• Not all patients requiring packing with rapid rhinos require admission

• Use of anticoagulation no longer an admission criterion for epistaxis requiring packing with rapid rhino

Please note a separate patient information leaflet is available specifically for discharging patients with nasal packing in-situ. Available in the patient advice leaflets of the “Patient Care” section of Ourplace.

This is a controlled document. If you are using a printed copy, check it against the guidelines site to ensure you are using the latest edition. Print copies must be destroyed after use.

Abbreviations

Definition of unstable

• Use of clinical discretion advised.

• Unable to provide blanket parameters (e.g. Hb <90g/L, BP <110mmHg systolic) as each patient’s normal values will vary.

• Reviewing previous blood results and observations where possible encouraged.

Continued bleeding

• This refers to ongoing active bleeding despite rapid rhino in situ

• Please note that the rapid rhino should be sufficiently inflated (balloon taut), as if insufficiently inflated ongoing ooze can be expected

• Ensure to examine oropharynx to check for bleeding posteriorly.

Posterior bleed

• Those requiring a 9cm rapid rhino or foley’s catheter

DOAC:

• Rarely reversed although reversal agents are available for most DOACs

• If patient takes for AF only (i.e. no previous DVT or PE) then generally we advise withholding for 48hrs however occasionally clinical discretion should be adopted (e.g. a patient in whom stopping of DOAC transiently in the past has led to TIA/stroke).

Warfarin:

• If bleeding necessitates reversal of warfarin, then generally these patients are admitted as their INR level needs to return to their usual aim with reintroduction of warfarin once bleeding is under control.