Hemostatic sponge - quick stop of bleeding

The hemostatic sponge is an important tool in the home and travel first aid kit and the best assistant to the surgeon. When used, it is possible to quickly stop bleeding. Today, hemostatic sponges come in a huge variety. They can be easily selected in size depending on the conditions of use.

Peculiarities

The hemostatic collagen sponge has a porous structure. It is produced in the form of individual plates approximately 7 mm thick. The hemostatic agent has a mild vinegar odor and a yellowish color. The hemostatic material is characterized by resistance to high temperatures. It is insoluble in water and organic solutions.

The hemostatic agent contains collagen substance. This is a thread-like protein that performs construction functions in the tissues of the human body. In the production of sponges, furatsilin and boric acid, which have antiseptic properties, are also used.

Collagen sponges are highly absorbent. The moisture absorption rate is 5 g per 1 g of dry matter. These drugs improve blood clotting. When used, they have an additional hemostatic and antiseptic effect, and stimulate the regeneration of damaged tissues. A sponge left in a wound will completely dissolve over time. As a rule, this takes 1.5-2 months.

The size and quantity of the sponge are selected depending on the complexity of the injury and the depth of the injured surface. In practice, the most popular is the hemostatic collagen sponge 50x50mm.

Any surgical intervention is inevitably associated with bleeding. At the same time, the main source of blood loss in operations on the liver, spleen and kidney when large vessels are intact is capillary-parenchymal bleeding, to stop which they resort to a variety of hemostatics: local hypothermia, thermo- and ultrasonic coagulation, laser irradiation, the use of hemostatic films, adhesives, gels , sponges, etc. [1].

The use of hemostatic materials alone in practical surgery is limited due to their low hemostatic activity and the occurrence of adhesions in the abdominal cavity. Toxicity, traumatic and antigenic properties, as well as the locally irritating effect of other drugs (for example, based on oxycellulose) contribute to the occurrence of an inflammatory process, necrosis of organ parenchyma, which predisposes to the development of infection [2]. However, according to many authors, sponges based on collagen, the most well-known and long-used traditional hemostatic agent, in combination with various substances, turn out to be the most effective compared, for example, with gauze packing (a physical method of hemostasis) and make it possible to stop bleeding in 1. 5-2, sometimes 3 times faster [3, 4]. In this regard, the development and study of new hemostatic sponges based on collagen, containing various substances that affect hemostasis, are urgent tasks with the goal of increasing the rate of onset of hemostasis, as well as expanding the scope of effective use of application procedures.

Achieving this goal involved consideration of known methods for assessing the effectiveness of the use of local hemostatic agents.

However, during the study of the problem, the presence of generalizing indicators was not revealed that would make it possible to give an integral assessment of the application of the corresponding method. For the most part, quantitative indicators are used here, expressed in the form of bleeding time, changes in sponge mass and similar characteristics. During the course of this work, no other indicators were found. In this regard, the task was set to develop a methodology that would allow assessing the effectiveness of using collagen sponges using quantitative, qualitative and integral indicators.

The purpose of the study was to study the effectiveness of new samples of hemostatic implants based on collagen and hemostatic agents deposited in them; development of a method for assessing the effectiveness of collagen hemostatic sponges in stopping parenchymal bleeding in surgical practice; study of new drugs based on collagen sponges in a comparative aspect.

As materials for experimental studies, samples of hemostatic collagen sponges with a length, width and height of material of 1 cm were used, weighed on a torsion balance, containing: hemoblock 2%; hemoblock 5% [5]; hemoblock and tranexamic acid; platelets and tranexamic acid [6, 7]; cryoprecipitate 10%; cryoprecipitate and tranexamic acid; chitosan and caprofen [8, 9]; tranexamic acid 9%. Hemostatic collagen sponges Belkozin and Zelenaya Dubrava were used as comparative samples.

In vivo experiments

were carried out on 110 white Wistar rats of both sexes weighing 180-200 g. For the study, animals without external signs of the disease were used, which underwent a quarantine regime in the vivarium of the Federal State Budgetary Educational Institution of Higher Education "Kursk State Medical University". All animals were kept under identical conditions on a standard diet.

