Preparing for a Hemorrhage at Time of Death in Hospice

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Introduction

Hemorrhage, referred to as a “Bleed-out” is a rare event and most often occurs due to tumor invasion and erosion of vessels. Any tumor that involves the vascular tissue or is near a major vessel can result in a bleed out.

Causes

Some diseases that may result in bleed out include but are not limited to:

  • head and neck cancers
  • lung cancer
  • tumors in the pelvic area
  • leukemia, thrombocytopenia, and other diseases that cause abnormal platelet function and/or coagulation disorders
  • liver diseases

Hemorrhage may be the cause of the patient suddenly going into the dying process, or it may occur when the patient is already in the dying process. The presence of massive bleeding is frightening for both the patient and family members and hospice attempts to lessen the anxiety and discomfort for them as much as possible.

Preparation

If a hemorrhage is anticipated, the patient and family are prepared that this may occur. Hospice professionals assure the patient that he/she will be kept as comfortable as possible. Normally, hemorrhage is frightening but not painful and results in shock and a rapid death. If there is time, the patient may need sedation. Hemorrhage, however, is more shocking to the family. If the family knows what to expect, their anxiety level may also decrease. Placing red towels in the home and using them for bleeding decreases the visual effects of this often traumatic event.

 

If a hemorrhage does occur, someone should stay with the family at all times to provide a calming environment, assist with cleaning of the blood, provide physical care and comfort measures and provide support and reassurance to the patient and family.

 

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