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.

District Nurses

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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.

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Planned Night End of Life Care

T. 0203 370 2208

This is an overnight service and is provided by Marie Curie via Meadow House Hospice for residents of Ealing and Hounslow. This service provides one to one overnight nursing support, symptom control, management of pain, emotional and practical support for patients in their last few weeks of life.

Referrals are made via Local Clinical Coordination Centre Monday to Sunday from 10.00pm to 7.00am.

Marie Curie Planned Night Services Referral Form (DOCX)
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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.

Rapid Response Referral Form (DOCX)

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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.

Patients can be referred to the service via the GP, 111 or by communicating with the Ealing Community Partners (ECP) Referrals Hub via telephone.

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