Experiments on animals were carried out under aseptic conditions in the operating unit of the Department of Operative Surgery and Topographic Anatomy named after. HELL. Myasnikov Federal State Budgetary Educational Institution of Higher Education "Kursk State Medical University".

Operations and manipulations with animals were carried out using general anesthesia (xylazine hydrochloride, zoletil), and removal from experiments was carried out by overdose of anesthesia, in accordance with the Convention for the Protection of Vertebrate Animals Used for Experimental or Other Scientific Purposes (adopted by the Council of Europe in 1986, Strasbourg, France), and Council Directive 86/609/EEC of 24.11.86 on the harmonization of the laws, regulations and administrative orders of the Member States regarding the protection of animals used for experimental and other scientific purposes.

For a comparative assessment of the time to stop bleeding and the amount of blood loss in an acute experiment, rats underwent a median laparotomy under general anesthesia (Fig. 1,

Rice. 1. Simulation of a liver wound. 2
).

Rice. 2. Simulation of a spleen wound.

The liver and spleen were removed alternately into the surgical wound. After careful hemostasis of the edges of the laparotomy wound and its delimitation with polyethylene, a dry sterile napkin with a known mass was placed under the intended area of ​​organ injury.

The liver wound was made on one of its lobes by cutting off the edge in such a way that the length of the wound was 1 cm (tangential to the circumference of the liver lobe), and the depth was 0.5 cm (in the place furthest from the edge) (Fig. 3).

Rice. 3. Application of hemostatic material to the area of ​​the liver wound. The spleen wound at one of its poles was modeled similarly (length - 0.5 cm, depth - 0.3 cm) (see Fig. 1,
2
).

The resulting capillary-parenchymal bleeding was immediately stopped by applying hemostatic material to the wound area. After the experiment, the sponge was weighed (see Fig. 3, 4

).

Rice.
4. Application of hemostatic material to the area of ​​the spleen wound. As a control, we used the above technology without the use of hemostatic materials, using a gauze pad, Belkozin collagen sponge, and Zelenaya Dubrava collagen sponge. Simultaneously with the application of the wound and the application of hemostatic material, time was started using a stopwatch to record the period of bleeding cessation. To determine the time of final bleeding cessation, the moment of cessation of bleeding from the drug or control wound was noted.

The amount of blood loss was measured using the method of E.M. Levite. To do this, the difference in the mass of the sterile material before the operation and after it was soaked in blood during the operation was determined and calculated by the expression:

m2–m1=m,

where m2 is the mass of the material after complete hemostasis (the blood flowing from the wound was absorbed into the material); m1 is the mass of the material before the experiment; m is the amount of blood loss.

The obtained data were statistically processed with the calculation of average values, standard errors of means and significance of differences. Differences for which the p

was less than or equal to 0.05. The significance of the differences was assessed using the Mann-Whitney test, as well as by calculating the confidence interval [10, 11].

In addition, a visualization coefficient was introduced, which made it possible to numerically express the ability of a particular sponge to absorb blood during the corresponding physical process. This coefficient (hereinafter K) was calculated as the difference between the rate of blood flow (ic) from the wound and the rate of its absorption by the sponge (pg). In this case, the rate of blood flow was determined as the volume of blood expended per unit of time, and the rate of blood absorption by the sponge was determined as the ratio of the difference in the weight of the sponge before and after the experiment to the time of bleeding.

TO

=
C
ik–
C
pgmg/s;

In order to track the dynamics of changes in the rate of blood flow per unit of time, we introduced an indicator of the deceleration of blood flow (hereinafter - H), which was calculated as the ratio of the K indicator to the bleeding time.

When studying in an acute experiment on rats in the comparative aspect of the time to stop bleeding on a model of experimental injuries of the liver and spleen using the studied samples, the results presented in table were obtained. 1,

Table 1. Average indicators of time to stop bleeding in a standard liver injury model, average K- and H-indicators (M±m), statistical analysis Note. Here and in the table. 2:* - p - significance of differences in mean values ​​in relation to control groups (1, 2, 3, 4) was calculated using the Mann-Whitney test. Data were considered reliable at p≤0.05; ** - significant differences relative to control groups with a probability of 95% when comparing confidence intervals. CI—confidence interval, TC—tranexamic acid. 2
.

