Merocel PVA Nasal Dressing

What it is

Merocel is a sterile, compressed polyvinyl alcohol (PVA) sponge that expands on contact with blood or saline to fill and tamponade the nasal cavity. In its compressed dry state it is a small, firm tablet; on contact with fluid it absorbs moisture and expands to many times its original volume, conforming to the nasal cavity shape and applying even pressure against the mucosa to achieve haemostasis. It is lint-free, non-adherent when wet, and designed for atraumatic removal after soaking with saline.

When & how it's used

Merocel nasal packing is used post-operatively following septoplasty and functional endoscopic sinus surgery (FESS) to maintain haemostasis and support the septum and sinus mucosa during the immediate post-operative period. It is also used in the emergency management of epistaxis when anterior nasal packing is required. The 8cm length is standard for most adult nasal cavities; the 10cm length provides additional posterior reach in longer cavities or for posterior epistaxis.

Merocel has become the most widely used nasal packing material in rhinological surgery, having largely replaced traditional ribbon gauze packing in many centres. Its key advantages over ribbon gauze are its self-expanding fill (which provides more uniform pressure distribution than manually packed gauze), its lint-free composition (which eliminates the risk of granuloma formation from fibres retained in the cavity), and its atraumatic removal when properly wetted with saline prior to extraction. Ribbon gauze and BIPP packing, if removed dry, can strip the regenerating mucosal surface from the septum and turbinates; Merocel that has been soaked with saline for 10–15 minutes before removal slides out without disturbing the healing mucosa.

In the post-FESS context, Merocel packs serve a dual function: haemostasis in the immediate post-operative period and maintenance of the nasal airway geometry while mucosal healing begins. In septoplasty, the packs support the repositioned septal cartilage and mucoperiosteal flaps on both sides, preventing haematoma formation and maintaining the corrected septal position. Packs are typically removed at 24–48 hours post-operatively in FESS and at 24–72 hours in septoplasty, depending on the surgeon’s preference and the degree of intraoperative bleeding. Their use alongside internal silicone nasal splints varies by surgeon — some use packs alone, others splints alone, and some use both in combination.

Design features

• PVA (polyvinyl alcohol) composition: Hydrophilic sponge that expands 5–8 times in volume on contact with blood or saline; provides even, conforming tamponade pressure.
• Compressed dry form: Small, firm tablet form in the dry state allows easy insertion without expanding before placement.
• Lint-free: No fibres shed into the nasal cavity; eliminates granuloma risk associated with gauze packing.
• Atraumatic when wet: Pre-soaking with saline before removal makes extraction gentle and non-traumatic to healing mucosa.
• Two lengths: 8cm for standard nasal cavities; 10cm for longer cavities or more posterior haemostasis.
• Sterile, single-use: Each pack is individually sterile and for single patient use.

Frequently Asked Questions

How is Merocel removed post-operatively? The pack is soaked with 5–10ml of normal saline via syringe instilled into the nostril 10–15 minutes before planned removal. Once saturated and softened, the pack is grasped with Tilley nasal packing forceps and withdrawn in the long axis of the nasal cavity with a smooth, continuous pull. Forcing a dry or partially wetted pack out causes mucosal stripping and pain.

How long is Merocel packing left in place after septoplasty or FESS? In most protocols, packing is removed at 24–48 hours post-operatively. Some surgeons leave packs for up to 72 hours where significant intraoperative bleeding has occurred. Leaving packing beyond 72 hours increases infection risk and patient discomfort without additional haemostatic benefit in most cases.

Can Merocel be used in both nostrils simultaneously? Yes — in septoplasty and bilateral FESS, packs are placed in both nasal cavities. This results in complete nasal obstruction during the packing period, requiring the patient to breathe through the mouth. Patients should be warned about this pre-operatively, and internal silicone splints with an airway tube are an alternative that permits nasal breathing.

Is Merocel the same as BIPP packing? No. BIPP (bismuth iodoform paraffin paste) is a medicated ribbon gauze impregnated with bismuth and iodoform compounds for its antiseptic properties. Merocel is an unmedicated PVA sponge. BIPP is predominantly used for infected sinuses and chronic middle ear disease packing; Merocel is used for haemostatic nasal packing in clean and post-operative settings.