What is the earliest time to remove a nasal tamponade (rhino rocket) after cessation of epistaxis (nosebleed)?

From the Guidelines

The earliest recommended time to remove a nasal tamponade (rhino rocket) after cessation of epistaxis (nosebleed) is typically no longer than 5 days, as stated in the clinical practice guideline for nosebleed (epistaxis) published in 2020 1. When considering the removal of nasal packing, it's essential to weigh the risks and benefits, taking into account the severity and location of the nosebleed, underlying medical conditions, and patient comfort.

• The duration of nasal packing should be determined by the clinician, considering factors such as the severity of the nosebleed and the patient's overall health.
• Nonresorbable packing should not be left in place for more than the recommended time to avoid potential complications, including infection, septal perforations, and scar bands in the nasal cavity 1.
• Patients should follow strict adherence to follow-up directions and keep the nose and packing moist with nasal saline sprays to reduce crusting and promote healing.
• After removal of the packing, patients may experience a small amount of bleeding from the raw surfaces inside the nose, and keeping the nose humid with saline spray and moisturizing agents can help prevent dry crusts and facilitate healing 1. The decision to remove the nasal tamponade should be made on a case-by-case basis, considering the individual patient's needs and the risk of potential complications.
• It's crucial to discuss the removal of the packing with the clinician at the time of placement to determine the best course of action for each patient.
• Patients should be aware of the potential symptoms to be concerned with, such as return of blood from the nose or mouth, fever, increasing pain, and vision changes, and seek medical attention if they experience any of these symptoms 1.

From the Research

Removal of Nasal Tamponade

• The provided studies do not specifically address the earliest time to remove a nasal tamponade (rhino rocket) after cessation of epistaxis (nosebleed) 2, 3, 4, 5, 6.
• However, the studies discuss various treatment options for epistaxis, including nasal packing, tranexamic acid, and anterior nasal packing, and their effectiveness in stopping bleeding and preventing rebleeding 2, 3, 4, 5, 6.
• The studies suggest that topical application of tranexamic acid can be an effective treatment for epistaxis, with faster bleeding cessation and less rebleeding compared to anterior nasal packing 4, 5, 6.
• However, there is no direct information on the removal of nasal tamponade, and the decision to remove it would likely depend on individual patient factors and the specific treatment protocol used 2, 3, 4, 5, 6.

Treatment Options for Epistaxis

• Nasal packing with non-absorbable materials, such as petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, and balloons (Rapid-Rhino) 2.
• Topical application of tranexamic acid, which has been shown to be effective in stopping bleeding and preventing rebleeding 3, 4, 5, 6.
• Anterior nasal packing with gel foam or other materials 5, 6.
• Endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing 2.
• Endoscopic cauterization, which is more effective than ligation 2.
• Embolization using gelatin sponge, foam, PVA, and coils, which has a high success rate and comparable efficacy and complications to surgical methods 2.