Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Epistaxis - Management
How should I perform nasal packing for acute epistaxis?

  • Consider nasal packing in primary care if:
    • Nasal cautery has been ineffective or the bleeding point cannot be seen, and
    • The appropriate expertise and facilities are available (good lighting, topical anaesthetic spray, and nasal speculum).
  • Anaesthetize the nasal cavity with topical local anaesthetic spray, preferably with a vasoconstrictor (such as lidocaine with phenylephrine — Co-phenylcaine®), if this has not already been done. Wait for 3–4 minutes for the full effect.
  • The decision concerning which product to use is based on availability, cost, and preference. The available products include:
    • Nasal tampons (for example Merocel®) — effective and easy to use.
    • Inflatable packs (for example Rapid-Rhino®) — effective, and may be more comfortable to insert and remove than nasal tampons. They may also be easier for the healthcare professional to use than nasal tampons.
    • Ribbon gauze impregnated with Vaseline® or bismuth-iodoform paraffin paste — packing with ribbon gauze is not recommended in primary care without specific training.
  • Insert the packing according to the manufacturers instructions.
    • Pack the person's nostril whilst they are sitting with their head tilted forwards and holding a receptacle allowing them to spit out blood, and breathing through their mouth.
    • Secure the pack (for example Merocel® packs have a string attached which can be taped to the cheek) and ensure there is no pressure on the cartilage around the nostril as this can cause a cosmetic defect.
    • Check the oropharynx for signs of bleeding from the back of the nose. If bleeding is seen, consider packing the other side to increase pressure on the bleeding vessel.
  • Admit the person to hospital for observation, preferably to an ear, nose, and throat ward.

© NHS Institute for Innovation and Improvement