Procedure in which a packing appropriate to the anatomical region is placed to control nosebleeds that do not stop despite compression, cold application, and local vasoconstrictors.
Indication
- Nosebleed that does not stop within 15-20 minutes of compression and local vasoconstrictor spray
- Anterior epistaxis (originating from Little's area / Kiesselbach's plexus, the front region) — the most common type
- Posterior epistaxis (originating from the sphenopalatine artery, the back region) — more severe, with swallowing of blood and a hemoptysis-like presentation
- Persistent bleeding in patients on anticoagulant or antiplatelet medications
- Bleeding developing on the background of uncontrolled hypertension
- Bleeding after nasal trauma or surgery
- Recurrent epistaxis in patients with hereditary bleeding disorders (HHT, von Willebrand, etc.)
Preparation
- Rapid clinical evaluation: pulse, blood pressure, amount of bleeding
- Inquiry about blood thinners in use and accompanying conditions (hypertension, liver disease)
- The patient is seated upright with the head tilted slightly forward to prevent aspiration of swallowed blood
- The anterior nasal region (soft part) is compressed continuously with the fingers for 10-15 minutes
- A spray or pack containing local anesthetic and vasoconstrictor is applied
How it's performed
- Anterior packing: an absorbent pack, dissolvable gel/sponge, or inflatable balloon pack is placed in the front region of the nose; this is the most commonly preferred method
- If a suspicious source is identified, cauterization (silver nitrate or electrocautery) is used to seal small vessels and stop the bleeding
- Posterior packing: if anterior packing is insufficient, a special double-balloon pack or traditional posterior pack is placed for the back region
- Patients with posterior packing are admitted for monitoring of respiration, oxygen levels, and arrhythmia
- Concurrent medical therapy is arranged if hypertension or a bleeding disorder is present
- Endoscopic vessel ligation or angiographic embolization is considered in resistant cases
Post-procedure
- Anterior packing is generally kept in place for 24-72 hours and removed in the outpatient clinic
- Patients with posterior packing are observed in inpatient settings; the pack is removed after 2-3 days
- Antibiotic prophylaxis may be considered while packing is in place (to prevent toxic shock syndrome)
- After pack removal, moisturizing ointment and saline spray are recommended for a period
- In recurrent bleeding, underlying causes (hypertension, medications, hematologic) are investigated
Risks
- Re-bleeding when the pack is removed
- Local mucosal injury, ulceration, and septal perforation (with prolonged packing)
- Pain around the nose, headache, and a sense of transient obstruction
- Hypoxia, arrhythmia, and exacerbation of sleep apnea with posterior packing (especially in older patients)
- Toxic shock syndrome — rare; high fever, rash, hypotension
- Sinusitis and middle ear inflammation (eustachian tube obstruction)
FAQ
What should I do when my nose is bleeding?
Sit upright calmly, tilt your head slightly forward (do not tilt back), and pinch the soft tip of the nose (the alae) with your fingers continuously for 10-15 minutes. You may apply a cold compress to the neck and forehead. Go to the emergency department if the bleeding does not stop or is very heavy.
How long does the packing stay in place and when is it removed?
Anterior packs are generally kept for 24-72 hours. Dissolvable types resorb on their own; classic packs are removed in the outpatient clinic by a physician. Posterior packs are kept under inpatient observation for 2-3 days.
How should I eat and move while the pack is in place?
Soft foods are preferred and very hot drinks should be avoided. Strenuous exercise, bending over, hot showers, and nose-picking are not recommended. Consult your physician for blood thinner use; regular follow-up is important if you have hypertension.
Why does my nose keep bleeding?
Frequently recurring epistaxis can be related to dry air, septal irritation, allergic rhinitis, hypertension, anticoagulant use, or bleeding disorders. A detailed ENT evaluation and, if necessary, a hematologic workup is appropriate.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Septoplasty
Otorhinolaryngology (ENT)
Septoplasty (deviated septum surgery) — surgical correction of a deviated nasal septum.
Nasal Polyp Surgery
Otorhinolaryngology (ENT)
Nasal polyp surgery — endoscopic removal of nasal polyps using the FESS technique.
Nasal Aspiration
Otorhinolaryngology (ENT)
Nasal aspiration — controlled suction clearance of nasal secretions, especially in infants and young children.
Endoscopic Sinus Surgery
Otorhinolaryngology (ENT)
Endoscopic sinus surgery (FESS) — minimally invasive endoscopic technique for chronic sinusitis and nasal polyp treatment.
Allergy test
Otorhinolaryngology (ENT)
Allergy test (ENT) — detection of sensitivity to inhalant allergens through skin prick testing.
Sleep apnea evaluation and treatment
Otorhinolaryngology (ENT)
Sleep apnea evaluation and treatment — assessment of snoring and breathing pauses during sleep from an ENT perspective.
Rhinoplasty
Surgical Outpatient Services
Rhinoplasty — surgical correction of functional and structural deformities of the nose.
Tonsillectomy
Otorhinolaryngology (ENT)
Tonsillectomy (tonsil surgery) — surgical removal of the tonsils.