Nasal packing is a medical intervention used to control severe or persistent bleeding from the nose, a condition known as epistaxis. The procedure involves carefully placing specialized materials inside the nasal cavity to apply direct mechanical pressure to the source of the bleeding. This pressure helps the body form a stable blood clot, ultimately stopping the flow of blood. It serves as a temporary measure to manage a bleed that cannot be controlled through less invasive means.
Why Nasal Packing is Required
Nasal packing is indicated when standard first-aid techniques, such as pinching the nose and leaning forward, have failed to halt the bleeding. It is also necessary when a bleed is too severe or originates from an area that is difficult to visualize and treat directly. While direct cauterization using chemicals like silver nitrate is often the next step, packing becomes the required intervention if cauterization proves unsuccessful or if the bleeding is too brisk to allow a clear view of the source. The procedure is reserved for cases of persistent epistaxis where the precise location of the bleeding vessel cannot be easily identified or controlled.
The Different Methods of Packing
The specific technique and material used for nasal packing depend primarily on where the bleeding originates within the nasal cavity. Nosebleeds are generally categorized as anterior, meaning they are closer to the front of the nose, or posterior, originating deeper inside the nasal passages. Anterior bleeds, which account for the majority of cases, typically come from the Kiesselbach’s plexus, a network of vessels on the front part of the nasal septum.
Anterior Packing
Anterior packing is the most common method and is aimed at stopping bleeding in the front nasal cavity. Materials used include pre-fabricated nasal tampons made of polyvinyl alcohol (PVA), which expand upon contact with blood or saline to provide pressure. Another common material is the inflatable balloon catheter, which is inflated with air or water after insertion, offering adjustable pressure. Traditional non-absorbable packing, involving petroleum jelly-impregnated gauze strips, is still used but is less common than modern expanding or inflatable products.
Posterior Packing
Posterior packing is a more complex procedure reserved for severe bleeding that originates deeper in the nasal cavity. This type of bleeding is less common but can be more serious and often requires hospitalization for monitoring. The goal is to block the posterior opening of the nasal cavity, the choana, to prevent blood from flowing down the throat.
Devices for posterior packing often utilize specialized balloon-based systems, sometimes including adapted Foley catheters, inflated to seat firmly in the back of the nasal cavity. A posterior pack is almost always accompanied by an anterior pack to fully seal the area and provide comprehensive pressure. Due to the increased complexity and potential for complications, posterior packing often requires consultation with an ear, nose, and throat (ENT) specialist.
What to Expect During and After Treatment
The insertion of nasal packing can be uncomfortable, and patients often experience a sensation of pressure within the nose and face, even after topical anesthetics have been applied. Since the packing material obstructs airflow, the patient must breathe through their mouth while the pack is in place, often leading to a feeling similar to a severe cold. Pain is typically managed with analgesics after the procedure.
Non-absorbable packing materials, such as tampons or gauze, are usually left in place for 24 to 72 hours to ensure the bleeding has fully stopped. Patients must return to a medical facility for removal, as this process requires careful technique to prevent re-bleeding. Absorbable packing materials, such as certain foams or gels, dissolve naturally, eliminating the need for a follow-up removal procedure.
Post-procedure care includes being aware of potential complications. The pack acts as a foreign body and can increase the risk of infection, including Toxic Shock Syndrome (TSS). Patients with non-absorbable packing may be prescribed prophylactic antibiotics for the duration the pack is in place. Other side effects include watery eyes, as the pack can temporarily block the tear duct drain, and a temporary alteration in the sense of smell and taste.