Hemostasis

Product Introduction: The HemCon Bandage

Mary Pappas, RN, Shari Slyder, RT(R), Tiana Riley, RN, Kathleen Nolan, RT(R)(CV), Alexandra Martyniuk, RT, Thomas Matella, RT(R)(CV), Zahid Amin, MD, and Ziyad M. Hijazi, MD, MPH, FSCAI, FACC, FAAP Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois
Mary Pappas, RN, Shari Slyder, RT(R), Tiana Riley, RN, Kathleen Nolan, RT(R)(CV), Alexandra Martyniuk, RT, Thomas Matella, RT(R)(CV), Zahid Amin, MD, and Ziyad M. Hijazi, MD, MPH, FSCAI, FACC, FAAP Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois
The world of medicine is fascinating. Each day presents itself with new opportunities to learn, invent, and most importantly, heal. In our years of working in cardiology, we have come across countless medical products and techniques, many of which we have chosen to incorporate in our practice at Rush University Medical Center. While patient safety will always be the primary concern, we cannot ignore the business aspects of financial and safety issues that exist in the acute setting. As medical professionals, we are all searching for products that will improve patient care while decreasing both infection risk and hospital spending. We have found that use of the HemCon Bandage in our cardiac cath lab speeds hemostasis, increases patient comfort and may help to prevent infection, in addition to saving time and money. About the HemCon Bandage HemCon hemostatic bandages and dressings (HemCon Medical Technologies Inc., Portland, OR) are composed of chitosan, a naturally occurring, biocompatible polysaccharide derived from shrimp shells. The chitosan is processed, lyophilized (freeze-dried), into bandages and then sterilized. When applied to bleeding wounds, the chitosan bandage seals the wound and stops bleeding — even severe arterial bleeding — within about five minutes. The bandage also acts as an antibacterial barrier against such micro-organisms as MRSA, VRE and acinetobacter baumannii, which may help to prevent hospital-acquired infections. It’s also possible that transmission of infection to other patients and health care workers may be limited as a result of the bandage. The HemCon bandage was originally created in 2003 for U.S. soldiers on the battlefields of Afghanistan and Iraq. It was developed for use by the U.S. Army to control hemorrhaging so that injured soldiers could be stabilized and transported for surgical intervention. The bandage continues to be used to stop bleeding from IED explosions, flying shrapnel and small firearms wounds. The HemCon Bandage is easy to use, flexible, portable and durable. Cleared by the FDA since 2003, the current HemCon Bandage indication is for the external, temporary control of severely bleeding wounds, intended for emergency use. The HemCon Bandage also controls bleeding in patients following hemodialysis and is indicated for the control of bleeding from the skin at percutaneous needle access, vascular access and percutaneous catheter access sites. HemCon dressings control bleeding by becoming extremely adhesive when in contact with blood. The bandage carries a positive charge; red blood cells are negatively charged and therefore attracted to the bandage. The adhesion seals the wound and stops hemorrhage. The HemCon Bandage is made with a non-stick labeled backing on one side to assist in the application process and prevent adhesion to healthcare personnel. The bandage functions independently of the clotting cascade and allows the body’s natural clotting process to occur in conjunction with acute wound healing. HemCon Bandages are effective on high-pressure, high-flow arterial bleeds and have proven successful in situations where gauze, pressure dressings and other hemostatic agents fail. Cath Lab Usage This type of hemostatic bandage can be extremely beneficial to catheterization labs in multiple ways. The most obvious benefit is its ability to stop severe bleeding at catheter insertion sites. Available in various sizes, the 2” x 2” HemCon Bandage is the most effective size to help catheterization patients reach hemostasis safely. At Rush, our most common use of the HemCon Bandage is on our cardiac cath lab interventional patients. If we choose not to use a closure device, the bandage serves as an enhancement to direct pressure protocol. We also turn to HemCon Bandages if a vascular closure device fails or where continuous oozing or bleeding occurs. According to The Journal of the American Medical Association and RxList.com, more than 90 million adults in the U.S. take aspirin regularly for long-term prevention of cardiovascular disease or take one of three leading blood-thinning prescriptions each year. Since low-dose aspirin regimens interfere with the body’s blood clotting ability, it can be difficult to control blood loss in these patients. However, since the HemCon Bandage creates an adhesive seal, it works just as well on anticoagulant patients as it does for those not on