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Nasal Packing - Purpose, Requirements, Types, and Complications

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Nasal packing means the placement of various types of materials in the nasal cavity to stop bleeding. Read this article for more information.

Published At December 27, 2022
Reviewed AtFebruary 1, 2023

Introduction:

Nosebleeds, also called epistaxis is a very common condition, and almost 60 percent of people worldwide will have at least one nosebleed in their lifetime. Nosebleeds are common because of the position of the nose and the presence of blood vessels in the lining of the nose. Most nosebleeds are not serious and can be managed at home. However, in cases where medical assistance is required, a nasal packing can be done to stop the bleeding, which is done by a medical professional.

Nasal packing means blocking the nose with a restorative material to stop the bleeding, such as gauze, foam, or cotton. In nasal packing, individual gauze strips or cotton pledgets are packed in the nose to form a plug. This may be coated with petroleum gel, antibiotics, or agents that help clot formation.

What Are the Causes of Nose Bleed?

The causes of nose bleeding include -

Local Causes -

  • Chronic sinusitis.

  • Nose picking (epistaxis digitorum).

  • Foreign bodies.

  • Trauma.

  • Intranasal neoplasm or polyps.

  • Medications such as topical corticosteroids.

  • Rhinitis (inflammation of the mucous membrane of the nose).

  • Irritants such as cigarette smoke.

  • Nasal septal deviation or perforation.

Systemic Causes -

  • Hemophilia (a bleeding disorder in which blood does not clot).

  • Hypertension.

  • Leukemia.

  • Liver disease such as cirrhosis (liver scarring due to alcohol drinking).

  • Thrombocytopenia (low level of platelets).

What Are the Types of Nose Bleeding?

Nose bleeding is of two types, based on the location of the bleeding, which includes -

  1. Anterior Epistaxis - This type of nose bleeding starts in the front of the nose on the lower part of the wall that separates the two sides of the nose. This area of the nose consists of small blood vessels and capillaries, which are fragile and can break easily and bleed. This is the most common type of nosebleed commonly seen in children. However, it is not that serious and can be treated at home.

  2. Posterior Epistaxis - This type of nosebleed occurs deep inside the nose, and the bleeding is caused due to the larger blood vessels in the posterior region of the nose. The posterior nosebleeds are more serious than the anterior and may result in heavy bleeding. Medical attention is required in case of heavy blood flow, and this type of nose bleeding is most commonly seen in adults.

What Is the Purpose of Nasal Packing?

Nasal packing can be anterior or posterior, depending on the location of the bleeding. The nasal packing helps in the following ways, which include -

  • Apply pressure and fill preformed spaces.

  • Function as a barrier.

  • Provide hemostasis after nose bleeding or surgery.

  • Provide support for the nasal structures.

  • The packs are used after nasal surgeries and are left for longer to prevent nose stenosis.

What Are the Requirements of Nasal Packing?

Following are the characteristics required for the nasal packs, which include the -

  • Non-toxic.

  • Non-allergic.

  • Easily placed and removed.

  • Painless.

  • Non-dislocating.

  • Helps in hemostasis and wound healing.

  • Apply uniform pressure to the membranes.

  • Ensure breathing.

  • Preserve smell.

What Are the Methods Used for Nasal Packing?

There are various types of packing available, which include -

Foley Catheter and Gelatin and Thrombin Matrix Combination -

The Foley catheter is commonly used for posterior epistaxis to tamponade the bleeding. The catheter is inserted into the posterior nasal cavity after administering topical anesthesia. It has a balloon at its tip, which is inflated at the region of bleeding in the nose with five milliliters of sterile water or saline.

Gelatin-thrombin matrix can also be used along with it, as the mixture is put on the balloon, inserted into the nasopharynx, and gets applied to the bleeding area, which helps in cessation of the bleeding.

Absorbable Packing -

  • Surgical - It is a packing of oxidized cellulose polymer (polyanhydroglucuronic acid) placed in the anterior region for anterior nasal bleeding. This packing gets reabsorbed within one to two weeks and has to change accordingly.

