Nasal packing is a medical procedure involving the insertion of material into the nasal passages. It is used to manage various conditions, primarily to control bleeding or provide internal support.
Understanding Nasal Packing
Nasal packing involves placing materials inside the nasal cavity to apply pressure and absorb fluids. Various materials are used, including gauze, compressed sponges, and inflatable balloons. Some packing materials are coated with substances like petrolatum or antibiotics to aid in healing and prevent infection. These materials function by directly compressing blood vessels and absorbing blood and other discharge.
Different types of packing are available, each with specific properties. For instance, compressed sponges like Merocel are designed to expand upon contact with moisture, filling the nasal cavity and exerting pressure. Inflatable balloon tampons, such as Rapid Rhino, also expand to apply pressure and may incorporate materials like carboxymethylcellulose, which can help facilitate platelet aggregation. Some packing materials are dissolvable, meaning they resorb over time and do not require physical removal, reducing potential discomfort.
Reasons for Nasal Packing
Nasal packing is commonly employed for significant nasal bleeding, known as epistaxis. It is considered when simpler methods, such as direct pressure or cauterization, have not stopped the bleeding. This procedure is used for severe or persistent nosebleeds, especially when the bleeding site is not clearly visible or easily controlled.
Beyond managing active bleeding, nasal packing also serves a role following nasal surgeries. Procedures like septoplasty, rhinoplasty, or sinus surgery can benefit from packing to stabilize internal tissues, reduce post-operative bleeding, and absorb drainage. The packing provides internal support to the nasal septum and other structures.
The Nasal Packing Process
Before inserting nasal packing, healthcare providers prepare the patient by positioning them upright, often in a sniffing position. They may apply a topical anesthetic and vasoconstrictor to the nasal passages. This helps to numb the area and reduce initial bleeding, making the insertion more tolerable. Any existing blood clots are cleared to allow for better visualization of the nasal cavity.
The insertion technique varies depending on the type of packing material. For instance, compressed sponges are lubricated and gently advanced horizontally along the nasal floor, expanding once moistened. Balloon catheters are inserted and then carefully inflated to apply pressure. Patients can expect some discomfort or pressure during insertion, and breathing through the nose will be obstructed, necessitating mouth breathing.
Aftercare and Removal
Aftercare is important for individuals with nasal packing to ensure healing and prevent complications. Patients are advised to avoid strenuous activities, heavy lifting, and bending over for about a week to prevent increased blood flow to the nose. It is also recommended to avoid blowing the nose forcefully and to sneeze with an open mouth to minimize pressure on the packed area. Pain management involves non-aspirin pain relievers, as certain medications can increase bleeding risk.
The duration the packing remains in place varies, but it is for a few days, up to five days, depending on the reason for insertion and the material type. Dissolvable packing does not require removal, but non-dissolvable types are removed by a healthcare professional. Removal involves gentle traction on the packing material, sometimes after moistening it to ease the process. Patients may experience some discomfort, pressure, or a brief nosebleed during removal, but this is temporary. After removal, mild swelling or continued discharge can occur, and saline nasal washes are recommended to keep the nasal passages clear and moist for recovery.