anticoagulant medications. Additionally, the bandage works well for the 5 to 8 percent of U.S. residents that suffer from clotting disorders1 and the thousands of U.S. residents with bleeding disorders.2 Infection Control Infection control is becoming of increasing concern in medical facilities. In addition to a direct concern for patient health, hospital-acquired infections add an estimated $30.5 billion annually to U.S. hospital costs. Patients, taxpayers and insurers pay a portion of that cost, but hospitals absorb much of it.3 In October 2008, the Center for Medicare and Medicaid Services (CMS) ended payments to hospitals for additional costs associated with treating patients for certain hospital-acquired infections and medical errors. CMS will no longer pay for care associated with treating certain catheter-associated urinary tract infections, vascular catheter-associated infections, mediastinitis after coronary artery bypass graft (CABG) surgery, and five other medical errors unrelated to infections (bed sores, objects left in patients’ bodies, blood incompatibility, air embolism and falls).4 So, what does that mean for cath labs? Our medical facilities will bear the responsibility for preventable infection costs. Catheter site infections are minimal, but when they do occur, they can be disastrous for patients and expensive for facilities. Our infection management practices are aided with use of the antibacterial HemCon Bandage. Patient Care Used frequently with no reported negative effects, the HemCon Bandage has surpassed the use of other hemostatic agents at Rush University Medical Center. In a controlled study of 20 femoral venous and/or arterial sheaths undergoing elective percutaneous diagnostic or therapeutic procedures performed by our group to outline our initial experience with the Hemcon patch, we successfully decreased our hold time and bed rest requirements. Prior to use of the HemCon Bandage, pressure was held anywhere from 7-28 minutes, depending on sheath size and access type (arterial vs. venous). Our time holding pressure was decreased to a mean of 11 minutes, consistently, with all sheath size and access types. We ambulated all patients after four hours with no complications. Our facility was also able to try HemCon’s new, smaller 1.5” x 1.5” patches. This is a smaller, more flexible patch. It is easy to identify the active side of the patch, making it a smooth transition from the previous patches. The improved flexibility of the patch was beneficial as it conformed to the shape of the fingers holding the groin, allowing for added control at the puncture site and reducing the risk of bleeding. A key difference our team observed was the ability to feel the arterial pulse through the patch. It is this ability to feel the pulse at the arterial level that assists in ensuring correct positioning. This was, in our opinion, a remarkable improvement. It is our expectation that the patch will continue to reduce patient ambulatory periods, manual hold times and hematoma risks. Since the HemCon Bandage controls bleeding within minutes, it also allows for increased staff resources and productivity in the lab. Less time spent holding pressure equals more time tending to other health care needs for staff and more comfort for the patient. Conclusion Hemostatic bandages and dressings provide a safe and effective option for achieving hemostasis. The HemCon Bandage’s external application make it a safe hemostatic option from an infection and distal embolization standpoint. It also eliminates the localized soreness occasionally associated with the presence of a foreign body (the closure device) in the groin area. The HemCon Bandage can also be used in conjunction with traditional closure devices and to enhance their value. It can be used to treat any oozing encountered after closure device deployment, and ultimately as a salvage approach to a failed closure device. HemCon bandages and dressings are available through Cardinal Health. For more information, visit www.hemcon. com or call (503) 245-0459.
References
1. Centers for Disease Control and Prevention. Blood Disorders: Thrombophilia/Clotting Disorders. Available at http://www.cdc.gov/NCBDDD/hbd/clotting.htm. Accessed February 16, 2009.
2. Centers for Disease Control and Prevention. Blood Disorders: Bleeding Disorders. Available at http://www.cdc. gov/NCBDDD/hbd/hemophilia.htm Accessed February 16, 2009.
3. The Committee to Reduce Infection Deaths (RID). RID: The Cost of Infection: Preventing Infections Makes Hospitals More Profitable. Available at http://www. hospitalinfection.org/costofinfection.shtml Accessed February 16, 2009.
4. Consumers Union. New Medicare Regulations Adopted to Reduce Certain Hospital Infections and Medical Errors: Medicare Will Withhold Payments To Hospitals For Failing To Keep Patients Safe. Available at http://www.consumersunion.org/pub/core_health_care/004786.html Accessed February 16, 2009.