Table 2. Average indicators of time to stop bleeding in a standard splenic injury model, average K- and H-indicators (M±m), statistical analysis

Analysis of the results showed that the drugs have hemostatic properties, significantly reducing bleeding time relative to the control. After a comparative assessment, it was concluded that a highly effective drug is a hemostatic sponge with tranexamic acid 9% ( p

≤0.05), since this drug received high ratings for quality properties (Table 3)

Table 3. Assessment of the qualitative properties of the drug Note.
A - adhesion to the wound surface (adhesion); AbP—absorption capacity in experiments on the liver, mg; AbS - on the spleen, mg; U - ease of use; * - light drug; ** - crumbles, crumbles when cutting or using. Rating scale: 1 - absence of attribute; 2 - unsatisfactory; 3 — satisfactory; 4 - good; 5 - excellent. and has the lowest K-indices both in experiments on the liver (1.072±0.130832) and in experiments on the spleen (1.08±0.044835) with a bleeding time of 50.7±1.9 s and 68.4 ±2.9 s respectively. The least effective drug was a hemostatic sponge with chitosan and caprofer (K ​​= 1.981 ± 0.054921, K = 2.424 ± 0.135248 for the liver and spleen, respectively), which also had a low rating for use, since it crumbled, crumbled when cut, stuck to gloves, was extremely light in weight, and poorly applied to the wound surface. At the same time, the H-index in experiments on the liver in both cases was approximately the same (≈0.02), while the K coefficient and the average bleeding time differed by almost 2 times.

The current situation indicates that, under conditions of the same rate of slowing down blood flow, a sponge with chitosan and caprofer absorbs 2 times more blood volume, since it requires 2 times more time to create hemostasis than a sponge with tranexamic acid 9% . This fact indicates the insufficient effectiveness of the active substance included in this sponge. The results obtained in experiments on the spleen confirm this fact (bleeding time 131.5±15, K=2.424±0.135248).

The next most effective drug is a hemostatic sponge with cryoprecipitate 10%, which, among other things, has one of the highest H-values ​​(H = 0.025) in experiments on a standard spleen injury model (reliable data). This is followed by a hemostatic sponge with cryoprecipitate and tranexamic acid ( p

≤0.05; unreliable differences in splenic injury when compared with Belkozin). With minimal differences, next comes a hemostatic sponge with a hemoblock of 5%, which, like the sponge with cryoprecipitate 10%, has H = 0.025 in experiments on the spleen. It is inferior to a hemostatic sponge with a hemoblock and tranexamic acid (unreliable differences in liver injury in relation to Belkozin, Zelenaya Dubrava). Despite the fact that it has the highest H-value in experiments on the liver (H = 0.035), it also has a fairly high K coefficient, which indicates that it absorbs a large volume of blood while slowing down the rate of bleeding from the wound quite quickly (Fig. 5) .

Rice. 5. Average values ​​of H- and K-indices in experiments on a model of standard liver injury. In experiments on the spleen, this material performs worse: it has one of the lowest H values ​​against the background of a high K value (Fig. 6).

Rice. 6. Average values ​​of H- and K-indices in experiments on a model of standard spleen injury. The hemostatic sponge with platelets and tranexamic acid performed somewhat worse (an unreliable difference in the data is determined only for Belkozin). In seventh place is a hemostatic sponge with a hemoblock of 2% ( p
>0.05 relative to Belkozin; non-significant differences are determined in case of spleen injury with Belkozin, Zelenaya Dubrava).

in vivo studies

in an acute experiment on rats, when studying in a comparative aspect the time to stop bleeding, the amount of blood loss on a model of experimental standard injuries of the liver and spleen, quantitative, qualitative and integral indicators allow us to conclude that all experimental samples have reliable hemostatic properties, expressed to varying degrees. The activity of the latter is associated with the hemostatic agents included in the sponges. Contrary to the expected results, monocomponent sponges turned out to be more effective: hemostatic sponges with tranexamic acid 9% and cryoprecipitate 10% performed better, followed by their combination. The same pattern was revealed with sponges containing hemoblock: a single drug (hemoblock 5%) turned out to be more effective than the combination of hemoblock and tranexamic acid. Apparently, these phenomena are associated with the mechanism of drug preparation, their interaction (destruction), and the nature of the substrate impregnation (layer-by-layer or continuous). The low hemostatic properties of the hemostatic sponge with chitosan and caprofer can be associated with the absorption properties of the polysaccharide included in the composition, which needs time for the fibers to swell.

