Nasal packing in epistaxis

Used when cautery fails to stop bleeding or if the bleeding point cannot be seen (1).

It can be divided according to the bleeding site into anterior or posterior nasal packing

• anterior nasal packing
  • packed, from posterior to anterior (2)
  • available products include
    • nasal tampons
      • easy to insert and requires minimal training
      • effective in 85% of patients
      • success rates are similar to traditional ribbon gauze (1)
    • inflatable pack - easier for both the patient and physicians to insert and remove (3)
    • ribbon gauze
      • available as Vaseline or bismuth-iodoform paraffin paste impregnated packs
      • nasal cavity should be anaesthetized before insertion under direct vision (1)
        • ongoing bleeding should be checked from contralateral nares or posteriorly after packing and if bleeding is present consider packing of the other side to increase pressure over the septum (1)
        • packs are usually left for 1-3 days
• posterior nasal packing
  • used in patients who continue to bleed despite an anterior nasal pack
  • is difficult to treat and requires specific training and usually done by an otolaryngologist (2)
  • inflatable balloons or traditional posterior packs with cotton gauze (may require general anaesthesia) can be used If the packs are left in for more than 48 hours topical antibiotic ointments (which coats the nasal packing) or oral antibiotics are given due to the risk of developing toxic shock syndrome (2)

Reference:

• 1. Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. 2005;81(955):309-14
• 2. Kucik CJ, Clenney T. Management of epistaxis. American Family Physician 2005; 71(2): 305-11
• 3. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. 2009;360(8):784-9
• 4. Leong SC, Roe RJ, Karkanevatos A. No frills management of epistaxis. Emerg Med J. 2005;22(7):470-2