Planning for management of bleeding in palliative care

Any bleeding in a patient with palliative care needs is a source of alarm to the patient and family. Planning for the management of bleeding can be of great benefit if bleeding does occur.

Principles for planning for management of bleeding in patients with palliative care needs include:

• advance care planning to explore the patient’s preferences for care, such as
  • the desired place of care (taking into account the confidence of the carer to manage if the patient prefers to be cared for at home)
  • whether or not the patient wants active intervention to stop the bleed
  • the possibility of using sedation to relieve distress and reduce awareness if a major bleed occurs
  • ensuring appropriate drugs are available in the home, or prescribed and available for an inpatient in anticipation of a bleed occurring
  • documentation of the patient’s preferences regarding ongoing transfusions (platelets, packed cells)
• discussing the likelihood of bleeding with patients who are at high risk, and their carers
• develop a management plan for carers to implement, including
  • strategies for symptom management
  • nominating a healthcare professional (eg palliative care team, GP) to call if advice is required
  • using dark towels (eg green, navy) to mask the visual impact of blood
  • remaining with the patient to provide the comfort of a physical presence during major bleeding; this is more important than giving drug therapies
  • calling an ambulance if additional assistance is required during major bleeding.

Even if a patient has indicated that they do not want active intervention in the event a bleed occurs, families and carers should still be given a list of who to call if they need advice.