  • Nanopore - It is a biodegradable, synthetic foam. This can be cut into appropriate sizes and shapes with the help of scissors. This will expand on exposure to fluid and be inserted into the nasal cavity with the help of an endoscope or bayonets, depending on the location and condition.

  • Floral or SurgiFlo - It is a hemostatic matrix (bovine gelatin- human thrombin matrix) of highly dense gel which adheres to irregular and moist surfaces like nasal sinuses. Applying this requires a mixing period and must be placed and held over the wound for appropriate clotting. It gets reabsorbed after six to eight weeks.

Temporary Packing - These packings can be placed for some duration and must be removed after some time. The duration can vary from two to five days and should include antibiotic prophylaxis to prevent infection. If the patient bleeds again, packing can be done again after removing the first one. However, even after the second packing, if the bleeding does not stop, a surgical procedure may have to be done to control the bleeding.

  • Strip Gauze and Lamb’s Wool - This can be used in emergency conditions to control bleeding. These materials are a little bulky and may require the cooperation of the patient.

  • Merocel - It is a polyvinyl alcohol sponge that is firm when dry and expands as it absorbs liquid. It can be cut into different sizes, and the original size may help in easy passage through the nasal canal, but when it gets wet, expansion can occur, and then it cannot be repositioned. A tape is attached to the cheek (pre-attached to the pack) to prevent any further migration of the pack posteriorly and also helps in the easy removal of the pack.

  • Rhino Rocket - It is a medical-grade expandable sponge with a disposable plastic applicator for positioning. A safety string is pre-attached to the pack and taped to the cheek to prevent posterior migration and assist in easy removal from the nasal cavity.

  • Rapid Rhino - This device comes in different sizes, such as unilateral 4.5 cm, 5.5 cm (for anterior), 7.5 cm (anterior or posterior), and bilateral 7.5 cm versions. These contain a balloon surrounded by hydrocolloid coating. The coating helps in easy insertion and removal and also helps in hemostasis. The balloon puts pressure on the nasal vessels, which helps prevent bleeding. Before insertion, the device must be soaked in sterile water, and the balloon must be taped to the cheek for easy removal and maintaining the positioning.

What Are the Complications of Nasal Packing?

Some of the complications that can occur with nasal packing include -

  • Pain on insertion or removal.

  • Failure to achieve hemostasis.

  • Dislodgement and airway obstruction.

  • Sinusitis (infection of sinuses).

  • Rebleeding on removal.

  • Otitis media (middle ear infection) due to eustachian tube obstruction.

  • Toxic shock syndrome (a life-threatening complication of bacterial infection).

  • Nasal alar necrosis (a rare condition that leads to cosmetic defects).

  • Aspiration.

Conclusion:

Nasal packing is an effective method to stop epistaxis. A trained physician usually does it, and the patient is kept under observation through regular checkups to prevent complications. The packing can be left for an extended period to promote healing.

Frequently Asked Questions

1.

What Consequences May Follow Nasal Surgery?

The following are the potential risks connected to rhinoplasty.
- Breathing through the nose is difficult.
- Numbness that lasts forever in the nose and surrounding area.
- The potential for a nose that seems uneven.
- Possible long-lasting pain, discoloration, or edema.
- Scarring.
- There is a gap between the left and right nostrils in the wall.

2.

What Are the Top 3 Reasons for Nosebleeds?

The common causes of nosebleeds include
- Picking the nose.
- Firmly blowing the nose.
- A somewhat mild nasal damage.
- The inside of the nose becomes dry and cracked due to temperature or humidity fluctuations.

3.

What Does a Nasal Pack Make Of?

Compressed hydroxylating polyvinyl acetate (PVA), which expands when in contact with liquid, makes these nasal packs. Antibiotic ointment and viscous lidocaine can be used on the pack to lubricate it for comfort.

4.

Which Antibiotic Is Applied to the Nasal Packing?

Most epistaxis patients with nasal packs do not need systemic prophylactic antibiotics. Topical antibiotics like Naseptin may be more suitable, affordable, and equally effective. Many doctors regularly employ antibiotic prophylaxis with nasal packing to prevent problems, such as infection.

