End-of-Life Care Challenge: Exsanguinating Patients

Recently, I have had a number of patients bleeding during their hospice care at the end-of-life. Patients may bleed out for a number of reasons. End-stage liver disease frequently causes bleeding, as the liver is essential to the creation of clotting factors, without which, the body is not able to clot properly. Complications, such as DIC or post-surgical may also cause patients to bleed at the end-of-life. Bleeding can vary between scant amounts of blood on linens to a very heavy flow that continues until death.

For any signs of bleeding, the use of green surgical towels may be helpful. The green color obscures the bright-red color of the blood, which may make it less disturbing for visiting friends and family.

Keep universal precautions in mind as well. A mask with goggles may be appropriate if the patient is bleeding in a way that is creating a spray, despite the barrier they create between you and the patient.

Following are recommendations for bleeding from specific orifices:

rectal bleeding:
A rectal tube may be inserted, attached to a catheter bag, to collect the blood.

nasal bleeding:
The nasal cavity may be filled with gauze. You may cut a respiratory mask to hold pressure on the nostrils while keeping the mouth exposed.

oral bleeding:
Suction may be necessary if large quantities of blood are coming from the mouth.

These are just some of the tips I have used with my limited experience with patients who are bleeding at the end of life. Although this is not a common occurrence, it is very distressing for patients, family, as well as staff, and is thus very memorable. I welcome anyone to comment other ideas or suggestions for how to manage bleeding at the end-of-life.