Nasal packing

Use if nose bleed won’t stop with simpler treatments

Anterior nasal packing

Attention

  • Do not pack both nostrils without medical consult — can cause fatal arrhythmias
  • Monitor person closely during and after nasal packing — see Nose bleeds (epistaxis)
  • Ask person to look straight ahead — tilting head back will make nasal cavity harder to see
  • If using a commercial product, follow the instructions and seek help if unsure

Merocel nasal packing

Can use for both anterior and posterior epistaxis

What you need

  • 10% local anaesthetic spray or phenylephrine-lidocaine (phenylephrine-lignocaine) spray
  • Merocel nasal tampons pack
    • Anterior epistaxis — 8cm pack or 10cm pack trimmed to size with scissors
    • Posterior epistaxis — 10cm pack
  • Normal saline

What you do

  • Ask person to gently blow nose — clear out clots
  • Spray topical anaesthetic up affected nostril
  • Refer to product instructions to prepare and insert
  • Once inserted check in mouth for blood trickling down back of throat

To remove

  • Merocel nasal packing should be removed after 24–72 hours
  • Wet end of pack with 10mL of normal saline or water
  • Leave for 5 minutes
  • Gently pull out with forceps

RapidRhino nasal packing

What you need

  • 10% local anaesthetic spray or phenylephrine-lidocaine (phenylephrine-lignocaine) spray
  • RapidRhino nasal tamponade-balloon device — choose correct length for potential bleed site
  • Sterile water in sterile bowl
  • 20mL syringe
  • Tape

What you do

  • Ask person to gently blow nose — clear out clots
  • Spray topical anaesthetic up affected nostril
  • Refer to product instructions to prepare and insert
  • Tape the protruding end of device to cheek
  • Once inserted check in mouth for blood trickling down back of throat

To remove

  • RapidRhino should be removed after 24–72 hours
  • Deflate cuff and gently remove — monitor for further bleeding for 30 minutes

Gauze anterior nasal packing

Attention

  • Hard to do properly — get help if you are not sure

What you need

  • Prepared nasal pack (if available)

OR

  • 10% local anaesthetic spray or phenylephrine-lidocaine (phenylephrine-lignocaine) spray
  • 1cm x 20cm sterile gauze soaked in white petrolatum jelly (eg Vasoline)
  • Nasal-packing forceps
  • Clean scissors — for cutting gauze
  • Paper tape

What you do

  • Ask person to gently blow nose - clear out clots
  • Spray topical anaesthetic up affected nostril
  • Leave end of gauze outside nostril
  • Use forceps to gently put soaked gauze as far as possible into nasal cavity and layer it back and forth until nostril completely packed — Figure 8.49

Figure 8.49   
  • Leave at least last 3cms of gauze outside nose
  • Cut off any extra gauze and tape both ends to face
  • Check in mouth for blood trickling down back of throat
  • If bleeding still won’t stop — only if experienced consider doing posterior nasal packing 
  • Remove after 24–72 hours

Posterior nasal packing

Balloon catheter

Attention

  • If person having trouble breathing — give oxygen to target O2 sats 94–98% OR if moderate/severe COPD 88–92% 
  • Person will need sedation before this procedure
  • Medical consult if trauma/suspected base of skull fracture

What you need

  • 10% local anaesthetic spray or phenylephrine-lidocaine (phenylephrine-lignocaine) spray
  • Water based lubricant
  • Small retaining catheter — no. 12 or 14 with 30mL balloon
  • 10mL syringe
  • 1cm gauze — Vaseline or vas-gauze pack
  • Clean scissors (for cutting gauze)
  • Tape

What you do

  • Ask person to gently blow nose — clear out clots
  • Spray topical anaesthetic up affected nostril
  • Measure half way point between nasal septum and tragus of ear
  • Lubricate tip of catheter
  • Put in in straight direction along floor of nasal cavity towards ear lobe — to half way point
  • Keep mouth open, you MUST be able to see the TIP of catheter in back of throat BEFORE inflating balloon
    • Inflate with 3mL air and pull catheter forward until it ‘catches’ in the back of the nose
    • Then inflate with up to 10 mL air, stopping when it gets too uncomfortable — Figure 8.50
  • Gently pull catheter until resistance felt

Figure 8.50   
  • Put in gauze nasal pack
  • Hold ends of gauze and catheter in place just outside nostril with tape or clamp (eg umbilical cord clamp). Cut off extra gauze, secure ends to face.
  • Put piece of gauze between nose and clamp to keep catheter taut and prevent pressure sore
  • If bleeding continues — take out catheter, try in other nostril
  • Remove after 24–72 hours