5.

Is Nasal Packing a Type of surgery?

Nasal packing is not a standard surgical procedure. It is a medical technique to stop nose bleeding or offer assistance following nasal surgery. Nasal packing involves inserting various nasal packs into the nasal canal to pressure bleeding blood vessels, encourage clotting, and stop additional bleeding. Nasal packs can be made of gauze, sponges, or balloons.

6.

How Can Nose Packing Be Removed?

A healthcare practitioner carefully and delicately removes nasal packing. If necessary, they wet the packing before carefully removing it from the nasal canal while keeping an eye on your comfort and any potential bleeding. Post-removal guidelines are given for the best possible healing.

7.

Is Packing of the Nose Necessary?

In some circumstances, packing the nose is required to stop bleeding, promote recovery after nasal surgery, or treat specific medical disorders. It can support the fragile nasal tissues during healing, prevent future bleeding, and offer stability. However, depending on the unique situation, a medical practitioner will decide whether nasal packing is required based on the patient's demands and condition.

8.

How Do Nurses Take Care of Nasal Packing?

In some circumstances, packing the nose is required to stop bleeding, promote recovery after nasal surgery, or treat specific medical disorders. It can support the fragile nasal tissues during healing, prevent future bleeding, and offer stability. However, depending on the unique situation, a medical practitioner will decide whether nasal packing is required based on the patient's demands and condition.

9.

How Should Nasal Packing Be Inserted?

A medical professional usually inserts nasal packing. They use sterile tools to carefully place the packing material into the nasal cavity to reduce bleeding, promote healing, or treat particular medical disorders. The packing material must be carefully moved into the proper position to ensure patient comfort. Depending on the packing style and the patient's health, the insertion procedure may change, but it is always carried out with care and accuracy.

10.

When Should Nasal Packing Be Removed?

Once the nasal packing serves its purpose, it is often removed. The purpose of packing, the patient's condition, and the healthcare provider's advice all affect when to remove items. For instance, packing used to control bleeding may be removed after the hemorrhage is under control. However, packing used to provide post-surgery support may be taken out following a specific healing period. A medical expert will evaluate the situation and choose the best time for a safe and pleasant packing removal.

11.

What Components Make Up the Nose?

Various essential parts make up the nose. The nasal bones, cartilage, and soft tissues that give the nose its outward shape make up this portion. The septum (dividing wall), turbinates (bony structures that aid in air filtration and humidification), and mucous membranes make up the nasal cavity internally. Breathing is made more accessible, air is filtered, and the sensation of scent is provided by these elements working together.

12.

Why Does Nose Bleed All at Once?

Nasal injuries, hard blowing, dry air, nose picking, or even underlying medical issues like high blood pressure or bleeding disorders can all cause nosebleeds. The tiny blood arteries inside the nose have the potential to burst, releasing large amounts of blood quickly. If nosebleeds occur regularly, seeking medical attention to determine and treat the underlying cause is advisable.

13.

How Should Nose Bleeding Be Treated?

These actions should be taken to address a nosebleed:
- Stay Calm: Remain composed by sitting up straight and leaning slightly forward to stop blood from running down your mouth.
- Pinch the Nostrils: Take the thumb and index finger, and for around 10 minutes, pinch the nostrils together, keeping the pressure constant.
- Apply Ice: Place an ice pack or cold compress over the nose and cheeks to tighten blood vessels.
- Reduce Irritants: Avoid bending over, blowing your nose, or sticking anything into your nostrils.

14.

Can Stress Lead to Nasal Bleeding?

Nasal hemorrhage can sometimes be caused by stress. Stress can increase blood pressure, weakening the already vulnerable blood vessels in the nasal passages and increasing the risk of a rupture. Stress can also alter blood flow and blood clotting processes, which increases the chance of nosebleeds. The risk of stress-related nose bleeding can be reduced by maintaining stress-reduction strategies and general well-being.
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Dr. Syed Peerzada Tehmid Ul Haque
Dr. Syed Peerzada Tehmid Ul Haque

Otolaryngology (E.N.T)

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