How to manage nasal oozing 20 hours post (after) rhinoplasty?

Managing Nasal Oozing 20 Hours After Rhinoplasty

To slow down nasal oozing 20 hours after rhinoplasty, apply gentle pressure with saline-soaked gauze and use a topical vasoconstrictor such as oxymetazoline nasal spray, followed by application of a moisturizing emollient once bleeding stops. 1

Initial Management

1. First-line interventions:

   • Apply gentle pressure with saline-soaked gauze to the bleeding site for 5-10 minutes
   • Use a topical vasoconstrictor (oxymetazoline/Afrin) applied via spray or on cotton pledget 1
   • Keep head elevated at 30-45 degrees to reduce blood flow to the nasal area 2

2. If bleeding site is visible:

   • Apply oxymetazoline directly to the bleeding site
   • Studies show 65-75% of patients have resolution of nasal bleeding with oxymetazoline 1

Secondary Interventions

If initial measures don't control the oozing:

1. Saline irrigation/spray:

   • Use isotonic saline spray to gently cleanse the nasal cavity
   • Helps remove blood clots while maintaining moisture 1
   • Avoid forceful blowing or irrigation that could disrupt clots

2. Cold application:

   • Apply cold compresses to the periorbital area and nasal dorsum
   • Helps reduce swelling and constrict blood vessels 2
   • Use for 10-15 minutes at a time with short breaks

Post-Bleeding Care

Once bleeding stops:

1. Moisturizing agents:

   • Apply emollient ointments to prevent dryness and recurrent bleeding 1
   • Petroleum-based ointments are particularly effective

2. Humidification:

   • Use a humidifier in the room to prevent drying of nasal mucosa 1
   • Maintain adequate hydration to support mucosal health

Important Cautions

• Avoid nasal packing if possible:

  • Nasal packing has been shown to increase periorbital ecchymosis and patient discomfort 3
  • Only use if other methods fail to control bleeding

• Avoid manipulation:

  • Do not pick, rub, or insert objects into the nose
  • Avoid sneezing or forceful nose blowing 1
  • If sneezing is unavoidable, do it with mouth open 1

• Monitor for warning signs:

  • Excessive bleeding that doesn't respond to the above measures
  • Severe pain, fever, or purulent discharge (could indicate infection)
  • Difficulty breathing through both nostrils

When to Seek Medical Attention

Return to your surgeon immediately if:

• Bleeding persists despite 20 minutes of direct pressure
• Large blood clots are being expelled
• You experience shortness of breath or dizziness
• Bleeding is accompanied by severe pain or fever

Prevention of Future Oozing

1. Head position:

   • Sleep with head elevated for at least 48-72 hours after surgery 2
   • Avoid bending over or positions that increase nasal blood flow

2. Activity restrictions:

   • Avoid strenuous physical activity for 7-10 days 1
   • Avoid swimming and situations with pressure changes (e.g., air travel) 1

3. Medication considerations:

   • Continue prescribed anti-inflammatory medications
   • Avoid blood-thinning medications unless specifically directed by your surgeon

By following these steps systematically, most post-rhinoplasty oozing can be effectively managed without requiring additional medical intervention.