Haemorrhage from malignant wounds

A malignant wound (e.g. a neck mass/lymph node) may erode into a major blood vessel and cause severe bleeding 

If a patient has a deep wound near a major blood vessel it is essential to have emergency injections (e.g. morphine and midazolam) available to calm the patient and stabilise the situation. 

It is good practice to gently explore this with the patient and carer. They can be reassured that major bleeding is very rare.

For superficial wound bleeds

  • Tranexamic acid 500mg/5ml Ampule for injection should be soaked into gauze and applied with pressure for 10 mins
  • Adrenaline 1:1000 soaked on gauze to be used in the same way
  • Kaltostat wound dressing is the best option for an oozing wound

Having dark coloured towels available to mop up bleeding can reduce distress.

Haemostatic sprays and Celox hamostatic granules are proving very effective for constantly bleeding wounds which do not respond to the above treatments. 

Recommended Resources

West Midlands Palliative Care: Major Haemorrhage

Published 1st January 2025

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24 hour Advice Line Meadow House Hospice
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24 hour Advice Line Meadow House Hospice

T. 0208 967 5597

W. http://meadowhouse.lnwh.nhs.uk

Meadow House Hospice 24 hour telephone support line to the hospice ward offers support and advice on palliative care issues.

24 hour Advice Line Michael Sobell Hospice
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24 hour Advice Line Michael Sobell Hospice

T. 0203 824 1268

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It is also an Advice Line for patients and families who live in Hillingdon and need advice on any aspect of palliative care. 

The Advice Line is answered by hospice nurses in the Inpatient Unit and queries are escalated to the on-call palliative medical team if needed.

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T. 0208 102 5000

W. https://www.pembridgehospice.org/

Pembridge Hospice provides palliative care services and advice to the residents of Brent, Central London, West London and Hammermith and Fulham.

This is a 24 hour, 7 days a week telephone advice line.

Referral form for clinician use only.

 

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24 hour Advice Line Royal Trinity Hospice

T. 0207 787 1062

W. https://www.royaltrinityhospice.london/

Royal Trinity Hospice provides a 24 hour, 7 days a week clinical advice line and OOH access to the on-call consultant.

24 hour Helpline Pall24 for North Brent and Harrow
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24 hour Helpline Pall24 for North Brent and Harrow

T. 03000 200 224

This service was formerly known as Single Point of Access (SPA)

This is a 24 hour 7 days a week helpline providing advice for patients, families and professionals, hosted by St Luke's Hospice for residents of Harrow and North Brent.

Urgent rapid response visits can be made to patients registered with a Harrow GP

 

24/7 Your Life Line 24/7 Hillingdon (YLL)
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24/7 Your Life Line 24/7 Hillingdon (YLL)

T. 0800 328 5697

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The team is made up of clinical nurse specialists and health care assistants (HCA) who can support patients with complex needs at home in the last weeks and months of their life (with any diagnosis). 

The service is open 24 hours a day, 365 days a year, and can offer advice.

 Urgent night visits  are available to patients already referred to the service.

If you have already been referred to this service, you will have been given a direct contact number.

Speak to your GP or district nurse to be referred to the service.

District Nurses

District Nurses Night Service Brent
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District Nurses Night Service Brent

T. 020 8102 3456

Calls will be routed directly to the clinical teams that operate after 5.00pm.

District Nurses Brent
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District Nurses Brent

T. 0208 102 3456 option 2

The service operates between Monday to Friday 8:30am to 5.00pm.

Referrals for same/next day appointments need to be received by 4.30pm Monday to Friday.

Brent North - Chalkhill team based at Chalkhill Primary Care Centre and Wembley team at Wembley House

Brent South - Harlesden and South Kilburn teams based at Hillside Primary Care Centre and Willesden team at Willesden Centre for Health

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T. 0208 102 5555 option 4

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District Nurses Ealing
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The District Nurses are based at Featherstone Road Health Centre, Acton Health Centre and Greenford Green Clinic.

Referrals can be made Monday to Sunday 8.00am to 8.00pm.

The Rapid Response District Nurse team are based at Clayponds Hospital and referrals can be made Monday to Sunday 8.00am to 12.00pm.

District Nurses Hammersmith and Fulham
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District Nurses Hammersmith and Fulham

T. 0208 102 5555 option 4

District Nurse referrals can be made Monday to Sunday 9.00am to 5.00pm.

District Nurses Harrow
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Harrow District Nursing Service (CLCH) provide routine monitoring tasks and syringe drivers Monday to Friday 8.00am to 6.00pm and on Saturdays and Bank Holidays 8.00am to 4.00pm. Please select option 3 from the call list.

The Rapid Response team provide (7/7) For prn sc medication and referrals can be made Monday to Friday 8.00am to 6.00pm. Please select option 2 from the call list.

District Nurses Hillingdon
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District Nurses Hillingdon

T. 01895 486 127/ 01895 234001

W. https://www.cnwl.nhs.uk/services/community-services/hillingdon-district-nursing-service

Hillingdon District Nurses support adult patients who are housebound and need nursing care in their own homes and/ or community settings and who live in Hillingdon or are registered with a Hillingdon GP.

 

 

District Nurses Hounslow
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District Nurse referrals can be made Monday to Friday 9.00am to 5.00pm.

District Nurses Night Service Central London and West London
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District Nurses Night Service Central London and West London

T. 0208 102 5500

The Dristrict Nurses Night Service is an OOH service for referrals and advice. Please leave a voicemail message if calls are made before 8.00pm. After 8.00pm please call 111 or 0208 969 7777. Please do not leave voicemail mesages after 8.00pm for same night referrals.

District Nurses Night Service Hammersmith and Fulham
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District Nurses Night Service Hammersmith and Fulham

T. 0208 102 5500

The Dristrict Nurses Night Service is an OOH service for referrals and advice. Please leave a voicemail message if calls are made before 8.00pm. After 8.00pm please call 111 or 0208 969 7777. Please do not leave voicemail mesages after 8.00pm for same night referrals.

District Nurses Night Service Harrow
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T. 0300 555 8889

Referrals to the night service can be made Monday to Friday 8.00pm to 8.00am. Please select option 3 from the call list.

District Nurses Night Service Hounslow
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Referrals to the night service can be made Monday to Sunday 5.00pm to 7.00am.

Planned Night End of Life Care
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Planned Night End of Life Care

T. 0203 370 2208

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Rapid Response End of Life Care Service

T. 0208 967 5126

Marie Curie Rapid Response Service provides short term palliative nursing interventions, symptom control, management of pain, advice, emotional and practical support to the residents of Ealing and Hounslow. This service is based at Meadow House Hospice.

The service can be contacted Monday to Sunday from 6.00pm to 7.00am.

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Rapid access services

Rapid Response Service Brent
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Rapid Response Service Brent

T. 020 8102 3456 option 3

The Brent Rapid Response Team provides admission avoidance in the community which supports expert clinical assessment and interventions to patients requiring urgent care and assessment.

Office hours are Monday to Sunday 8.00am to 10.30pm.

Rapid Response Service Ealing
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The Ealing Rapid Response Service provides admission avoidance in the community which supports expert clinical assessment and interventions to patients requiring urgent care and assessment at home. The service does not initiate planned interventions and should not be used in advance of other service like District Nursing and Marie Curie to provide care to patients in receipt of palliation.  The team can offer assessment and interventions where there is an urgent need for clinical support outside of the operating times for planned services which includes out of hours’ symptom management and assessment.

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