II. Epidemiology: Study of 88 episodes of posterior Epistaxis
- Etiologies
- Hypertension
- Aspirin or Coumadin
- Prior history of Epistaxis
- Re-bleeding
- Associated with removal nasal pack under 48 hours
III. General
- Consult with otolaryngology
- Posterior bleeding is much more serious than anterior
- Significant blood loss can result
IV. Preparation
- Apply Topical Anesthetic and Decongestant to mucosa
V. Management: Tamponade techniques
- Posterior Nasal Packing
- Usually performed by otolaryngology
- Double balloon device
- Apply Bactroban ointment to catheter
- Insert device completely into nare
- Posterior balloon inflated with 7-10 cc saline
- Withdraw catheter until posterior balloon seats
- Balloon stops at posterior nasal cavity
- Anterior balloon inflated with 15-30 cc saline
- Apply padded umbilical clamp across catheter
- Prevents balloon from dislodging
- Leave balloons in place for 2-5 days
-
Foley Catheter (10 to 14 french with 30 cc balloon)
- Apply Bactroban ointment to catheter
- Insert catheter into nostril
- Visualize catheter tip in back of throat
- Inflate balloon with 10 cc saline (not 30 cc!)
- Withdraw balloon gently until seats posteriorly
- Pack anterior nasal cavity
- See Anterior Nasal Packing
- Apply padded umbilical clamp across catheter
- Prevents balloon from dislodging
VI. Management: Persistent Bleeding despite packing
- Consult Otolaryngology
- Nasal Packing assistance
- Possible surgical intervention (uncommon)
- Consult Intervention Radiology
- Embolization (preferred over surgical intervention)