it is a simple and minor intervention the sclerosing on an ENT station in local anesthesia (Local anesthesia) occur. To do this, the patient sits in a special chair that is slightly tilted so that the doctor has a good view of the nasal cavities. In some patients can also be a short one anesthesia No necessary for the procedure, so that as part of a small operation the bleeding is stopped.

With both options, the doctor first tries one To provide an overview in the nosewhich can be more difficult depending on how bad the bleeding is. With help of a Rhinoscope the doctor spreads his nostrils open to get a better view. In addition, the doctor usually enters Head or headlampthat gives him a better view.

First of all, the doctor did this Aim to find the source of the bleeding. Most of the bleeding is there in the front area in the Tip of the nose. There is a well networked one under the skin Vascular plexuswhich as Locus Kiesselbachii referred to as. Sclerotherapy can also take place there very well, as bleeding in the anterior nasal area can be easily reached with the equipment. Even while the doctor is still looking for the source of the bleeding, he can already be possible open vessels with a bipolar, a device which is sent via electric current heat generated and thus the Vessels burns, close. At very heavy bleeding Only then do the actual sources of bleeding usually become visible. The device consists of two tips, into which electric current is shot with a foot pedal. The tips can then, guided by the operating doctor, grasp and burn the hole in a vessel or vessel ends. At the same time, the doctor can dab away any draining blood until the Bleeding stopped is.

Some clinics have one in the operating theater laserthat can be used for various operations. There is also the possibility of obliterating the source of bleeding with a laser. The attending physician guides the Laser head and aims at the area to be deserted. The prerequisite for using a laser is that the The strength and thickness of the laser can be set well and that the Bleeding source can be reached at all with the laser beam.

Whether the vessel is closed shows whether blood is still flowing out of the nose directly or through the throat. Many doctors lay after coagulation yet Tamponades into the bleeding nostril. The tamponades exercise you Pressure on the nasal wall and the vessels off. On the one hand, this becomes a Prevents swellingOn the other hand, the wound can be helped to heal and remain closed. Often the swabs are also in Otrives Nasal drops soaked. The nasal drops have a constricting effect on the vessels, which helps stop the bleeding and at the same time, their ingredients prevent the nasal mucous membrane from swelling due to the manipulation.

Is an outpatient sclerotherapy possible?

In the most cases is the clogging of a blood vessel in the nose carried out on an outpatient basis. Patients will usually after a short observation period back home dismiss.
It should be one very profuse bleeding that could not be breast-fed through a single sclerotherapy, it may well be possible that the affected person has to stay in hospital for monitoring. In this case, it should be ensured that immediate action can be taken if bleeding occurs again.

Side effects

The sclerosing of bleeding vessels in the nose is general not a major intervention however, it can be a little more difficult depending on the severity of the bleeding or the constitution of the patient. For the patients can desolate be very different. Some patients report that the procedure, if performed under local anesthesia, unpleasant was but not painful. Other Patients feel against it increased pain in coagulation.

During coagulation, the Mucous membrane and the vessel walls downright burned. A disadvantage of the procedure is therefore that it smells like burned skin. For many patients, the smell lingers longer in the nose and also affects taste perception afterwards. The Food can taste smoky and banished.

Another inconvenience arises from the result Wound in the nose and the intervention itself. With electrocoagulation and the instruments that hold the nose open, the Nasal mucosa very irritated and claimed. Some patients react to this with a more or less strong one swelling of the mucous membranes. This with special needs in addition to any tamponade used Breathing through your nose. Many patients also report with one in this context Burn the nasal mucous membranes. A blocked nose is a particular problem for patients if they are used to breathing through their nose at night. Decongestant medication like Otriven nasal drops can relieve the discomfort.

Pain

For most patients, this is the sclerosing of vessels in the nose not very painful, rather tolerable but uncomfortable. Nevertheless, there may be patients who find the procedure very painful. In this case the operation can also take place in the operating room anesthesia take place so that the patient can benefit from the procedure not aware of anything. The choice of general anesthesia is therefore particularly suitable for patients who are very anxious and who otherwise would not be able to keep still.

Since it's basically the Electrocoagulation to the combustion is about skin, as a result a wound arises in the nose, which also in hindsight pain can prepare. This can help relieve the pain Painkiller how Paracetamol or Ibuprofen be taken as directed by the doctor.

Does it make sense to cauterize blood vessels?

Sclerosing blood vessels in the nose can be particularly useful in patients who frequent or even very slight nosebleeds to get. A sclerosing of vessels can then frequency from nosebleeds reduce. In addition, larger, often bleeding vessels can also be completely closed without endangering the blood supply to the nose, because the nose has a very well networked network of blood vessels.

Even in patients who are under the hemophilia suffer and them too lost a lot of blood even with a harmless nosebleed surgery can be very useful because it is often a very quick and uncomplicated measure to stop the bleeding.

Whether and when to coagulate depends on the severity of the bleeding and is decided by the attending physician. In contrast, there is coagulation not usefulwhen a patient Rare over Epistaxis complains. Often enough then non-invasive methods like inserting Tamponades off to stop the bleeding.

Also with childrenwho have nosebleeds will often this Avoided desolation. Many doctors also try other methods of stopping the bleeding first, and keep the sclerotherapy as a last resort if all other measures are not effective.

Alternatives

The Sclerosing blood vessels in the nose is always necessary when conventional methods of stopping a nosebleed are insufficient.
Sclerotherapy of the responsible blood vessel is carried out either with a so-called acid etching or with electro- or laser coagulation. In most cases, this will stop the heavy bleeding.
If there is still no hemostasis, is either the Exit point of the vessel not found been, or else the Desolation was not enough. The ENT doctor will then do the vascular site desolate again.
Parallel should also always follow other causes be sought that cause a nosebleed. Has a strong increased blood pressure e.g. If the nosebleed is triggered, a nosebleed can occur again and again, despite sclerotherapy, if the blood pressure is not lowered sufficiently. Even if Blood disorders With decreased blood platelet count If you have a heavy nosebleed, you can always get a nosebleed.
As a further measure, this can Ligating a larger blood vessel. A larger branch from which the bleeding vessel branches off is closed. This can significantly reduce the amount of blood that would pass into the bleeding.

costs

The sclerosing of a bleeding vessel in the nose represents an ENT specialist emergency the cost will be too 100% from the statutory health insurance accepted. Depending on which method is chosen for the obliteration of the blood vessels, arise Costs between 20 and 50 euros. The more modern laser process is slightly more expensive than the conventional process.