Anterior and posterior tamponade of the nose: indications and procedure description

Tamponade of the nose is used in traumatology and otorhinolaryngology to stop nasal bleeding of various etiologies. And if the front tamponade is a fairly frequent procedure, then the back is done only by the "elected". Those who do not want blood to stop under any pretext, or those whose damage is more serious than it seems at first glance.

Nose bleed

Nasal is called bleeding from the nasal cavity, when fluid flows through the nostrils to the face, or through the choana on the back wall of the pharynx. There are two types of bleeding: the front and back. In some cases, the blood enters the nasolacrimal canal (due to the suction effect) and flows through the orbit. This can be misleading eyewitnesses of this phenomenon and doctors who provide first aid.

Fresh blood and its clots can get through the esophagus into the stomach, causing a feeling of nausea or even vomiting. Very rarely nosebleeds can result in death. In the literature mentions the leader Attila, who drowned his blood in a dream on the wedding night.

Tamponade of the nose is needed to stop nasal bleeding. Perhaps the loss of fluid while this and a small, but the presence of complications makes this state urgent.

Causes

The choice of procedure (the front or back tamponade of the nose is required for the patient) depends on which vessels are damaged. This is the only criterion. But there are a lot of factors that can provoke bleeding. They are divided into local and system.

Local include:

• Trauma to the nose;
• Foreign bodies;
• Inflammation and swelling of nasal mucosa.

These are the three most common factors that cause nasal bleeding. There are also more exotic:

• Anatomical deformities;
• Inhalation of drugs;
• Oncological processes in the nasal cavity;
• Cold and dry air;
• Abuse of drops from the common cold;
• Barotrauma and surgical intervention.

The systemic factors include allergies, a constant increase in blood pressure, the presence of colds. In addition, bleeding from the nose is possible as a result of taking non-steroidal anti-inflammatory drugs, drinking alcohol, having problems with the clotting system, deficiency of vitamins K and C, systemic autoimmune diseases.

Pathophysiology

In order to open bleeding, you need to damage the wall of the vessel. The nasal mucosa is very well vascularized, so even a small application of force is enough to allow blood to flow.

Most often, nosebleeds occur in children under 10 years of age and in people older than sixty, as a rule, in men.

Against the background of high blood pressure, bleeding occurs spontaneously and can be long enough if no timely measures are taken. In the elderly, the mucosa is so thin that even basic hygienic procedures can provoke a rupture of the vessel.

In 95% of cases, the source of bleeding is the anterior section of the nasal septum. There is the so-called Kisselbach Plexus. There are also "signaling" bleedings. They are characterized by spontaneity, short duration and abundance. These episodes can be caused by damage to a large vessel on the face, rupture of an aneurysm or a disintegrating tumor.

Anterior tamponade of the nose

Anterior tamponade of the nose with bleeding is used most often. Such "love" of physicians for this procedure is caused by the fact that in the vast majority of cases the anterior vessels of the nasal cavity are damaged, and there is no need for other methods.

As a rule, such bleeding is not an independent disease. They are just symptoms of more global changes in the body. Therefore, with frequent recurrent bleeding, you need to think about what other changes have occurred in your health and whether there is a reason to look to the doctor.

Etiology

There are traumatic causes of bleeding. They include traumas of any origin, including surgical interventions. And also there are symptomatic reasons that are associated with manifestations of systemic diseases in the anatomical integrity of the nose.

In women, there are concomitant (ie, going simultaneously with menstruation) and vicarious (ie, menstrual replacement) bleeding. The mechanism of their formation has not been sufficiently studied.

Anyway, whatever the reasons for the appearance of blood from the nasal passages, it is necessary to stop its expiration.

Methods of stopping bleeding from the nose

To date, there are many ways to stop bleeding. The choice depends on the massiveness and the reason for this state. Not necessarily as the main method should be used tamponade of the nose. The algorithm for stopping bleeding consists of the following stages:

1. Detect bleeding.
2. Determine its cause.
3. Identify the damaged vessel.
4. Stop bleeding in the most convenient and fastest way.
5. Monitor the patient's condition.

Self-management of mild nasal bleeding can be done in the following ways:

1. Tamponade of the nose. The technique is simple: in the lumen of the nasal conch shell is put a cotton or gauze swab impregnated with 3% hydrogen peroxide.

2. Pre-moisten the cotton turundum in the vasoconstrictor drops, and then insert into the nasal passage, from which the blood flows.

3. Ask the patient to take a deep breath in his nose, exhale through the mouth and at the same time put the ice on the bridge of the nose and neck.

During any of the procedures, the patient should sit or occupy a semi-sitting position, and head forward. This is to ensure that the blood does not flow into the back of the pharynx into the stomach.

Front Tamponade Technique

If all of the above methods are ineffective, an anterior tamponade of the nose is performed. Its technique is quite simple in execution. First and foremost, the doctor should do local anesthesia of the nasal cavity with a solution of lidocaine or novocaine (having preliminarily conducted allergic tests, of course). Then the doctor injects into the bleeding course a sterile gauze moistened with a hemostatic drug or a vaseline ointment. The length of the gauze can be about seventy centimeters, but the width is only one and a half. Turundu is laid in the form of an accordion so that the nasal cavity is completely filled.

Such a tampon is left almost for three days, and after this period is removed. With particularly severe bleeding, gauze can be left for seven days, but in this case it must be moistened with solutions of antibiotics and aminocaproic acid.

Reasons for a posterior tamponade

Anterior tamponade of the nose may not produce the expected results. Or the source of bleeding may be further than originally thought. In such cases, a more laborious but effective method is used.

The posterior tamponade of the nose is performed to stop nasal bleeding if:

1. The patient had a direct stroke in the nose area or a foreign body got into the nasal passage.
2. If bleeding is caused by a prolonged course of rhinitis or sinusitis.
3. In cases where high systemic blood pressure does not allow the walls of the vessel to fall off and prevents the formation of a thrombus.
4. The cause of bleeding is a decaying tumor.
5. The patient has blood diseases.

Technique for performing a tamponade of the nose

Perform this manipulation is able only trained specialist, do not try to do self-medication at home. In addition to a doctor, two or even three people take part in this action. One of them is needed in order to maintain the correct position of the patient's head. The second feeds tampons and helps to fix them, and the third prepares new sterile tampons if necessary.

Before starting the procedure, the patient is administered any sedative to relax it and reduce the gag reflex. Then into the oral cavity a soft catheter, smeared with sterile vaseline oil, is inserted through the nose. By the end of this tube attached gauze tampon of the appropriate size. There are three strands on the tampon: two fix them on the catheter, and one remains in the mouth, and then is attached to the cheek with a band-aid. The next step is removal of the catheter through the nose. At the same time, the tampon is pressed against the hoan and completely closes the nasopharynx. After this, make the front tamponade and tie the remaining two threads in front. Remove the swab in two to three days.

Complications

Tamponade of the nasal cavity, like any other manipulation, can cause complications. Among them, such phenomena as necrosis of the nasal mucosa. This is due to prolonged compression of blood vessels and nerves during the exposure of turunda. The second problem can be an exacerbation or development of purulent diseases of the sinuses of the nose (sinusitis, sinusitis), since blood and gauze are a good environment for the reproduction of bacteria.

In difficult cases, posterior tamponade can lead to deformation of the nose and nasal septum. In addition, therapy may result in the formation of a hematoma or septic fusion of the septum due to the attachment of a secondary infection.