INSTRUCTIONS FOR HOME CARE AND FOLLOWUP AFTER DISCHARGE WITH NASAL PACKING PRESENT:

You are being discharged with nasal packing in place.  It is important that this packing is not removed until your scheduled follow up appointment.  In general, nasal packing is removed approximately 5 days after placement.  In patients with an increased risk for bleeding (on aspirin, Coumadin, bleeding disorder etc..) the packing may be left in for an additional 2-3 days.  If you have not received an appointment at the time of discharge, please call our appointment coordinator to schedule an appointment with our ENT Clinic.  The telephone number is (XXX) XXX-XXXX.  The ENT Clinic is located XXXXXXX.  Please plan to arrive at least 15 minutes prior to your scheduled appointment so that you may have time to check in.  While we recommend returning to our clinic, if you will be unable to follow up at our facility, please arrange an appointment with a local ENT physician or primary care provider to have the packing removed and your nose examined.

You will be prescribed an antibiotic to take.  It is very important that you take this medication as prescribed for the full course, as failure to do so may result in a serious infection.

If the packing has a small string secured to the outside of your nose, please do not remove this, but keep it taped to the outside of your nose.  This may be required to retrieve the packing in an emergent situation.

It is normal to have a small amount of pink blood tinged mucous oozing from around the packing.  If this is a nuisance you may secure a small "moustache dressing" to the outside of your nose.

If you develop a nosebleed despite having the packing in place, do NOT remove the packing.  Apply pressure to the outside of the nose (over the flexible end of the nose) for 30 minutes and lean forward so that you do not swallow blood.  Hold constant, firm pressure for the entire duration without "peeking" to see if it has stopped as this will likely result in repeated bleeding.  If you continue to have a nose bleed or if the bleeding is very rapid or excessive, please present to the nearest emergency department emergently for medical evaluation. 

CONTACT OUR OFFICE IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING:

1. Pain that is not relieved by Tylenol or other prescribed pain relievers.

2. Any change in vision, or pain with eye movements.

3. Increased swelling or bruising around the eyes or nose.

4. Bleeding that is excessive or that does not stop with holding pressure.  If this occurs, you should present to the nearest emergency room immediately.

5. Increased nasal discharge that is dark or of pus appearance.

6. Unraveling of the nasal packing into the back of the throat

7. Persistent dark, tar color stools, or increased light headedness or fatigue

8. A temperature consistently greater than 101F (38C).

While you have the packing in place, we recommend that you moisten the packing a minimum of twice daily with water or saline.  This prevents the packing from drying to the nasal mucosa (skin) and causing trauma after being removed.

In order to decrease your risk for future nosebleeds we recommend the following strategies:

1. Avoid aspirin or other similar medications, unless prescribed by your physician

2. If you are taking Coumadin or other blood thinners, we recommend tight management to avoid excessive blood thinning which can cause recurrent bleeding.

3. Avoid trauma to your nose.  This includes irritation from exploring digits (nose picking) and excessive nose blowing.  If you sneeze or cough, do so with a widely open mouth to avoid excessive pressure buildup in your nose.

4. If you have elevated blood pressure, keeping your blood pressure controlled will decrease your risk for future bleeds.

5. Using a room humidifier at night, especially during the dry winter months will keep your nose moist and less susceptible to bleeding.

6. For those with a history of many severe nose bleeds, it is helpful to irrigate the nose twice daily with normal saline (salt water rinses) to keep the nasal mucosa healthy.

Nosebleeds are very common and regularly occur in otherwise healthy people, however frequent or recurrent severe nose bleeds may be a sign of a serious underlying medical condition.  We recommend that you discuss this episode with your primary care physician so that if warranted further testing may be performed.