Your surgical toolbox should include topical hemostatic agents



Vessel-sealing devices and hemostatic adjuvants are expanding the surgical armamentarium. These products provide a spectrum of alternatives that can serve you and your surgical patient well when traditional techniques for obtaining hemostasis fail to provide a satisfactory result. (Keep in mind, however, that technology is no substitute for excellent technique!)To get more news about Bleeding Control Products, you can visit rusunmedical.com official website.

In this article, we highlight three common scenarios in which topical hemostatic agents may be useful during gynecologic surgery. In addition, in the sidebar, five surgeons describe the hemostatic products they rely on most often—and tell why.

You perform adnexectomy on a 47-year-old woman who has a large (7 to 8 cm), benign ovarian mass. As you operate, you discover that the lesion is adherent to the sigmoid mesentery and the posterior aspect of the uterus; it is also adherent to the pelvic sidewall, directly along the course of the ureter. Although you are able to release the various adhesive attachments, persistent bleeding is noted at multiple pinpoint areas along the mesentery, uterine serosa, and pelvic sidewall, even after the application of direct pressure.

You decide to apply a foam hemostatic agent because of its ability to conform to the irregular space. You also continue to apply gentle pressure to the point of bleeding, using a moist gauze. Within minutes, hemostasis is achieved. You are then able to finish the operation.

As these three cases illustrate, the use of hemostatic agents to control surgical bleeding requires an individualized approach. The site and amount of bleeding, as well as the patient’s hemodynamic and coagulation status, are key variables to be considered when selecting an agent.
Hemostatic agents such as Celox, QuikClot and Hemcon are designed to promote rapid blood coagulation in the event of a traumatic wound involving an arterial bleed. Hemostatic gauze products are now widely available to EMS professionals and first responders, and approved for all levels of training in some areas. These products have saved many lives on the battlefield and are now also being used to stop traumatic bleeding in workplace, motor vehicle, and at-home accidents.

QuikClot was the first hemostatic agent adopted by the United States Military. QuikClot Combat Gauze is still favored by much of the US Military. Later developments led to chitosan-based products such as Celox, which are proven safe and effective. Celox granules are preferred in some instances, such as in the event of a scalp evulsion, where impregnated gauze products would have to be later removed, meaning the flap would need to be lifted. This may not be necessary if Celox granules are used, as they are readily metabolized. Gauze-based products are more suited for wound-packing a penetrating injury. The use of Celox hemostatic granules and chitosan-impregnated gauze can quickly and safely stop blood flow from potentially lethal wounds. Hemostatic gauze dressings using the active ingredient chitosan include Celox, Chito-SAM and Hemcon. CoTCCC (the Committee on Tactical Combat Casualty Care) has long recommended QuikClot Combat Gauze as the hemostatic agent of choice for all branches of the US Military.