These samples can be used during operations on parenchymal organs, which will significantly reduce postoperative complications associated with the presence of delayed bleeding. However, to make a final decision, it is necessary to carry out a wider range of studies in order to study such properties as biodegradation, bioinertness, the severity of the adhesive process at the implantation site, the presence of local and systemic effects after using materials. The methodology for assessing the quality of hemostatic sponges developed during the study can be used in similar studies, and the qualitative K-index can serve as a criterion for classifying sponges and act as a marker of the degree of sorption.

Based on the results of the study, we can conclude that all presented samples reliably have hemostatic properties, most of which are superior to analogues available on the market. A new technique has been developed that makes it possible to evaluate the properties of hemostatic sponges in an acute experiment using integral indicators.

The authors declare
no conflict of interest.
Information about authors

Bezhin A.I. (Bezhin AI)

— Doctor of Medical Sciences, Head of the Department of Operative Surgery and Topographic Anatomy named after. HELL. Myasnikov KSMU; Kursk, st. K. Marksa, 3, 305041; e-mail

Soldatova Daria Sergeevna (Soldatova DS)

- doctor - pediatric surgeon of the Regional Children's Hospital No. 2, candidate of the Department of Operative Surgery and Topographic Anatomy named after. HELL. Myasnikov KSMU; Kursk, st. Khutorskaya, 43 "a" 305029; e-mail;

https://orcid.org/0000-0002-9278-2737

Litvinenko I.V. (Litvinenko IV)

— 3rd year student of KSMU; Kursk, st. K. Marksa, 3, 305041; e-mail

Ryzhov A.S. (Ryzhov AS)

— 3rd year student of KSMU;

Kursk, st. K. Marksa, 3, 305041; e-mail

Istranova E.V. (Istranova EV)

— Ph.D., leading researcher at the Institute of Regenerative Medicine, Sechenov University; Moscow, st. Trubetskaya, 8, building 2, 119991;

e-mail

Istranov L.P. (Istranov LP)

— Doctor of Pharmaceutical Sciences, Professor, Chief Researcher at the Institute of Regenerative Medicine, Sechenov University; Moscow, st. Trubetskaya, 8, building 2, 19991; e-mail: [email protected]

Indications

The purpose of using collagen sponges is to stop bleeding. This means that these hemostatic agents are in demand in various medical fields: traumatology. Surgery, traumatology, etc.

Nowadays, collagen hemostatic sponges are widely used in cases of external bleeding. Pathological conditions can arise from various causes.

Also, hemostatic sponges are often used in the treatment of the following pathologies:

• Hemorrhoids. When the disease worsens, bleeding from the rectum often occurs.
• Trophic ulcers of the lower extremities that develop against the background of venous insufficiency.
• Acute ear infections that require surgical treatment.

Hemostatic sponges are used during dental procedures, in particular after tooth extraction. In this case, it is possible to speed up the wound healing process and guarantee increased antiseptic and antibacterial protection.

Collagen hemostatic sponges are an indispensable tool when performing serious operations on internal organs. In particular, they are used to close the gallbladder bed after its removal. They also make it possible to strengthen sutures after various surgical interventions.

At home, it is recommended to use a hemostatic collagen sponge to stop capillary bleeding in domestic injuries.

What it is

A hemostatic sponge is a medical device made in the form of a compact block of porous natural material that looks like a sponge or sponge. A device is used to stop bleeding and accelerate tissue regeneration during surgery.

The product is used as a wound dressing, closing the cavity, keeping the hole sterile and stimulating the formation of a blood clot. Stopping bleeding occurs by absorbing excess blood and wetting the sponge. The sponge increases in size and compresses the walls of the hole, pinching the capillaries.

There are two types of devices:

• Cubes with dimensions 1x1x1 cm.
• Blocks (10x10x1 cm).

