BIPP Pack

Introduction:

Bismuth iodine paraffin paste is routinely used to pack nasal cavities. This was first used by James Morrison Rutherford Professor of surgery Durham to dress first world war soldier's wounds.

BIPP Pack:

This is a sterile gauze (ribbon) impregnated with a paste containing:

1. one part bismuth subnitrate
2. Two parts iodoform
3. One part sterile liquid paraffin by weight

Role of Bismuth subnitrate:

It is a topical astringent and antiseptic. It is soluble in weak acid but insoluble in water and alcohol. It contributes to the antibacterial properties of BIPP pack by releasing dilute nitric acid on hydrolysis.

Bismuth is not completely safe from complications. It is considered to be less toxic than antimony and polonium. It has a half life of 5 days in the body but is known to remain in kidney for a long time. Bismuth can cause neurotoxicity because it is known to interfere with oxidative metabolism of brain. This complication is very rare when BIPP pack is used to pack the nasal cavity.

Symptoms of Bismuth toxicity:

1. Head ache
2. Nausea
3. Stomatitis
4. Bismuth line in the gingiva (Bismuth line)

Absorption of bismuth is more when packing is made on tissues that has already been injured. Hence considerable amount of caution should be exercised before repeated nasal packing due to epistaxis.

Iodoform:

Its chemical name is triiodomethane.

This is another component of BIPP pack. It has a dinstinctive color and smell. It is insoluble in water and is highly soluble in chloroform / ether. Iodoform decomposes to release iodine which is an antiseptic. Iodine toxicity is common when BIPP packing is used to pack large wounds.

Paraffin:

Serves to lubricate the area packed. It minimizes trauma which could occur during packing.

Uses of BIPP Packs:

1. Used to pack ears following surgery
2. Used to pack nasal cavities after nasal surgeries

Bismuth is radio opaque. BIPP packs also contain a radio opaque marker strip which makes its identification easier when it is lost inside the cavities. Plain radiograph of the area is sufficient to identify the pack.

Advantage of BIPP packing is that it can safely be left in place for more than a week.