From the Guidelines
Yes, Rapid Rhino can be used to manage epistaxis (nosebleed) in patients with nasal bone fractures. Rapid Rhino is a nasal tampon device made of carboxymethylcellulose that expands when hydrated with water, creating gentle pressure against the bleeding site. For application, first soak the Rapid Rhino in sterile water for approximately 30 seconds until it becomes slippery, then gently insert it along the floor of the nasal cavity to the appropriate depth (typically 7-10 cm for adults). Once positioned, inflate the device with air using the attached pilot balloon until bleeding stops and the patient feels pressure but not pain. The device can typically remain in place for 24-72 hours depending on the severity of bleeding. Rapid Rhino is particularly useful in nasal fracture cases because it conforms to the nasal anatomy, providing even pressure distribution without causing additional trauma to already damaged tissues. It also has the advantage of being less traumatic upon removal compared to traditional nasal packing, as the carboxymethylcellulose coating prevents adherence to the nasal mucosa. However, caution should be exercised in cases with suspected cribriform plate fractures or CSF leaks, where neurosurgical consultation should be obtained before packing.
Key Considerations
- The use of nasal packing, including Rapid Rhino, is supported by clinical practice guidelines for the management of epistaxis, as stated in 1 and 1.
- Patient education on the type of packing, removal plan, post-procedure care, and signs of complications is crucial, as emphasized in 1.
- The application and management of Rapid Rhino should be tailored to the individual patient's needs and the severity of their epistaxis.
Application and Management
- Soak the Rapid Rhino in sterile water for approximately 30 seconds before insertion.
- Insert the device along the floor of the nasal cavity to the appropriate depth.
- Inflate the device with air until bleeding stops and the patient feels pressure but not pain.
- Monitor the patient for signs of complications and remove the device as planned or sooner if necessary.
From the Research
Nasal Packing for Epistaxis in Nasal Bone Fractures
- Rapid Rhino (nasal packing) can be used to control epistaxis in nasal bone fractures, as it is a type of nasal packing that can be applied to control bleeding 2, 3.
- The use of Rapid Rhino has been compared to other types of nasal packing, such as choanal balloon tamponade, and has been found to be less painful and effective in controlling epistaxis 3.
- However, the use of nasal packing, including Rapid Rhino, can cause complications such as damage to the nasal mucosa, septum, and alar skin, and should be avoided if possible 4.
- Other studies have compared the efficacy and safety of different types of nasal packing materials, such as polyvinyl alcohol sponge (PVAS) and gauze, and found that PVAS may be a better option for certain patients, such as those at elevated risk of bleeding 5.
- The use of antibiotics in nasal bone fracture treatment is not routinely recommended, unless there are complications or other indications for their use 6.
Types of Nasal Packing
- Nasal packing can be applied with non-absorbable materials, such as petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, balloons (Rapid-Rhino) 2.
- Absorbable materials, such as nasal tampon (Nasopore), and newer hemostatic materials, such as hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan), and fibrin glue, can also be used 2.