The required piece of sponge is cut from the block or cube using scissors or a scalpel. The final shape of the sponge is modeled taking into account the characteristics of the wound and needs.

Contraindications

The main contraindication to the use of collagen sponges to stop bleeding is hypersensitivity to any components used in their manufacture. In particular, this is intolerance to nitrofuran drugs. With increased sensitivity to them, severe allergic skin reactions are observed, accompanied by severe itching.

Collagen sponges should not be used to stop arterial bleeding. In this case, a tourniquet must be applied and the person must be urgently transported to a medical facility to provide qualified surgical care.

Contraindications to the use of collagen-based hemostatic sponges are skin lesions caused by pyogenic bacteria. In this case, the wound must be periodically treated with antiseptic agents to remove its purulent contents.

Types of hemostatic tubes

For the manufacture of hemostatic sponges the following is used:

• Collagen extracted from bovine tendons.
• Gelatin is made from bovine bone tissue.
• Components of human blood plasma.

The latter option is used strictly as prescribed by a doctor.

In some cases, the base is impregnated with drugs:

• Antiseptic solutions.
• Antibacterial drugs.
• Local anesthetics.
• Stimulators of tissue repair.
• Aqueous solutions of herbal extracts and natural substances.

Among the popular domestic manufacturers of hemostatic tubes are Belkozin, etc.

Recommendations

The collagen sponge should be removed from the packaging immediately before use. It is important to follow the rules of asepsis to prevent accidental infection in the wound. The hemostatic agent is carefully applied to the bleeding area and held for a couple of minutes. Deep wounds are tightly packed and then bandaged.

After the collagen sponge is saturated with blood, it will slightly increase in size. This will ensure that it adheres tightly to the damaged bleeding area. In cases where it is necessary to close damaged areas of parenchymal organs, a sponge of a suitable size is placed in the existing cavities. To stop bleeding, it is allowed to form several layers from it. After this, it is fixed using a U-shaped seam.

You can now buy a collagen hemostatic tube in pharmacies at an affordable price. It is presented by manufacturers in a wide range. You can also pick up the product in specialized online stores. Now you can use the booking service or order delivery of the product to the specified address.

Before using a collagen-based hemostatic sponge, you should carefully read the manufacturer's instructions. The product should be stored in a dry place where the temperature is maintained in the range of 10°C - 30°C. With high humidity, the sponge quickly becomes unusable. The shelf life of the product, subject to the required conditions, is 5 years.

Analogs

Some patients believe that a hemostatic sponge is not able to stop bleeding and alleviate the patient’s plight. In reality, the effect of this medication is selective, and it is also important to consider the risk of side effects. In such clinical pictures, the attending physician introduces a replacement and suggests using an analogue of the specified pharmacological group. Here is a replacement worthy of modern pharmacology, which can also be purchased over the counter, but after consulting with your doctor first:

• Kaprofer;
• Alginatol;
• Natalsid;
• Eavisel;
• Polyhemostat;
• Tissucol Keith;
• Posterisan;
• Feracryl;
• Tachocomb;
• Styptic pencil;
• Tissucol.

Appearance and release form

The hemostatic sponge looks like a cube or plate, which looks like a small sponge or a piece of yellow or white foam rubber. Although in fact it consists mainly of natural collagen with various medicinal additives. The plate is quite soft and easy to cut, which allows the dentist to cut the desired size according to the shape of the hole.

The plate is quite soft and easy to cut

Manufacturers produce both small (1x1 centimeter) and large sponges (10x10 cm). The plates are tightly sealed in transparent bags, and the cubes are sealed in dark, opaque bottles. Hemostatic powders and gels are also produced. Absolutely all collagen hemostatics dissolve on their own in the wound over time.

Features of wound healing after tooth extraction

Before moving directly to hemostatic sponges, what they consist of and how to use them, you need to understand how the wound heals after removal and what can go wrong here. More on this later.

Why is there bleeding after removal?

Bleeding is a natural reaction to surgery. After all, when a tooth is removed, the smallest capillaries that penetrate the gums and ligamentous apparatus - the periodontium, which attaches the roots to the bone socket - are torn. And with difficult removal, the bleeding may be even stronger, because... The dentist makes incisions in the gums and drills into the jaw bone - the tissue is more damaged.

