How should a nasal tamponade device be inserted into the nose?

Proper Insertion Technique for Nasal Tamponade Devices

A nasal tamponade device should be inserted parallel to the nasal floor (not upwards), with the patient's head tilted back at approximately 70 degrees. 1

Anatomical Considerations and Proper Technique

The proper insertion technique for nasal tamponade devices follows the natural anatomy of the nasal cavity:

1. Patient positioning:

   • Tilt the patient's head back approximately 70 degrees
   • This position provides optimal access to the nasal cavity

2. Direction of insertion:

   • Insert the tamponade device through the nares parallel to the nasal palate/floor
   • AVOID inserting upwards as this can cause trauma to sensitive nasal structures

3. Depth of insertion:

   • Continue insertion until:
     • Resistance is met, OR
     • The distance equals that from the patient's ear to their nostril

4. After insertion:

   • If using non-resorbable packing, leave in place for the recommended duration (typically no more than 5 days)
   • For resorbable packing in patients with bleeding disorders or on anticoagulants, follow specific manufacturer instructions

Evidence-Based Rationale

The Clinical Practice Guideline for Epistaxis from the American Academy of Otolaryngology-Head and Neck Surgery specifically states that when inserting nasal packing, clinicians should "insert flexible shaft mini-tip swab through nares parallel to palate (not upwards)" 1. This approach follows the natural anatomy of the nasal cavity.

Inserting the device parallel to the nasal floor rather than angling upward helps avoid trauma to the sensitive nasal structures and ensures proper placement to control bleeding effectively. Improper insertion technique can lead to:

• Inadequate tamponade effect
• Patient discomfort
• Potential injury to nasal structures
• Failure to control bleeding

Special Considerations

• For patients on anticoagulants or with bleeding disorders: Consider using resorbable packing to reduce the risk of rebleeding when the pack is removed 1

• Patient comfort: Proper insertion technique minimizes discomfort. Patients should be educated about expected sensations (nasal obstruction, decreased ability to smell, facial pressure) 1

• Complications to watch for: Infection, septal perforation, pressure sores, and sleep disturbances can occur with nasal packing 1

Common Pitfalls to Avoid

1. Inserting at the wrong angle: Inserting upward rather than parallel to the nasal floor can cause trauma and ineffective tamponade

2. Inadequate depth: Not inserting the device far enough to reach the bleeding site

3. Excessive force: Using too much force during insertion can damage nasal structures

4. Improper patient positioning: Not tilting the patient's head back sufficiently

By following these evidence-based guidelines for nasal tamponade insertion, clinicians can effectively control epistaxis while minimizing patient discomfort and potential complications.