Introduction
This leaflet has been given to you as your team is worried that you or your relative may be at risk of suffering a major bleed.
Your care team will talk to you about the risk of bleeding and provide a suggested care plan, but you may find this leaflet helpful.
This leaflet is designed to take family and carers through what to do in the event of a bleed, to support a relative and prioritise their comfort. Some patients can suffer large bleeds that they cannot recover from and sadly die. In the event of a bleed, minimising anxiety and providing comfort and support is important.
Living with the risk of bleeding can be a worrying time for patients and their families and carers. If you have any questions or worries after reading this leaflet or need further support, please discuss these with your doctor or specialist nurse.
Being Prepared
Talking to your Care Team
Your care team can talk to you about your personal bleeding risk and if there are any measures to lower the risk. They can also discuss what a patient might experience in the event of bleeding, and a suggested care plan.
In these discussions, you may want to talk about other aspects of your care, your wishes, and what matters most to you. However, this process is completely voluntary, and you may not wish to have these discussions.
Please let your team know how much information you want to receive so they can best support you.
Useful Equipment
It can be useful to have some equipment easily accessible in the event of bleeding including:
- Dark coloured towels and dressings to place over the site of bleeding
- Blankets for warmth and comfort
- Waterproof absorbent sheets, gloves and aprons
- A phone nearby and emergency contact numbers
- You may be offered an emergency anti-anxiety medication called midazolam. Midazolam should be safely stored in a secure, cool, and dark place that is easily accessible.
In the Event of Bleeding
A: Assurance - If a large bleed occurs, it is important for family and carers to remain calm and provide reassurance that the bleed was anticipated and prepared for.
B: Be there - The most important care you can offer is to stay by your relative’s side all the time. Please try to avoid leaving them alone.
C: Comfort and Calm - Large bleeds rarely cause pain, but they can cause distress. Continue to comfort your relative and try to keep them calm. If available, dark towels and repositioning can make bleeding less apparent. If the bleeding is coming from a wound, you can apply firm pressure and dressings. Blankets can be used to keep someone warm.
D: Dial for Help - Call for help using your emergency contacts. District nurses, palliative nurses, or other healthcare professionals will aim to arrive as soon as possible to provide support and help keep your relative comfortable. In some cases, bleeding can happen very quickly and sometimes people can lose awareness within a few minutes and before help arrives.
E: Extras - In the event of a large bleed, carers can give any emergency medications supplied, if accessible. Midazolam is the medication most often provided.
In the event of bleeding, when help arrives, healthcare professionals will assist family and carers, help clean-up, and offer ongoing support.
About Midazolam
Midazolam is an anti-anxiety medication, which is given to lessen distress and awareness of bleeding and works in around 15 minutes. If a patient recovers from a bleed, it can reduce memories of the event and midazolam usually wears off in several hours. The usual adult dose is 10mg and it comes as a prefilled sealed syringe. Smaller doses can be given for patients of low weight.
Storage and Disposal
It should be stored at room temperature in a dark, accessible place that is secure and out of reach of children and pets. Do not refrigerate. Please return unused or expired midazolam to your local pharmacy for safe disposal.
When to Give
If appropriate, your medical team may provide midazolam. It should only be used in the event of a major bleed, particularly if there are signs of distress or anxiety. Family or carers will usually need to administer this medication. A further 10mg dose can be given after 10 minutes if needed. There is widespread agreement that it is a helpful medication, however if you feel unable to give the medication please do not worry.
How to Give
Half of the Midazolam should be slowly squirted between the gums and inside of a cheek, and the rest on the opposite side of the mouth. Your team will talk you through administering the Midazolam in greater detail. Please read the medicine information leaflet that comes with the Midazolam.
Side Effects and Limitations
Sometimes patients will become unconscious in minutes before the medication has had time to work. The main side effect of midazolam is drowsiness and sedation, and rarely it can slow down breathing. Your relative may become drowsier or lose awareness after midazolam has been given. Please do not worry if this happens.
Key information in the event of bleeding
Contact Details
Emergency Contact Numbers
District Nurses (24 hours a day)
Tel No:
Specialist Palliative Care Nurse (8.30am - 4pm)
Tel No:
GP (usually 9am - 5pm)
Tel No: (Out of hours call 111)
For urgent advice whilst waiting for help call 999.
Date of Review: January 2024
Date of Next Review: January 2026
Ref No: PI_M_1884 (Oldham)