Traditional (Vaseline gauze) packing:
This traditional method of anterior nasal packing has been supplanted by readily available and more easily placed tampons and balloons. It is commonly performed incorrectly, using an insufficient amount of packing placed primarily in the anterior naris. Placed in this way, the gauze serves as a plug rather than as a hemostatic pack. Physicians inexperienced in proper placement of a gauze pack should use a nasal tampon or balloon. The proper technique for placement of a gauze pack is as follows:
Grasp the gauze ribbon, about 6 inches from its end, with bayonet forceps. Place it in the nasal cavity as far back as possible, ensuring that the free end protrudes from the nose. On the first pass, the gauze is pressed onto the floor of nasopharynx with closed bayonets.
Next, grasp the ribbon about 4-5 inches from the nasal alae and reposition the nasal speculum so that the lower blade holds the ribbon against lower border of nasal alae. Bring a second strip into the nose and press downward.
Continue this process, layering the gauze from inferior to superior until the naris is completely packed. Both ends of ribbon must protrude from the naris and should be secured with tape. If this does not stop the bleeding, consider bilateral nasal packing
Compressed sponge (Merocel)
Trim the sponge to fit snugly through the naris. Moisten the tip with surgical lubricant or topical antibiotic ointment. Firmly grasp the length of the sponge with bayonet forceps, spread the naris vertically with a nasal speculum, and advance the sponge along the floor of the nasal cavity. Once wet with blood or a small amount of saline, the sponge expands to fill the nasal cavity and tamponade bleeding.
