How is posterior nasal packing performed in the treatment of epistaxis (nosebleed)?

Updated: May 08, 2020
  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
  • Print
Answer

Epistaxis that cannot be controlled by anterior packing can be managed with posterior packing. Classically, rolled gauzes are used, but medium tonsil sponges can be substituted.

Recently, inflatable balloon devices (eg, 12 or 14 French Foley catheters) or specially designed catheters manufactured by companies such as Storz and Xomed (eg, Storz Epistaxis Catheter, Xomed Treace Nasal Post Pac) have become popular because they are easier to place. Avoiding overinflation of the balloon is important because it can cause pain and displacement of the soft palate inferiorly, interfering with swallowing.

A 2010 study by Garcia Callejo et al determined that gauze packing, despite being slower and more uncomfortable, has a higher success rate, produces fewer local injuries, and costs less than inflatable balloon packing. [22]

Regardless of the type of posterior pack used, an anterior pack should also be placed. Admit all patients with posterior packing to the intensive care unit (ICU) for close monitoring of oxygenation, fluid status, and pain control. An antibiotic should also be given to prevent rhinosinusitis and possible toxic shock syndrome.

Also see Posterior Epistaxis Nasal Pack.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!