M. Klinger et R. Siegert, THE INFLUENCE OF CUFFED EPISTAXIS CATHETE RS ON NASAL-MUCOSA BLOOD-FLOW MEASURED BY LASER-DOPPLER FLOWMETRY, Laryngo-, Rhino-, Otologie, 76(3), 1997, pp. 127-130
Background: Nasal packings are commonly accepted in the treatment of s
evere epistaxis. Cuffed catheters are known to cause damage to the nas
al mucosa most likely by interfering with tissue perfusion. In this st
udy the effect of different pressure levels on local perfusion of sept
al mucosa is investigated. Method: In 15 healthy subjects the blood fl
ow in septal mucosa was measured by laser doppler flowmetry by positio
ning a cuffed epistaxis catheter into the nasal cavity with a laser pr
obe attached to it. Increasing pressure was administered by injecting
saline solution while continuously recording intraluminal pressure, pe
rfusion, and filling volume. The local pressure affecting the septal m
ucosa at the moment of stalling perfusion was determined by subtractin
g the extranasal cuff pressure from the current intranasal cuff pressu
re at same inflation volumes. Results: Microcirculation of the septal
mucosa stopped when the local pressure exceeded a value of p(mean) = 4
2 mmHg. Individual variations (n = 15) were small (s = 9 mmHg). The in
traluminal cuff pressure was measured to be about ten times higher due
to the retraction force of the cuff. Spontaneous oscillations of the
blood flow were reduced with increasing pressure to the blood vessels.
Filling volumes up to 3.2 ml were sufficient to stop perfusion. Concl
usions: Cuffed nasal packings stop the blood flow in nasal mucosa even
at low local pressures. Depending on the material characteristics of
different cuffs the pressure to dilate the cuff may, however, be sever
al times higher than the actual local pressure. This effect may cause
problems in the proper use of cuffed catheters. Laser doppler flowmetr
y proved to be helpful in determining reproducible perfusion values.