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Nasal Packing

Nasal Packing

Definition

Nasal packing is the application of gauze or cotton packs to the nasal chambers.

Purpose

The most common purpose of nasal packing is to control bleeding following surgery to the septum or nasal reconstruction and to treat chronic nosebleeds. Packing is also used to provide support to the septum after surgery.

Description

Packing is the placement of gauze or cotton into the nasal area. Packing comes in three forms: gauze, cotton balls, and preformed cotton wedges. Packing is usually coated with antibiotics and, sometimes, petrolatum. The end of the nose may be taped to keep the packings in place or to prevent the patient from pulling them out. In cases of surgery, packings are frequently removed within 24-48 hours following surgery. In the case of nosebleeds, packing is left in for extended periods of time to promote healing and to prevent the patient from removing scar tissue which might reopen the wound. If both sides of the nose are packed, the patient must breathe through his or her mouth while the packs are in place.

In patients who are chronic nose pickers, frequent bleeding is common and ulceration of nasal tissue is possible. To promote healing and to prevent nose picking, both sides of the nose are packed with cotton that contains antibiotics. The nose is taped shut with surgical tape to prevent the packing from being removed. The packing is left in the nose for seven to 10 days. If the wound is high up in the nasal cavity, gauze strips treated with petrolatum and antibiotics are used. The strips are placed into the nose one layer at a time, folding one layer on top of the other until the area is completely packed.

Local packing is a procedure used when only a small part of the nose must be packed. Typically, this occurs when one blood vessel is prone to bleeding, and there is no need to block breathing through the nose. Local packing is used when the pack can remain in place by itself. This situation can be found at the turbinates. Turbinates are folds of tissue on the insides of the nose. The folds are sufficiently firm to support packing. A small piece of gauze or cotton is wedged in between the turbinates where the blood vessel being treated is located. Local packing is left in place for up to 48 hours and then removed. The main advantage to this type of packing is that it enables the patient to breathe through his or her nose. Local packing is also more comfortable than complete packing, although the patient will still experience a sensation that something is in the nasal cavity. The patient must be instructed not to interfere with or probe the packing while it is in place.

A postnasal pack is used to treat bleeding in the postnasal area. This is a difficult area to pack. Packs used in this area are made from cotton balls or gauze that have been tied into a tubular shape with heavy gauge suture or umbilical tape. Long lengths of suture or tape are left free. The lengths of suture or tape are used to help position the pack during installation and to remove it. An alternative is to cut a vaginal tampon and reposition the strings. Balloons have been tried as a method to replace postnasal packing, but have not proved effective. After being tied, the pack is soaked with an antibiotic ointment. Generally, packs are formed larger than needed, so that they completely block the nasal passage. A catheter is passed through the nose and pulled out through the mouth. Strings from one end of the pack are tied to the catheter and the pack pulled into place by passing through the mouth and up the back of the nasal cavity. The pack is removed in a similar manner. Complications may occur if a pack compresses the Eustachian tube, causing ear problems. The ear should be examined to ensure that infection is not developing.

Packing of the anterior (front) part of the nose is also performed following surgery such as septoplasty and rhinoplasty. In these operations, the surgeon cuts through the skin flap covering cartilage and bone in the center, top, and bottom of the nose to correct the shape of the nose. At the conclusion of the surgery, the skin flap is sutured back into place. The purposes of packing are to absorb any drainage from the incision and mucus produced by nasal tissue, and to support the skin flap and cartilage. The packing used is either gauze or preformed adsorbent wedges of cotton. Both are usually treated with antibiotic to reduce the chance of infections at the incision site. Generally, there is little bleeding following septoplasty and rhinoplasty, and the incisions heal normally. These packs are left in place for 24 to 48 hours and then removed.

Aftercare

Ice chips or mouthwash can be used to moisten the mouth while packing is in place, as the mouth may be dry from breathing through it. Humidifiers may also help with breathing. After nasal packing, the nose should not be blown for two to three days.

KEY TERMS

Turbinate Ridge-shaped cartilage or soft bony tissue inside the nose.

Ulcer A sore on the skin or mucous tissue that produces pus and in which tissue is destroyed.

Since one of the major reasons that packing is performed is to heal damage to nasal blood vessels from nose-picking, follow-up examination should be done to ensure that the patient is no longer practicing this habit. If the patient has restarted nose-picking, therapy to alter this behavior should be pursued. When the packing completely blocks the nasal cavity and prevents breathing through the nose, the patient should adjust to breathing through the mouth. In elderly patients, adjustment may be more difficult. This leads to a drop in the blood oxygen content and an increase in blood carbon dioxide levels (CO2). This, in turn, can cause respiratory and cardiac complications, including a racing pulse.

Risks

Nasal packing could cause a lack of oxygen in those who have difficulty breathing through their mouths. Rarely, sinus infection or middle ear infection may occur.

Resources

BOOKS

Bluestone, C. D., S. E. Stool, and M. A. Kenna. Pediatric Otolaryngology. Philadelphia: W. B. Saunders Co., 1996.

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