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Drainage of the pleura and mediastinum after cardiac surgery is routinely achieved with rigid, wide-bore plastic drains. 1 Although these drains are effective, they are also painful, particularly during removal, 2 and they may cause damage to bypass grafts, impair ventilation, and cause cardiac arrhythmias. 3 Flexible fluted silicone drains may be just as effective. 4 Because of the fluted design, smaller sizes can be used without any reduction in the effective drainage capacity. The small size and flexibility may cause less pain, interfere less with the heart and surrounding structures, and result in fewer drain site infections. To investigate these potential benefits and to establish the efficacy of these drains, we designed a prospective, randomized trial that compared the two types of drain.

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There are various effective treatment options for refractory posterior epistaxis including endoscopic diathermy or endoscopic artery ligation. If these treatment options are not immediately available, posterior nasal packing with Foley catheter is an effective and rapid non-surgical treatment alternative. A systematic approach is presented. The principles and mechanisms of action of the posterior nasal packing are explained. Nevertheless, there are morbidities involved and posterior packing can be painful and uncomfortable for the patient. Marking and modifying the catheter will help one inflate the balloon in the correct place and avoid the problem of nasal alar pressure necrosis.