12 This required preparation is not problematic in an elective surgery setting, in which clinicians can frequently predict the need for a hemostatic agent and can prepare it ahead of time; however, preparation requirements make Tisseel an impractical choice in the emergency setting. Evicel incorporates human pooled plasma thrombin and human pooled fibrinogen.13 Evicel can be frozen for as long as two years at −18° C (−0.4° F), and thawing can require up to 10 minutes.13 The agent can also be refrigerated for as long as 30 days at 2° C to 8° C (35.6°

F to 46.4° F), allowing it to be quickly available with only a few minutes of preparation time. One important benefit of Evicel is that it can be connected to a pressure regulator to form a thin film over broad bleeding surface areas with no distinct bleeding JNK phosphorylation site.13 Evicel also can be applied to control oozing from major blood vessels after bleeding has been controlled with silk sutures.13 Research has found that fibrin sealants are more effective than standard topical hemostats in achieving hemostasis.24 For example, in a prospective multicenter trial, 121 patients undergoing liver selleck products resection were randomly assigned to receive treatment with either Crosseal (the predecessor of Evicel) or a standard topical hemostatic agent such as Surgicel or

Gelfoam.24 The researchers found that the mean time to hemostasis was 282 seconds in the group receiving Crosseal, whereas 468 seconds was required to control bleeding in patients who were treated with a standard agent (P = .06). In addition, 91.4% of patients receiving Crosseal achieved hemostasis within 10 minutes, compared with 69.8% of patients treated with a standard topical hemostat (P = .003). 24 Furthermore, the postoperative complication rate was lower in the group receiving Crosseal compared with the standard agent cohort, at 17.2% versus 36.5%, respectively—suggesting that fibrin sealants are more effective in achieving hemostasis.

24 Hemostatic dressings Etoposide chemical structure are a relatively new hemostatic option that was initially used in combat situations and is increasingly being used in civilian settings. Although use of these dressings outside the combat setting currently is likely limited to large trauma centers, their use in the prehospital setting is increasing. This increased use necessitates that perioperative nurses be familiar with these products, because these may begin appearing more frequently in the surgical setting after preoperative trauma management. A wide variety of hemostatic dressings have been developed for military and civilian use. One effective hemostatic dressing, HemCon®, includes chitosan, a substance derived from shrimp shells. Chitosan has mucoadhesive properties that enable the HemCon bandage to stick to the wound, forming a seal to stop bleeding.