An Overview of Hemostatic Agents and How They Are Used
What are Topical Hemostatic Agents?
What is Arista ™ AH Absorbable Hemostat?
Hemostasis includes the following steps:
When control of capillary, venous, and arteriolar bleeding by pressure, ligature, and other conventional procedures is ineffective or impractical, hemostatic agents are introduced and work either mechanically or by augmenting the coagulation cascade in order to stop the bleeding. The purpose of a hemostatic agent is to maintain hemostasis of the patient during surgery or trauma.
Without hemostatic agents, operating times may need to be prolonged and the risk of side effects increases.
Hemostatic agents can also help to decrease risk in emergency cases such as trauma. Hemorrhagic shock is the second leading cause of death for civilian trauma patients.
There are three main subtypes of hemostatic agents:
The MPH™ particles concentrate blood solids such as platelets, red blood cells and blood proteins to form a gelled matrix. By providing a barrier to further blood loss, the normal clotting process is enhanced, regardless of the patient’s coagulation status. This hemostat can be used in the following surgeries:
Avitene™ is approved for use for use in all procedures where a topical hemostat is indicated, including neurosurgery.
Hemostatic dressings are a crucial supplement in regards to external hemorrhage control when bleeding site is not salvageable. The 3 hemostatic dressing gauze’s (combat, celox, chito) are applied similarly. When using hemostatic dressings, place entire dressing firmly and carefully over area of active bleeding site. When the dressing is all packed into wound, hold pressure there for 3-5 minutes. Keep in mind the importance of overpacking wound with enough hemostatic dressing so when estatic pressure dressing is applied, it will adjunct pressure of previous action.
“Thrombin is a Na+ -activated, allosteric serine protease that plays opposing functional roles in blood coagulation”(NCBI). Thrombin works by acting as a procoagulant factor when it converts fibrinogen to fibrin. As a result, a stable fibrin clot is formed. Fibrin works as scaffold for platelets when it became crosslinked.
Oxidized cellulose, also known as a treated surgical gauze, comes in many forms (strips, gauze pads, pledgets). It works, acting like a physical matrix to form clots while not actively causing alterations of clotting cascade. Oxidized cellulose is usually removed after coagulation, but can be left on surgical site.
Absorbable Gelatin Sponge (Gelfoam) is a gelatin powder that is applied dry to wound with light pressure. The absorbable gelatin allows for clot formation and forms granulation tissue while holding the blood. Gelfoam aids in forming bulky artificial clot in vascular areas to stop further bleeding.
Hemostatic hemostasis in surgery are a crucial element to the achievement of a positive outcome. Along with maintenance of homeostasis of the patient during surgery or trauma, it also provides many benefits such as reduction time in hospital stay, number of redo interventions for bleeding, reduce surgery time, intra- and postoperative complication rate and high economic efficiency. When selecting a hemostat for surgical practice, it is important doctors keep in mind the accessibility of bleeding site, size of wound, and the type of agent. In addition, they should take into account the severity of the bleed, patient’s coagulation status, patient’s medical or surgical history, and likelihood of reoperation when choosing agent and identification of bleeding risk.
Benefits of using a hemostatic agent in surgery and in emergency situations include maintenance of the patient’s hemostasis. Potential benefits encompasses shorter operation duration, reduction in transfusion requirement, greater management of anticoagulated patient, reduction in patient recovery time, reduce intra- and postoperative complication rate and a reduction in wound exposure.
How you use a hemostat will depend on the type of bleeding. Below are directions for two common types:
AVITENE™ (MCH) must be applied directly to the source of bleeding. Because of its adhesiveness, it may seal over the exit site of deeper hemorrhage and conceal an underlying hematoma as in penetrating liver wounds. When possible, surfaces to be treated should be compressed with dry sponges immediately prior to application of the dry AVITENE™. It is then advantageous to apply pressure over the AVITENE™ with a dry sponge for a period of time which varies with the force and severity of bleeding. A minute may suffice for capillary bleeding (e.g., skin graft donor sites, dermatologic curettage) but three to five or more minutes may be required for brisk bleeding (e.g. splenic tears) or high pressure leaks in major artery suture holes. For control of oozing from cancellous bone, it should be firmly packed into the spongy bone surface. After five to ten minutes, excess MCH may be teased away (see Precautions); this can usually be accomplished with blunt forceps and is facilitated by wetting with sterile 0.9% saline solution and irrigation. If breakthrough bleeding occurs in areas of thin application, additional AVITENE™ may be applied…. In neurosurgical and other procedures the non-woven web may conveniently be used by applying small squares to bleeding areas and then covering the sites with moist cottonoid “patties””. After five to ten minutes excess MCH may be removed by teasing and irrigation.
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