Rapid Rhino and NasoPore Nasal packing

Rapid Rhino Nasal Packing

• remove the pack from its sleeve
• place it in a bowl of sterile water for 30 sec (not saline - it inactivates the coating) until the white coating goes translucent
• do not leave in the water too long as the coating will fall off
• with your non-dominant hand, push up on the tip of the nose to see into the bleeding nostril
• the space you are aiming for is medial and inferior; you should insert the pack against the septum and aiming in the same plane as the ear lobe
• in one motion, push the pack into the nose
• the outer tip of the pack should sit next to the tip of the nose
• attach a syringe full of air and inflate until the pilot cuff is firm with some bounce
• there is no set number of mls of air; the pilot cuff is your guide
• be wary that every time you attach a syringe to the Luer connection you open the valve - you may inadvertently deflate the pack so always double-check the pressure in the pilot cuff.

Rapid Rhino nasal pack insertion video link

NasoPore Nasal Packing

This is a dissolvable nasal packing that is stored in the fridge.

It can be cut/torn into pieces to help with placement.

It can be soaked in 1 ml 1/1000 Adrenaline mixed with 10 mls 2% Lidocaine and inserted with forceps.

It is not as good at stopping bleeding in severe epistaxis but is helpful in certain conditions

Consider when

• coagulopathy that can not be reversed e.g. low platelets, metallic heart valve
• bleeding source seen but ongoing ooze despite cautery
• high risk of re-bleed due to coagulation status or history