If you are given non-resorbable packing packing that does not dissolve , leaving the packing in past the time recommended by your healthcare provider can cause possible complications. It is important to stick to the exact follow-up directions from your healthcare provider.
Packing is a foreign object that can allow the growth of bacteria in the nose. There is a low risk of infection spreading to the nose and sinuses or, in extremely rare cases, throughout the body. The packing also provides pressure inside the nose. This may lower blood flow to areas of the nose and result in injury. Septal perforations hole in the partition dividing the right and left nasal cavity and scarring in the nasal cavity can form after the packing is removed.
If the packing is held with clips at the nasal opening, pressure sores of the outside skin can form over time and result in scarring. Packing blocks airflow into the nose, making it harder to breathe through your nose, and can interrupt sleep at night, which can contribute to or worsen obstructive sleep apnea. In some cases, your healthcare provider will prescribe oral antibiotics if the risk for infection is high.
Antibiotics, while generally safe, do have some risks, including allergic reactions and gastrointestinal stomach problems. You should discuss the risks and benefits of antibiotics with your healthcare provider.
Keeping the nose and packing moist with nasal saline saltwater sprays throughout the day can reduce dry crusting and help resorbable packing melt away. If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Important Phone Numbers. When should you call for help? Where can you learn more? Top of the page. Your Care Instructions After a nose injury or surgery, gauze is packed high up into the nose.
How can you care for yourself at home? Avoid strenuous activities for 1 week or until your doctor says it is okay. These include bicycle riding, jogging, weight lifting, and aerobic exercise. You may drive when you are no longer taking prescription pain pills and feel up to it. Do not take aspirin, medicines that contain aspirin, or anti-inflammatory medicines such as ibuprofen Advil, Motrin or naproxen Aleve for 3 weeks after surgery unless your doctor says it is okay. If the doctor gave you a prescription medicine for pain, take it as prescribed.
For bleeding that is likely to require more aggressive treatment, a local anesthetic, such as a 4 percent cocaine solution or tetracaine or lidocaine Xylocaine solution, should be used. Adequate anesthesia should be obtained before treatment proceeds. Intravenous access should be obtained in difficult cases, especially when anxiolytic medications are to be used. Cotton pledgets soaked in vasoconstrictor and anesthetic should be placed in the anterior nasal cavity, and direct pressure should be applied at both sides of the nose for at least five minutes.
Then the pledgets can be removed for reinspection of the bleeding site. If this measure is unsuccessful, chemical cautery can be attempted using a silver nitrate stick applied directly to the bleeding site for approximately 30 seconds. Larger vessels generally respond more readily to electrocautery. However, electrocautery must be performed cautiously to avoid excessive destruction of healthy surrounding tissues.
Note that use of electrocautery on both sides of the septum may increase the risk of septal perforation. If local treatments fail to stop anterior bleeding, the anterior nasal cavity should be packed, from posterior to anterior, with ribbon gauze impregnated with petroleum jelly or polymyxin B-bacitracin zinc-neomycin Neosporin ointment. Nonadherent gauze impregnated with petroleum jelly and 3 percent bismuth tribromophenate Xeroform also works well for this purpose.
Each layer should be pressed down firmly before the next layer is inserted Figure 3. Packing of the anterior nasal cavity using gauze strip impregnated with petroleum jelly. Gauze is gripped with bayonet forceps and inserted into the anterior nasal cavity. With a nasal speculum not shown used for exposure, the first packing layer is inserted along the floor of the anterior nasal cavity. Forceps and speculum then are withdrawn. Additional layers of packing are added in an accordion-fold fashion, with the nasal speculum used to hold the positioned layers down while a new layer is inserted.
Packing is continued until the anterior nasal cavity is filled. Alternatively, a preformed nasal tampon Merocel or Doyle sponge may be used. Application of lubricant jelly to the tip of the tampon facilitates placement. After the nasal tampon has been inserted, wetting it with a small amount of topical vasoconstrictor may hasten effectiveness. It may be necessary to drip saline into the nostril to achieve full expansion of the tampon if the bleeding has decreased at the time of insertion.
Although one study 15 found no significant difference in patient comfort or efficacy with nasal tampons or ribbon gauze packing, simplicity of placement makes the tampons highly useful in primary care settings. When applied in the outpatient setting, nasal packing may be left in place for three to five days to ensure formation of an adequate clot. Complications of nasal packing procedures include septal hematomas and abscesses from traumatic packing, sinusitis, neurogenic syncope during packing, and pressure necrosis secondary to excessively tight packing.
Posterior bleeding is much less common than anterior bleeding 16 and usually is treated by an otolaryngologist. Posterior packing may be accomplished by passing a catheter through one nostril or both nostrils , through the nasopharynx, and out the mouth Figure 4. A gauze pack then is secured to the end of the catheter and positioned in the posterior nasopharynx by pulling back on the catheter until the pack is seated in the posterior choana, sealing the posterior nasal passage and applying pressure to the site of the posterior bleeding.
Posterior nasal packing. After adequate anesthesia has been obtained, a catheter is passed through the affected nostril and through the nasopharynx, and drawn out the mouth with the aid of ring forceps. A gauze pack is secured to the end of the catheter using umbilical tape or suture material, with long tails left to protrude from the mouth. The gauze pack is guided through the mouth and around the soft palate using a combination of careful traction on the catheter and pushing with a gloved finger.
The gauze pack should come to rest in the posterior nasal cavity. It is secured in position by maintaining tension on the catheter with a padded clamp or firm gauze roll placed anterior to the nostril. Various balloon systems are effective for managing posterior bleeding and are less complicated than the packing procedure.
The double-balloon device Figure 2 is passed into the affected nostril under topical anesthesia until it reaches the nasopharynx. The posterior balloon then is inflated with 7 to 10 mL of saline, and the catheter extending out of the nostril is withdrawn carefully so that the balloon seats in the posterior nasal cavity to tamponade the bleeding source.
Next, the anterior balloon is inflated with roughly 15 to 30 mL of saline in the anterior nasal cavity to prevent retrograde travel of the posterior balloon and subsequent airway obstruction. An umbilical clamp or other device can be placed across the stalk of the balloon adjacent to the nostril to further prevent dislodgement; the clamp should be padded to prevent pressure necrosis of the nasal skin. Balloon packs generally are left in place for two to five days. As with anterior packing, tissue necrosis can occur if a posterior pack is inserted improperly or balloons are overinflated.
If a specialized balloon device is not available, a Foley catheter 10 to 14 French with a mL balloon may be used. The catheter is inserted through the bleeding nostril and visualized in the oropharynx before inflation of the balloon. The balloon should seat in the posterior nasal cavity and tamponade a posterior bleed. With traction maintained on the catheter, the anterior nasal cavity then is packed as previously described.
Traction is maintained by placing an umbilical clamp on the catheter beyond the nostrils, which should be padded to prevent soft tissue damage. As with anterior epistaxis, topical antistaphylococcal antibiotic ointment may be used to prevent toxic shock syndrome.
However, use of oral or intravenous antibiotics for posterior nasal packing most likely is unnecessary. Patients with anterior or posterior bleeding that continues despite packing or balloon procedures may require treatment by an otolaryngologist.
Endoscopy may be used to locate the exact site of bleeding for direct cauterization. Yes No Tell us more. Check all that apply. Wrong topic—not what I was looking for. It was hard to understand. It didn't answer any of my questions. I still don't know what to do next. All rights reserved.
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