A Better Epistaxis Clip
Epistaxis is a common problem. Although usually minor, 6-10% require medical care 1. 95% of the bleeding occurs in Little's Area, a part of the septum with a rich blood supply. This area is amenable to local pressure applied to the soft aprt of the nose distal to the nasal bones. However a simple manually applied pressure either by the patient or a first aider is subject to inconsistent control and failure. Implements that deliver this pressure are avaliable 2. The RhinoPinch3 is one such device, and is a cheap solution. These have several limitations. They inevitably occlude both nostrils, the use is limited to 15 minutes at a time because for potential for tissue ischaemia, there is no way to determine the actual pressure applied to the tissues and no adjuvant haemostasis occurs while the device is being implemented. Furthermore, the pressure delvered is not uniformly applied across the septum because of shielding from the nasal bones and the possible decline in delivered pressure further away from the epicenter of the compression.
The JWEC objectives are 1) increase likelihood that pressure will reach the bleeding point 2) there is some protection from over-application of pressure 3) spare areas that do not need to be compressed, 4) allow nasal breathing 5) deliver local adjuvant haemostatic agents. In order to do this we first assess objectively the efficacy of conventional nasal occlusion methods, in terms of the the above parameters.
As a prime objective is delivery of pressure, mapping and quantifying the pressure is important. Pressure mapping systems exist for example, that can map the contact pressure of feet during stance and gait4. The authors know of no published way to do this practically for the scenarios under consideration. A simple device is therefore designed using multiple layers of absorbent paper, and dye transmission. This is calibrated using a probe applied to the surface for a fixed interval, and the dye pentration evaluated. The reliability of this novel device is tested.
The device is then customised for the nasal cavity, and a swimmer's clip and manual pressure is tested for the area covered and pressure delivered.
The JWEC is developed that attempts to solve the problems identfied. Its efficacy is tested using the method described above and iteratively optimiised. The result is a new clip that exceeds current modalities for primary compressive epistaxis control.
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Current Approaches to Epistaxis Treatment in Primary and Secondary Care
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BMJ Best Practice (2018) Epistaxis. BMJ Publishing Group. http://bestpractice.bmj.com