Nasal Packing

If first aid measures and attempts at cautery are unsuccessful or there is bilateral bleeding, then the nose should be packed.

Traditional ribbon gauze soaked in BIPP (Bismuth Iodoform Paraffin Paste) packing has been superseded by the development of nasal tampons.

There are two main types:

• Compressed sponge (e.g. Merocel, Rhino Rocket)
• Inflatable balloon tampon (e.g. Rapid Rhino)

There are two sizes of Rapid rhio nasal packs i.e. 5.5cm and 7.5 cm. Immerse in saline or distilled water before insertion and for all anterior nasal packs, try to place them as horizontally as possible to prevent misplacement. For rapid rhino inject air to the amount either tolerated or cause haemostasis as too much air instillation could lead to more patients’ discomfort as well as could lead to pack trauma. For Merosel packs, ideally apply antiseptic cream like Naseptin before the insertion and once inserted, instil few mls of saline or distilled water for the pack to expand. Secure the threads of Merosel or tube end of rapid rhino with tape applied on to nose or face.

Make sure to re-examine the oropharynx after the nasal pack for blood diversion or poster epistaxis.

These are shown in the image below.

The Merocel pack is as effective and comfortable as a traditional ribbon gauze but the Merocel pack is far easier to insert.

Research has shown the Rapid Rhino to be as effective in controlling the epistaxis as a compressed sponge tampon, but less painful to insert and easier to remove.

After an anterior pack has been placed, it is important to observe the patient for a minimum of 30 minutes, to check that no further leakage occurs, either from the nose or posteriorly into the pharynx.

Learning bite

When packing the anterior nose, inflatable balloon tampons (e.g. Rapid Rhino) are the least painful to insert and easiest to remove.