The introduction of tampons into the nasal cavity is used to stop nosebleeds. This condition can occur as a result of trauma, various systemic diseases, hematological diseases, the presence of neoplasms (for example, angiomas). Nasal bleeding is rarely perceived as a serious pathology - many episodes are stopped on their own or require simple measures carried out either by the patient himself or by people around him. However, there are options for severe bleeding, which are associated with the threat of significant blood loss. In this case, the patient needs emergency care, which consists in using sterile cotton balls or tamponing the mucous membrane using special turundas.
Tamponade method
Epistaxis can occur for a variety of reasons, but is not beneficial in all cases and should be stopped as soon as possible. There is a simple algorithm of actions regarding first aid that the patient can perform on his own. First of all, do not throw your head back - although this technique is most famous, it can do harm. The blood swallowed by the patient causes a deterioration in health, the appearance of nausea and vomiting. Therefore, the head is lowered forward, it is suggested to breathe through the nose with exhalation through the mouth. It is also practiced pressing the nasal wings with a finger, the introduction of cotton wool soaked in hydrogen peroxide or a vasoconstrictor drug (Xylometazoline, Oxymetazoline).
The above measures are sufficient for minor bleeding. It can be stopped with simple means and is not a major concern. But if the bleeding is profuse and for a long time, the patient's condition can worsen significantly. A person is really capable of losing a lot of blood during nosebleeds, since the nasal cavity has an extensive network of blood vessels. In this case, emergency measures to stop bleeding are necessary, among which the most accessible are various options for tamponade.
Tamponade of the nose is a method of mechanical stopping of bleeding. The essence of the manipulation is the introduction of tampons into the nasal cavity, which fit tightly to each other and do not allow bleeding to resume. What can tamponade achieve? The objectives are as follows:
- Pressing the bleeding vessels against the walls of the nasal cavity.
- Contributing to the acceleration of the formation of a blood clot.
What matters is the material used for the manipulation. The mesh structure of the gauze bandage is most favorable for the formation of a single blood clot. A white thrombus filling the cavity prevents a recurrence of the bleeding episode. A significant drawback is the duration of its formation - in order for the clot to be "high-quality", you need to wait from 1 to 3 days. All this time, the bandages are in the nasal cavity, and the patient is forced to breathe through his mouth. As a rule, it is recommended to leave tampons in the nose for no longer than 24 hours - a foreign body creates the prerequisites for the development of an infectious and inflammatory process. Repeated tamponades contribute to trauma to the mucous membrane and are unpleasant for the patient, therefore, alternative methods of dealing with bleeding after relief of the emergency should also be considered.
The tampon material must be sterile.
When stopping bleeding, only sterilized bandages should be used. Nose swabs are intended
for single use only.
Classification and preparation
There are two main types of tamponade:
- front;
- back.
Tamponade is carried out by a doctor or a trained paramedic in a hospital setting.
Performing tamponade is a medical manipulation. It can also be carried out by a paramedic (for example, working as part of an ambulance team). In this case, assistants are needed (paramedic, nurse, doctor). The patient cannot and should not independently insert tampons into the nose, this is fraught with the risk of injury. Posterior tamponade is performed by a specialist who knows the technique of intubation. This is due to the likelihood of airway obstruction.
Anterior nasal tamponade is used for massive bleeding from the anterior and middle sections. Gauze turundas are inserted into the nose through the nostrils. In the case of posterior tamponade, a tampon that closes the vessels must be inserted through the mouth using a special guide located in the nasal cavity.
How to make nose turundas? A gauze bandage is required, the width of which is about 3-4 cm. To obtain a blank for the turunda, you need to bend the edges of the bandage inward. A tape 1 cm wide is formed (widths of 1.5 and 2 cm are allowed). The length of the tape is up to 70 cm. It is sterilized, soaked in vaseline oil or antibacterial ointment before use. It is impossible to do nose turundas as separate tampons right away. Manipulation requires the use of a long gauze tape.
For anterior tamponade, you will need a tray, tweezers and scissors (they must be sterile), as well as a dressing (bandage, cotton wool), sterile napkins, hand sanitizer and gloves. For posterior tamponade - additionally a rubber catheter, gauze swab, silk threads, plaster, liquid paraffin, dressing material.
Anterior and posterior nasal tamponade is a painful procedure. To reduce the severity of discomfort and eliminate pain, local anesthetics are used (in particular, Lidocaine).
If there is an allergy, the patient should be informed of this prior to the procedure.
Sometimes the use of sedative (anti-anxiety) drugs is required. If posterior tamponade is indicated, intubation anesthesia is considered.
Algorithm for manipulation
Stages of anterior tamponade:
- Cleansing the nasal cavity. Blood clots that are in the nasal cavity must be carefully removed. If necessary, the patient spits blood into a special tray.
- Anesthesia. For the purpose of anesthesia, the nasal mucosa is irrigated with a local anesthetic solution.
- Filling the nasal cavity. The tampon is taken with tweezers, while the free end is about 4 cm. It is left outside so that you can later remove the gauze bandage. They begin to insert the tape into the nostril, introducing it into the nasal cavity with gentle movements, round by round. It is necessary to advance the tampon to the posterior part, so the first round is inserted all the way, the next are laid out with an "accordion". Tamponade is continued until the cavity is densely filled. Repeat the manipulation for the other nostril.
After the tamponade is done, a sling-like dressing is applied. For this, a wide bandage is taken, from which 4 free ends are cut off, and a strip of fabric is left in the middle. This strip covers the nose, and the cut ribbons are tied in pairs at the back of the head, passing them above and below the ears.
The posterior nasal tamponade is also carried out in stages. A guidewire, which is a rubber catheter lubricated with vaseline oil, is inserted into the nasal cavity and out through the mouth. A pre-prepared tampon is tied with silk threads (about 40 cm long) and tightly attached to the catheter. Two threads are inserted together with a tampon, one is left outside. The tampon is advanced by pulling on the free end of the catheter.Once the tampon reaches the desired anatomical area, the doctor controls its position with his finger.
The posterior tamponade is combined with the anterior one. When the posterior tamponade is in position, the assistant holds the sutures, and the doctor performs the anterior tamponade, completing the procedure with a sling bandage.
