Interventions for haematomas

Minor (small) haematomas will resolve over time with minimal intervention. If on a limb, they may require compression to decrease local swelling and aid absorption of fluid.

Treatment for a minor haematoma includes:

• rest, ice, compression and elevation (RICE)
• adequate analgesia
• monitoring for complications (eg extension).

Refer patients with systemic symptoms or with a haematoma that is:

• large
• tense
• painful
• infected
• over a joint or airway
• expanding.

The best method for evacuation of a haematoma is incision and drainage, undertaken by a competent practitioner. The skin over a haematoma can be thin, tense, hypoxic or necrosed, so the incision should be made at the periphery. The clot can be removed with irrigation, lavage or low-frequency ultrasound debridement. Some patients require skin grafting.

Refer patients with arterial or venous disease to a vascular surgeon; see Venous leg ulcers.

Review the need for tetanus vaccination; see Tetanus-prone wounds.

Selection of an appropriate dressing is based on the haematoma depth, location, amount of exudate, interventions needed, and patient preference.

Review the patient’s current medications to identify any that promote bleeding (including nonprescribed medications). If the patient is taking an anticoagulant and the haematoma is expanding, seek advice about whether medication can be stopped.