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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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District Nurses

District Nursing Enfield
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The Enfield District Nursing team provides a broad range of nursing services including:

  • palliative care and end-of-life care
  • wound care management
  • pressure area care, including assessment for equipment and manual handling requirements
  • medicines management, including chemotherapy, Hickman and PCC lines following individual patient assessment and including the teaching of patients and carers
  • management and education of appropriate specialist feeding regimes
  • continence services, including assessment, management and advice to those with indwelling catheters

This service is available from 8.00am to 4.30pm Monday to Friday.

Enfield District Nurse Out of Hours Service
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Enfield District Nurse Out of Hours Service

T. 020 8702 3000

W. https://www.royalfree.nhs.uk/services/community-services-enfield/district-nursing-service

The night team provided by St Ann’s Hospital is available from 4.30pm to 8.00am, Monday to Friday, weekends and bank holidays.

Palliative care advice lines

NCL Palliative Advice Team
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NCL Palliative Advice Team

T. 020 8152 3252

W. https://northlondonhospice.org/get-support/out-of-hours-telephone-advice

The North Central London Palliative Advice Team is a telephone service providing palliative care patients, families, carers, and healthcare professionals (in NCL ICS boroughs) with out of hours advice and support.

The telephone service is available 8.00pm to 8.00am, seven days a week.

St Joseph's Hospice
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St Joseph's Hospice

T. 0300 30 30 400

W. https://www.stjh.org.uk/

St Joseph's Hospice provide palliative care in the Hospice and in the community for residents in Enfield, Haringey and Islington.

There is a 24 hour advice and support line.

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