Nasal tamponade
In case of severe nosebleeds, it is not possible to stop them by introducing a cotton ball or gauze. In such cases, they resort to tamponade, which, depending on the part of the nose, can be anterior or posterior.
Anterior tamponade
Anterior nasal packing is used quite often. To achieve the analgesic effect, the mucous membrane is first lubricated with a topical anesthetic. This could be a solution of dicaine, lidocaine, etc.
There are several techniques for performing the procedure, but the generally accepted one is loop method according to Mikulicz.
The basis is a gauze turunda about one and a half centimeters wide. Its length varies from 60 to 70 cm. The necessary components also include cranked tweezers and hemostatic paste. In some cases, turundas are impregnated with indifferent ointment (levomekol, petroleum jelly, etc. are used).
Anterior nasal packing
Loop packing is carried out from the vestibule of the nose to the choanae. The tampon is placed in the form of an accordion until the half of the nose from which blood flows is completely filled. In case of bilateral bleeding, tamponade of the second half is carried out in the same way. Removal of tampons begins with preliminary impregnation with a weak solution of hydrogen peroxide and usually occurs on the third day. Resumption of bleeding is a reason to leave the tampon on for six days. During this period, it is soaked daily with a solution of penicillin, etc.
Along with gauze turundas, sterilized tampons are also used for anterior tamponade, with which the nasal cavity is tightly filled. They are distinguished by their effectiveness and are considered more gentle.
Posterior tamponade
In case of severe bleeding, when the volume of blood loss reaches 1 liter or more, posterior nasal tamponade is performed. To do this, use special tampons that are pre-sterilized. They are made from gauze, folded in several layers in the form of a bale, and tied with silk threads crosswise. Their length is approximately 20 cm. After dressing, three ends remain free, and one is cut off. The size of such a tampon is calculated individually.
Posterior packing consists of several stages:
- First, a rubber catheter is inserted into the bleeding half of the nose until it exits into the middle part of the pharynx.
- After this, using Hartmann’s pharyngeal forceps (can be replaced with ordinary tweezers), the catheter is removed through the oral cavity to the outside, where a tampon is tied to it with two threads.
- The tampon fixed in this way is passed behind the soft palate and pressed against the choana. The ends of the threads are brought out through the nose.
- At the end of the manipulations, anterior tamponade is performed. The final step is to tie the threads over a gauze roller.
The installed swab is subsequently removed using a Kocher clamp if the end of the third thread has been cut. Sometimes the thread is left and attached with a plaster to the cheek. Removal usually occurs within 3-4 days. Severe clinical cases require tamponade of both choanae, which is carried out in a similar way. It is also possible to produce a larger tampon designed to obstruct the entire nasopharyngeal cavity. It is removed no earlier than after a week. To avoid the development of otitis media due to impaired drainage of the auditory tubes, tampons are impregnated with an antibiotic solution. After nasal tamponade, a course of antibiotic therapy is often prescribed.
You can make an appointment with an otolaryngologist at the Prima Medica clinic by calling +7 495 120-01-07. You can check prices here.