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May 26, 2012

How Does Nasal Packing Stop Nosebleeds?

It is not unusual for an ENT or an Emergency Room physician to see a patient with a very bad nosebleed... the kind that can potentially be life-threatening given how much active bleeding is occurring.

In these situations, nasal packing is the fastest and best way of stopping the nosebleed.

For any type of active bleeding, direct pressure tamponades the bleeding thereby stopping it... whether it be a stab wound to the leg or a bad nosebleed. In essence, direct pressure exerts a certain amount of pressure that exceeds the blood pressure preventing blood flow. The corollary being if the amount of direct pressure being exerted is LESS than the blood pressure, bleeding will still occur.

With nasal packing, pressure is exerted by the packing material and pressed against whatever the bleeding source is within the nose.

My personal favorite packing material is called the rapid rhino made by Arthrocare (I have no financial ties to the company). It is in essence a balloon covered by a bio-compatible self-lubricating fabric. This device is inserted into the nose in a deflated state. 
Once fully inserted into the nose, it is than inflated using a standard syringe. Enough air is inflated into the device such that the pressure exerted by the balloon exceeds the blood pressure of the vessels within the nose.

The key point here is that enough pressure must be exerted by the balloon device. If the patient's blood pressure exceeds the balloon pressure, bleeding will still occur and MORE air must be pushed in. As such, in patients with high blood pressure, more air must be inflated into the balloon device to stop a nosebleed compared to a patient with low blood pressure.


So, here is what it looks like to insert a rapid rhino nasal packing.

Step 1: After hydrating the fabric, the nasal packing is placed at entrance of nose.


Step 2: Nasal packing is fully inserted into the nasal cavity.


Step 3: The nasal packing balloon is than inflated with enough air pressure to stop the nosebleed.


Obviously, blood pressure must also be controlled and the nasal packing can be removed in about 3 days for patients not taking any blood thinners or anti-coagulants (coumadin, plavix, ticlid, pradaxa, aspirin, ibuprofen, etc). For those on such medications, packing may need to be kept in place longer.

For more information about nosebleeds.

Watch a video regarding how cauterization can stop nosebleeds.


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

9 comments:

  1. Want happen if packing comes out bin less than 24 hours

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  2. Believe me, that packing is NOT coming out. It must be removed! I had that thing and it was horrible and it didn't budge. I had to get it removed by a ear, nose and throat specialist.

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  3. Thank you. I had a patient return from ER today with 2 of these in. I had never seen them before. Your article was very helpful.

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  4. Is it normal for blood and fluid to seep out around a nasal balloon? I had one inserted at the emergency room on Sunday, July 6th and I am to have it removed on Wednesday. I took a shower and then noticed that dark red blood was seeping out around the bottom of the nasal balloon. Does this mean I won't be able to get this out on Wednesday like planned? It was so painful! My face and teeth just ache! I slipped and fell on the ice outside of my office in February and hit my head. I had a bad concussion. Two weeks later, I started to have nose bleeds. I am 59 and never have had one before. Now I was getting 3-5 a day and they were very hard to stop. Most of the time I could stop them within 20 minutes but the one that I got on Sunday wouldn't stop so I called 911 for help. They couldn't stop it and I ended up in the ER with this vial thing up my nose! No one will listen to me when I tell them that something happened in the fall that has caused this. I saw my VA doctor and she sent me to the ENT before this bad bleed on Sunday. The ENT doctor cauterized some spots but couldn't see where the rest was coming from and felt it was posterior. I was to start my only vacation for the year on Monday. Now, I have lost three days to this incident. What can I say to the doctors to get them to pay attention to this? There has to be a reason that a 59 year old woman who has never had nose bleeds to all of a sudden to have them after falling and hitting her head on the ice. I need some advise on what to do. I can't take much more of this nasal balloon. It just hurts too much? Is Ultram OK to take for the pain? All I have taken is Tylenol and it hasn't helped the pain at all.

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  5. Freedancer, I know that you left your message 2 years ago but I just want to say that I empathize with you completely. Just had this device inserted today at the ER for a nosebleed that wouldn't stop. There is a constant slight drip of watery blood. And in the 2nd hour after application the pain kicked in to where my teeth are hurting - just like you. They gave me Tramadol but I'm scared to use it after reading all of the warnings. The worst thing is that the ER doctor said that the packing could be removed in 2-3 days but every doctor is telling me that their policy is 4-5 days. And since this is a Tuesday that means that I've got to wait through the weekend until next Monday. That will be 6 full days. :-( I may try calling around to see if any doctors will remove it earlier. Can't see living like this for a week.

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  6. I'm wondering what the outcome was for both of you? I've had it since Fri. Have had kids with no epidural and this at least ties on the discomfort scale. Seeing the ENT tomorrow.

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  7. Mine is slowly coming out? It's sticking out further then it was when they put it in so,uncomfortable is it bad if it comes out

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  8. I have a nasal pack in at the moment from waking up Saturday with a bad nosebleed for the first time ever. This thing is so annoying and uncomfortable,cant sleep can barely eat mouth is so dry from breathing with it lol. ARRRRGGGG. The stupid strings are itching my face. Seeing a ENT tomorrow for removal.

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  9. Currently have nasal pack in past 48 hours. Had a bad nosebleeed went to ER. The thing is really annoying hard to sleep and eat very uncomfortable seeing ENT tomorrow hopefully for removal.

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