From the Guidelines
Proper Technique for Applying Nasal Packing
The proper technique for applying nasal packing to control epistaxis involves inserting the packing material into the nasal cavity to apply pressure on the bleeding site, with the goal of stopping the bleeding, and educating the patient on post-procedure care and potential complications 1.
Key Considerations
- Type of packing: The choice of packing material, whether resorbable or non-resorbable, should be based on the severity and location of the nosebleed, as well as the patient's underlying medical conditions and comfort level 1.
- Duration of packing: The packing should typically remain in place for no longer than 5 days, depending on the factors mentioned above, and should be removed as soon as possible to minimize the risk of complications 1.
- Patient education: The patient should be educated on post-procedure care, including the use of nasal saline sprays to keep the packing moist and reduce crusting, and signs and symptoms that would warrant prompt reassessment, such as return of bleeding, fever, or increasing pain 1.
- Complications: The patient should be aware of potential complications, including infection, septal perforation, and pressure sores, and should be instructed to avoid straining, lifting, and exercising to minimize the risk of further bleeding 1.
Best Practices
- Apply gentle pressure: When inserting the packing material, gentle pressure should be applied to avoid causing further trauma to the nasal mucosa 1.
- Monitor for complications: The patient should be closely monitored for signs of complications, such as bleeding, fever, or increasing pain, and should be instructed to seek medical attention immediately if any of these symptoms occur 1.
- Follow-up care: The patient should be scheduled for follow-up care to remove the packing and assess for any potential complications 1.
From the Research
Nasal Packing Techniques
The proper technique for applying nasal packing to control epistaxis involves several key considerations:
- The use of correct insertion technique is crucial, as noted in a study on Merocel nasal packs 2
- Nasal packing can be applied with non-absorbable materials, such as petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, and balloons (Rapid-Rhino) 3
- Absorbable materials, such as nasal tampon (Nasopore), and newer hemostatic materials, like hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan), and fibrin glue, can also be used 3
- Endoscopically guided nasal packing, such as with chitosan dressing, can be an effective and safe treatment for intractable epistaxis 4
Effectiveness of Nasal Packing
The effectiveness of nasal packing in controlling epistaxis has been demonstrated in several studies:
- Merocel nasal packs were found to successfully control bleeding in 91.5% of patients 2
- Rapid Rhino packs were shown to be effective and well-tolerated, with re-bleed rates similar to Merocel 5
- Endoscopically guided chitosan packing resulted in effective and immediate hemostasis in 95% of subjects 4
Important Considerations
When applying nasal packing, it is essential to consider the following:
- The packing should be applied by trained professionals, as this can impact the effectiveness of the treatment 5
- The duration of pack use and the economic effects of pack choice are areas where more research is needed 5
- There is no strong evidence to support prophylactic antibiotic use with nasal packing 5