Introduction
Nasal packing is a critical intervention for controlling epistaxis (nosebleeds), especially when first-line measures like direct pressure or cautery fail.
It is one of the most common emergency procedures used for managing patients with epistaxis nonoperatively.
Definition
Nasal packing refers to the placement of an intranasal device/absorbent material that applies constant pressure to the nasal septum to control bleeding.
Purposes
- To control bleeding following septal/nasal surgery.
- To treat acute/chronic nosebleeds (epistaxis).
Types
- Anterior nasal packing.
- Posterior nasal packing.
Indications
- Suspected epistaxis.
- Bleeding from bilateral nares.
- Hemoptysis or hematemesis.
- Failure of bilateral anterior nasal packing.
Contraindications
- Skull base fracture.
- Nasal bone or maxillofacial trauma.
- Septal deviation.
- Hemodynamic instability
- Cardiopulmonary instability.
Articles
| Articles | Purpose |
| Personal protective equipment | To prevent contamination. |
| Headlamp or light source | To visualize clearly. |
| Kidney tray | To dispose of medical waste. |
| Nasal speculum | To examine the nose. |
| Tongue depressor | To examine the throat. |
| Suction canister | To store secretion or fluids removed from the body. |
| Frazier suction tip | To remove tissue during suctioning. |
| Yankauer suction tip | To prevent aspiration. |
| Bayonet forceps | To lift the tissue. |
| Foley’s catheter (10-14 Fr) | To collect the drain from posterior epistaxis. |
| Umbilical cord clamp | To secure the pack. |
| Nasal tampon | To absorb bleeding. |
| Topical anesthetic (4% lidocaine) | To promote loss of sensation. |
| Sterile water | To administer the medication. |
| Normal saline | To prevent dehydration. |
| 10-mL syringe | To administer the medication. |
| Lubricant jelly | To provide lubrication and reduce discomfort. |
| Sterile gauze pack | To cleanse the site by means of absorbing. |
| Cotton ball | To clean bleeding. |
| Cardiac monitor | To check vital parameters. |
| Pulse oximeter | To check oxygen level in blood. |
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Allays anxiety and obtains cooperation from the patient. |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence.Prevents litigation of the staff. |
| 3. | Wash hands with antiseptic solution. | To prevent cross-infection. |
| Anterior nasal packing procedure | ||
| 4. | Position the patient in a comfortable sitting upright position. | General preparation before the procedure. |
| 5. | Hydrate the nasal pack before insertion. | To avoid irritation of nasal mucosa. |
| 6. | Insert the nasal pack slowly through the right nostril. | To avoid bleeding. |
| 7. | Inflate the nasal pack balloon with air using syringe (add enough air). | To apply pressure at the site of bleeding. |
| 8. | Secure the nasal pack around the cheek with tape. | To prevent displacement. |
| 9. | Instruct the patient not to remove the nasal pack (1-5 days). | Aids in healing process. |
| 10. | Instruct the patient to maintain the same position for 10-15 minutes. | To enhance comfort. |
| 11. | Replace the articles and document the procedure. | Serves as legal evidence and prevents duplication of care. |
| 12. | Repeat the above-mentioned steps (1-11) for the left nostril also. | |
| Posterior nasal packing procedure | ||
| 13. | Instruct the patient to be in NPO for 5 hours. | To prevent nausea. |
| 14. | Position the patient in a comfortable sitting upright position. | General preparation before the procedure. |
| 15. | Wash hands and wear sterile gloves. | To prevent infection. |
| 16. | Anesthetize the right nostril with 0.5-mL lidocaine (soaked in gauze). | To relieve pain. |
| 17. | While placing the tongue depressor over the tongue, a lubricated catheter is inserted into the right nostril with the dominant hand. | To visualize the catheter tip in the back of throat. |
| 18. | Inflate the balloon with 10 mL of sterile water. | To secure the tubing. |
| 19. | Withdraw the balloon gently. | To position it firmly in the posterior cavity. |
| 20. | Pack the anterior nasal cavity with a balloon or layered ribbon gauze. | To absorb bleeding. |
| 21. | Secure the Foley’s catheter with an umbilical clip (or tubing clamp) at the nostril. | To prevent the catheter slipping back. |
| 22. | Place a roll of gauze or other padding between the clamp and the skin of the nose. | To prevent pressure necrosis. |
| 23. | The catheter should be secured to the patient’s face with tap. | To prevent dislodging. |
| 24. | Repeat the above-mentioned steps (1-11) for the left nostril also. | |
| 25. | Replace the articles and document the procedure. | Serves as legal evidence and prevents duplication of care. |
Special Considerations
- Monitor closely for airway compromise
- Increased risk of mucosal injury, aspiration, or vagal response
- Monitor for bradycardia or hypotension
- Coordinate with haematology for reversal agents or transfusion
- Packing may need to stay longer; monitor for rebleeding
- Consider prophylactic antibiotics for non-absorbable packing left >24–48 hours
- Educate patients to avoid nose blowing, straining, or heavy lifting
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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