ear, nose, and throat disorders
How To Treat Anterior Epistaxis With Nasal Packing
Equipment for Treating Anterior Epistaxis With Packing
Gloves, mask, and gown Gown or drapes for patient Suction source and Frazier-tip and/or other suction-tip catheters Nasal packing device or material* Emesis basin Chair with headrest or an ear, nose, and throat (ENT) specialist's chair Light source and head mirror or headlamp with adjustable narrow beam Nasal speculum Tongue depressors Bayonet forceps Scissors for cutting nasal gauze or sponges Antibiotic ointment (bacitracin) 5-mL sterile saline solution Topical anesthetic/vasoconstrictor mixture (eg, 4%cocaine, 1%tetracaineor 4%lidocaineplus 0.5%oxymetazoline) or topical vasoconstrictor alone (eg, 0.5%oxymetazolinespray) Cotton swabs or pledgets * There are several types of nasal packing materials/devices divided into the following resorbable and nonresorbable options: Resorbable packing Gelatinthrombinhemostatic matrix Carboxymethylcellulose compounds Oxidized regenerated cellulose Synthetic polyurethane sponge Chitosan-containing polymers Nonresorbable packing Polyvinyl acetate sponge (sometimes with an internal airway tube), ideally with removal strings that can be secured to the patient's cheek to prevent aspiration and aid removal High-volume, low-pressure inflatable ballon with carboxymethylcellulose fabric cover One or two balloon catheters 1.25 cm (½-inch) petrolatum gauze strip Resorbable packing is associated with less discomfort than nonresorbable packing. Placement instructions vary for the different types of resorbable packing; follow the manufacturer's instructions. Use of resorbable packing is recommended in patients with bleeding disorders, those on antithrombotic medications, and in those with vascular malformations (eg, hereditary hemorrhagic telangiectasia) to avoid potential mucosal trauma and re-bleeding associated with the removal of nonresorbable packing. Nonresorbable nasal sponges are highly compressed for ease of insertion and expand and become soft when hydrated. Nasal sponges and inflatable balloon packing are easier to insert and cause less discomfort than petrolatum gauze strips and are, therefore, preferred when available. Some types of inflatable balloon packing have a carboxymethylcellulose outer fabric that facilitates insertion and removal, which reduces patient discomfort. Insertion of a petrolatum gauze strip is uncomfortable and often requires some analgesia and/or mild sedation (however, not enough to risk airway compromise). Thus, this procedure should be done only when other methods fail or are not available. 