Failure of Anterior Nasal Packing

Failure of an anterior nasal pack to stop epistaxis is most likely due to bleeding arising from the posterior nasal cavity.

In this situation, a variety of management options are available, including endoscopy with cauterisation, ligation of the sphenopalatine artery and posterior packing.

The further management of posterior epistaxis is the province of the Otolaryngology department. If there is likely to be a significant delay before specialist input or the patients haemodynamic status is deteriorating, then Foley catheters can be used as a temporary solution in the ED. Size 12 or 14 gauge catheters should be advanced one at a time through the nostril, along the floor of the nose into the nasopharynx, until seen in the pharynx. Each balloon should be inflated with 5-10 ml water and gentle traction applied.

Learning bite

Insertion of Foley catheters to stop uncontrolled posterior bleeding is a technique of last resort when immediate specialist help is unavailable.