- Materials
- Ribbon gauze soaked in bismuth iodoform paraffin paste (BIPP) or antibiotic ointment
- Alternatively, use a balloon tamponade device (e.g. posterior nasal balloon (Rapid Rhino) or Foley catheter)
- Nasal speculum and bayonet forceps
- Technique (gauze method)
- Gently pass a lubricated gauze pack or specially prepared posterior pack along the nasal floor using forceps
- The pack should pass all the way into the choana to tamponade the posterior nasal cavity
- Layer additional gauze strips anteriorly until the nasal cavity is filled
- Secure with an external bolster (e.g. tape across the nostrils)
- Consider placing a pack on the contralateral side if bleeding persists
- Alternative: balloon method
- Foley
- Insert a 10–14 Fr Foley catheter gently along the floor of the nasal cavity until visible in the oropharynx
- Inflate balloon with 5–10 mL of saline
- Gently retract balloon until it rests against the posterior choana
- Clamp and secure the catheter externally with a bolster
- Add anterior nasal packing if needed to support the posterior pack
- Rapid Rhino
- Lubricate
- Run along floor of nose
- Inflate
- Combination
- Can use both a Foley and RR with foley more posterior