Bleeding is a natural reaction to surgery

Read on the topic: How long can a tooth hurt after extraction - normal and pathological.

How long does bleeding last normally?

Normally, the blood stops within 15-20 minutes (less often, within 45 minutes) and a blood clot forms in the socket. It seals the hole like a cork, preventing germs from penetrating inside. If the patient has problems that affect blood clotting, then the bleeding time is prolonged, and a clot may not form at all. And this is already fraught with inflammation of the bone socket (the pathology is called “alveolitis”). Therefore, according to indications, the dentist applies a hemostatic drug to the area of ​​the extracted tooth.

On a note! Bleeding may appear again for a short time (and there will be quite a bit of blood) after the anesthetic wears off - if it contained adrenaline. This substance narrows the blood vessels in the intervention area, and as they expand normally, slight bleeding occurs. It goes away quickly.

Why does the bleeding not stop for a long time?

As a rule, after tooth extraction, the dentist says that you should not eat or drink for 2 hours. But few people say that you should not rinse your mouth or suck drinks out of a straw. In the first days, only oral baths are allowed, and it is better to drink in the usual way. Also, do not touch the wound with a brush. It is better to chew food on the healthy “side” of the jaw. Otherwise, there is a risk of moving or “pulling” the clot out of the hole - which will provoke new bleeding or even inflammation, which will result in long-term treatment.

The following groups of patients are also at risk:

• who has not formed a blood clot,
• with blood diseases,
• who takes blood clotting medications,
• having high blood pressure,
• women during menstruation or menopause,
• exposing themselves to physical activity immediately after removal and during the recovery process,
• if there was already inflammation at the extraction site (for example, pericoronitis above a wisdom tooth),
• during complex operations: when several teeth were removed at the same time, or manipulations were performed with increased tissue trauma.

Bleeding may occur during physical exertion after removal.

When you need urgent help

If the bleeding is profuse and does not stop for a long time, if after normalization of the condition the blood begins to ooze heavily again, this is a reason to consult a dentist. In a situation where the patient, in the presence of continuous bleeding, feels weakness, apathy, if the temperature has risen sharply (above 39 degrees Celsius), it is better to call an ambulance or go to the hospital on your own.

How to cure a chronic wound?

But what to do if prevention does not help? Treatment of long-term non-healing wounds depends on their type, the condition of the patient and the underlying disease. The main thing is to identify the root cause of the resulting pathologies in order to prevent the condition from worsening.

Treatment of diabetic foot syndrome:

1. Taking antibiotics prescribed by a doctor against infection, treating and cleaning wounds by the doctor himself.
2. Quitting bad habits and reducing the load on the foot.
3. Selection of shoes and socks on the recommendation of a doctor, changing them regularly.
4. Continue therapy at home: clean the wound, monitor discharge, and protect it from infection.

Treatment of trophic ulcers:

1. Conservative therapy - taking medications to eliminate the symptoms of trophic lesions: antibiotics, phlebotonics, antiplatelet agents, as well as ointments for treating the skin (Solcoseryl, Actoverig, Tocopherol).
2. Treatment of affected tissues with an ointment containing an antiseptic, an anesthetic or enzymes that accelerate healing (Levomekol, Levosin, Curiosin). Used with compresses.
3. Surgery – after the ulcers have healed, the doctor restores blood flow through shunting and phlebectomy.

Treatment of bedsores:

1. Restoring blood circulation using anti-decubitus circles, anti-decubitus mattresses, pillows.
2. Cleansing the damaged area of ​​necrotic tissue. If necessary, the doctor prescribes antibiotics to prevent infection. Surgical removal of necrotic masses is also possible.
3. Procedures for healing bedsores include regular dressings with the use of wound-healing drugs.

Hemostatic sponge price

The specified drug is easy to find on the open market, but it is also easy to order via the Internet on thematic websites from detailed catalogs. In the latter case, it turns out to be somewhat cheaper, and delivery is not delayed. Before making such a relevant purchase for yourself, it is important to find out not how much the hemostatic sponge costs, but whether it is suitable for the patient’s specific clinical picture or not. If there are no medical contraindications for use, you can use reliable information from the table below with metropolitan prices: