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Nasal pack removal

Nasal packing is the application of sterile tampons to the nasal chambers.

The most common purpose of nasal packing is to control bleeding and provide support to the septum following surgery and nasal reconstruction. It is also used to treat chronic nosebleeds (Stool et al 1996).

The nasal packing is made out of synthetic open cell foam polymer of hydroxylated polyvinyl acetal.

The surface is smooth so it can not stick to the tissue and reduces bacterial growth. The nasal packs are stitched together at the end of the nose. They can hold 25 times their initial weight (Martelli 2002).

Background

As both nostrils are packed, the nasal cavity is completely blocked, preventing the patient breathing through their nose. Therefore, the patient must adjust to breathing through the mouth (Martelli 2002).

Nasal packing could cause a lack of oxygen in those who have difficulty breathing through their mouth. Also, very rarely sinus infections and middle ear infection can occur (Stool et al 1996).

Nasal packs should be removed within 24-48 hours post-op, or when the doctor states.

Preparation

Inform the child, if they are old enough to understand, and their family that you are going to remove the nasal packs. Answer any questions they may have about the procedure (Rationale 1, 2, 3 and 4).

Administer analgesia one hour before procedure.

Prior to the procedure put on apron and wash your hands (Rationale 5).

Gather the following equipment in order to prepare to remove the nasal packs using the clean technique:

  • clean blue tray
  • saline
  • syringe
  • stitch cutter
  • clean gauze
  • clean forceps
Wash hands after and apply gloves.

Procedure

Check the patient's name band and inform them of every step (Rationale 6).

Soak the packs with saline using the syringe to soften them.

Using the stitch cutters, cut the one stitch between the two nasal packs.

Using the forceps, grip the nasal pack and gently but firmly, pull one out then the other.

If necessary, use gauze to lightly clean the nose of any old ooze.

Following the procedure

Monitor the nose for two hours after for bleeding. Maintain patient in an upright position.

Dispose of stitch cutter in sharps bin and all other waste in a yellow bin.

Wash hands and document in nursing notes (Rationale 7).

The nose should not be blown for two to three days.

Inform parents about applying pressure if the nose begins to re-bleed at home.

Rationale

Rationale 1: To obtain verbal consent for the procedure.
Rationale 2: To obtain their co-operation if old enough.
Rationale 3: To allay any worries they may have.
Rationale 4: To address their information needs.
Rationale 5: To minimise the risk of cross infection.
Rationale 6: To ensure the correct child.
Rationale 7: To maintain an accurate record.

References

Reference 1:
Martelli ME (2002) Gate Encyclopedia of Nursing and Allied Health. Detriot, The Gate Group Inc.

Reference 2:
Stool SE, Kenna MA (1996) Pediatric Otalaryngology. Philadelphia, Sanders Co.

Document control information

Lead author(s)

Sarah Carmichael, Sister, Dinosaur Ward

Document owner
Sarah Carmichael, Sister, Dinosaur Ward

Approved by
Guideline Approval Group

First introduced: 10 August 2009
Date approved:
10 July 2014
Review schedule: Three years
Next review: 
10 July 2017 
Document version:
1.2
Replaces version:
N/A