1. Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S. In Vitro Antimicrobial Activity of Oxidized Cellulose Against Antibiotic-Resistant Microorganisms. Surg Infect. 2003;4(3):255-262
2. Hong Y, Loughlin K. The Use of Haemostatic Agents and Sealants in Urology. J Urol. 2006;176:2367-2374.
Full Prescribing Information
Oxycel is used as an adjunct treatment to help haemostasis in bleeding from the capillaries and other small vessels, when conventional methods of haemostasis are inadequate, or not applicable. It may be used in surgical procedures and in the control of epistaxis.
Oxycel should be used with due observation of sound surgical technique, including surgical haemostasis by accepted methods, and in accordance with recommended procedures for application.
Oxycel is contraindicated in clean bone surgery when vascularisation is poor and in instances when rapid callus formation is desired. It must not be used in infected wounds without adequate drainage. Oxycel is not intended for use in the treatment of surface wounds.
Haemostatic agents such as Oxycel are not substitutes for careful surgery and proper use of clamps, sutures, ligatures and pressure. These agents are adjuncts to be used particularly when conventional methods fail adequately to control oozing or microscopic bleeding. It is recommended to use only the amount of Oxycel that is necessary for haemostasis, to remove all excess prior to surgical closure to facilitate absorption, and to minimize the possibility of foreign-body reaction.
Oxycel is best employed by loosely packing it against the bleeding surface. Wadding or packing should be avoided, especially within the bony enclosure of the central nervous system, and within other relatively rigid cavities, where the extra pressure induced by the swelling mass may interfere with normal function and even cause necrosis.
Use sparingly to control bleeding in open reduction fractures and in cancellous bone, to minimize the possibility of interference with callus formation and the theoretical chance of cyst formation – remove any excess after bleeding is controlled.
Though Oxycel may be left in clean wounds without drainage, provided excess material has been removed, closure in contaminated wounds is hazardous unless adequate drainage can be maintained.
Oxycel is supplied as a sterile preparation. However it will not withstand autoclave temperatures or other types of heat sterilization. Oxycel should be removed aseptically from the container and unused portions from opened containers should be discarded.
Since absorption of Oxycel is prevented in chemically cauterized areas, its use should not be preceded by application of silver nitrate or any other escharotic chemical. Avoid fresh blood on instruments when handling Oxycel as this may cause its adherence to the instruments.
If Oxycel is used temporarily to line the cavity of large open wounds, it should be placed so as not to overlap the skin edges. It should also be removed from open wounds by forceps, or by irrigation with sterile water or saline solution, after bleeding has stopped.
Oxidized cellulose should not be impregnated with penicillin, or other anti-infective agents. If antimicrobial therapy is indicated, it should be given systematically.
Do not use Oxycel in conjunction with other haemostatic agents, such as thrombin, except in patients unusually prone to bleeding, such as those with haemophilia. If used with thrombin, the solution should be rendered more alkaline to avoid inactivation of thrombin.
Adverse reactions, particularly foreign-body reactions, may occur, but the possibility is minimised by using the least amount of Oxycel required for haemostasis, and by observing all other instructions for proper use of the product (see indications, contraindications, and precautions).
Adverse reactions, though reported infrequently, have included:
· foreign-body reactions, with or without infection
· necrosis of nasal mucous membrane, or perforation of nasal septum due to tight packing
· intestinal obstruction due to transmigration of the product from the gallbladder bed to the terminal ileum, or due to adhesions in a loop of denuded intestine to which the product has been applied
· urethral obstruction following retropubic prostatectomy and introduction of the product within enucleated prostatic capsule
Preparation for use:
Sterile technique should be observed in removing Oxycel from its double wrapped pouch. Usually the circulating nurse or attendant in the operating area opens the outer pouch and delivers the sterile inner pouch into the sterile field.
The inner pouch is then opened and the Oxycel is handed to a member of the surgical team. Unused Oxycel should be discarded, since it cannot be resterilised.
Oxycel should be applied in a dry state and should not be moistened prior to application. Upon contact with blood, Oxycel quickly adheres to any bleeding sites to which it is applied. After 24 to 48 hours it becomes gelatinous and can be removed, usually without causing additional haemorrhage.
Absorption, under optimum conditions, takes place without undue foreign–body reaction. Oxycel swells upon contact with blood, adding pressure to the normal haemostatic action. Generally, Oxycel is best used by loosely packing it against the bleeding surface.
In small quantities Oxycel may be used in the same general manner as cotton gauze. Whenever brisk bleeding is present, pressure is also required for adequate bleeding control.
If Oxycel is used in wounds of incised or lacerated organs, closure without drainage may be accomplished, provided the wound is not infected. If the wound is infected, drainage should be maintained.
If Oxycel is used temporarily to line the cavity of large open wounds, it should be placed so as not to overlap the skin edges. When Oxycel is used for haemostasis in open wounds, it should be removed by forceps, or irrigation, after it has served its purpose.
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