When it contacts nasal secretions, blood, or added sterile saline, the tampon expands to fill the nasal cavity and applies direct pressure to the walls of the nasal cavity The Rhino Rocket represents a compressed foam polymer tampon made of polyvinyl alcohol and a delivery device to aid insertion The nasal tampon comes loaded in a slim, syringe-like applicator, which is placed on the floor of the nose at the entrance or just inside the nose The tampon is expelled into the nose from the applicator expanding as it contacts blood and nasal fluid The retention strings should be secured to the side of the face The Rapid Rhino is a carboxymethyl cellulose pack with an inflatable balloon that secures it in the nasal cavity after insertion It facilitates platelet aggregation and also forms a gel-like lubricant over its surface to ease insertion and removal Classic anterior pack with ribbon gauze ( Fig 130.20 ) Using bayonet forceps, grasp a length of petroleum-jelly-impregnated gauze approximately to cm from its end, and insert it straight back along the floor of the nose for to cm This will form a loop in the nose, with the end of the gauze protruding from the nostril by to cm to prevent it from falling into the nasopharynx and causing the child to gag Withdraw the bayonet forceps and grasp the long end of the looped gauze approximately cm from where it is now exiting the nose This portion of the gauze should then be placed into the nose on top of the initial layer to form a second loop Repeat the process until the nasal cavity is filled with layers of gauze from bottom to top Any free end of gauze should be directed anteriorly so that it does not fall into the posterior nasopharynx and lead to gagging A small piece of tape can be used to cover the nostril and prevent the child from disturbing the pack Because the nasal pack causes stasis of the nasal secretions, oral antibiotics may be considered to prevent the occurrence of sinusitis Anterior packs should be removed in to days Posterior Pack If an anterior pack is not sufficient to stop an episode of epistaxis, a posterior pack may be required The placement of posterior packs is extremely uncomfortable; therefore, procedural sedation is strongly recommended Posterior packs can consist of a double-balloon catheter or a Foley catheter and are generally inserted by an otorhinolaryngology specialist Important note Toxic shock syndrome has been reported with nasal packing If a nasal pack is left in place, it is recommended that an oral antibiotic, such as amoxicillin–clavulanate, be initiated and continued until packing removal Posterior nasal packs are associated with hypoxia and hypercapnia In addition, the sedation often required in these patients may decrease respiratory effort and