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Nasal PackingAka: Anterior Nasal Hemorrhage Management, Epistaxis Management with Nasal Packing

See Also
1. Epistaxis
2. Posterior Nasal Hemorrhage Management
Indications
1. Epistaxis not controlled with basic measure
2. Recurrent Epistaxis
Complications of nasal packing
1. Septal Hematoma or abscess
  1. Avoid excessive trauma on nasal packing insertion
2. Septal pressure necrosis
  1. Avoid overly tight nasal packing
3. Risk of Sinusitis or toxic shock syndrome
  1. Apply Bactroban Topical Ointment in nares
  2. Oral antibiotic prophylaxis is usually not indicated
    1. Amoxicillin had been used in the past
    2. Derkay (1989) Arch Otolaryngol Head Neck Surg :
Local Anesthetic and Topical Decongestant
1. Lidocaine 2% and Phenylephrine 4% mix 1:1 on cotton
General
1. Use topical Bactroban in nares with packing
2. Remove non-absorbable nasal packs after 3-5 days
Nasal packing options
1. Vaseline Gauze pack or 0.5 x 72 inch strips
  1. Use Bayonet forceps with nasal speculum
  2. Layer (accordion-fold) from bottom to top
  3. Start each layer as far posterior as possible
  4. Press down each layer before inserting next one
2. Rocket pack (Rhino Rocket)
3. Absorbable Gelatin foam (Gelfoam)
4. Oxidized Cellulose (Surgicel)
5. Nasal tampon (Merocel or Doyle sponge)
  1. Easier to insert then other methods
  2. Gently insert along floor of nose
  3. Expand with saline or Phenylephrine
  4. Absorbable oxidized cellulose
    1. Effective for those on anticoagulants
    2. Do not need to be removed (will absorb)
Patient Instructions after nasal packing
1. Return for removal of non-absorbable packs in 3-5 days
2. Apply Bactroban Topical Ointment in nares
3. Home Instructions for those with Nasal packing
  1. Avoid vasodilating actions
    1. Physical exertion
    2. Spicy foods
    3. Alcohol
  2. Avoid Nasal manipulation or nose blowing
  3. Sneeze with mouth open
  4. Alleviate drying
    1. Saline Nasal Sprays several times per day
    2. Apply Bacitracin ointment qd to bid
    3. Vaseline does not appear effective in children
      1. Loughran (2004) Clin Otolaryngol 29:266

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 7/1/2009. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.