From the Guidelines
Nasal packing typically needs to be removed, and the duration of placement varies from 48 hours to 5 days, depending on the severity and location of bleeding, as well as medical comorbidities, as stated in the clinical practice guideline: nosebleed (epistaxis) 1. The removal of nasal packing is crucial to prevent complications such as infection, septal perforation, and pressure sores. Non-resorbable packing must be removed by a clinician, while resorbable packing may dissolve on its own over time 1. Some key points to consider when dealing with nasal packing include:
- The type of packing used, whether absorbable or non-absorbable, will determine the need for removal and the timing of removal 1.
- Patients should be educated on post-procedure care, including the importance of follow-up appointments for packing removal and monitoring for complications 1.
- Patients should also be aware of warning signs of infection, such as fever, increasing pain, and bleeding, and should seek medical attention if these symptoms occur 1. It is essential to follow the clinician's specific instructions regarding nasal packing and attend all follow-up appointments for proper care to minimize the risk of complications and ensure optimal outcomes.
From the Research
Nasal Packing Removal
- Nasal packing after septoplasty or FESS (Functional Endoscopic Sinus Surgery) is a topic of debate, with some studies suggesting it is unnecessary and can cause patient discomfort 2, 3, 4.
- The use of nasal packing has been associated with increased postoperative pain, headache, epiphora, dysphagia, and sleep disturbance 2.
- Some studies have found that nasal packing does not reduce complications such as bleeding, septal hematoma, and adhesion formation 2, 4.
- The optimal time for nasal packing removal has been studied, with one study finding that removal after 24 hours is preferable to removal after 48 hours or more due to less patient discomfort and increased cost-effectiveness 5.
- Another study found that removing intranasal splints after 24 hours is sufficient to avoid postoperative complications and minimizes postoperative discomfort 6.
Complications and Risks
- Nasal packing can cause complications such as naso-pulmonary reflex, intractable pain, sleep disorder, postoperative infection, and toxic shock syndrome 4.
- The use of nasal packing materials with a smooth surface can minimize mucosal damage and negative impact on patient comfort, but hemostatic/resorbable materials can cause increased synechiae and foreign body reactions 3.