Surgicel: Minimal amounts in appropriate size of cellulose are laid or applied to the bleeding site or held firmly against the tissues until hemostasis occurs; remove excess material.
Pelvic adhesion reduction: Topical:
Interceed: Following hemostasis, apply in single layer on and between raw (denuded) surfaces.
Refer to adult dosing.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Cardiovascular: Vascular insufficiency (stenosis when applied as a wrap)
Gastrointestinal: Intestinal obstruction (after small bowel biopsy) (Bakhit 2019)
Genitourinary: Difficulty in micturition (after prostatectomy), ureteral obstruction (after kidney resection)
Hypersensitivity: Anaphylaxis (Corti 2021), angioedema (Corti 2021)
Local: Application-site burning, application-site edema (encapsulation)
Nervous system: Foreign body reaction (Lin 2014), headache, neurotoxicity, paralysis, paraplegia (after thoracotomy) (Brodbelt 2002), stinging sensation
Ophthalmic: Blindness (when placed in anterior cranial fossa), optic neuropathy (compressive: after orbital surgery) (Arat 2006)
Respiratory: Sneezing (epistaxis and rhinological procedures)
Surgicel: Implantation into bone defects (eg, fractures); hemorrhage from large arteries or veins; nonhemorrhagic oozing; use as an adhesion prevention product; intraluminal procedures or use in open blood vessels. Note: Multiple products are available and contraindications may vary by product; also refer to manufacturer's labeling.
Concerns related to adverse effects:
• Foreign body reactions: Have occurred. Remove excess product before surgical closure to facilitate absorption and reduce risk.
• Pain/numbness/nerve damage/paralysis: Pain, numbness, nerve damage, and paralysis have been reported if used near a bony or neural space and/or the optic nerve and chiasm; use minimum amount necessary to achieve hemostasis.
Dosage forms specific issues:
• Powder: Unintentional placement may result in powder scattering and device migration that may increase the risk of adhesion formation. Do not use in conjunction with autologous blood salvage circuits (fragments may pass through the transfusion filters of blood-scavenging system).
• Appropriate use (Interceed): Not indicated as a hemostatic agent. Appropriate means of achieving hemostasis must be employed. Safety and effectiveness in laparoscopic surgery or any procedures other than open (laparotomy) gynecologic microsurgical procedures have not been established. Also refer to manufacturer's labeling for additional warnings/precautions.
• Appropriate use (Surgicel): The material should not be moistened before insertion since the hemostatic effect is greater when applied dry. The material should not be impregnated with anti-infective agents or with other materials such as buffering or hemostatic substances. Remove as much of agent as possible with sterile water or saline solution after hemostasis is achieved. Do not leave in a contaminated or infected space without drainage. Always remove completely following hemostasis if applied in proximity to foramina in bone, areas of bony confine, the spinal cord, and/or the optic nerve and chasm; product may swell and exert unwanted pressure. Although packing or wadding sometimes is medically necessary, cellulose should not be used in this manner, unless it is to be removed after hemostasis is achieved. In urological procedures, care must be exercised to prevent plugging of the urethra, ureter, or a catheter. In otorhinolaryngologic surgery, ensure that the material is not aspirated by the patient (eg, controlling hemorrhage after tonsillectomy and controlling epistaxis). In cauterized areas, absorption could be prevented in chemically cauterized areas; cellulose use should not be preceded by application of silver nitrate or any other escharotic chemicals. Also refer to manufacturer's labeling for additional warnings/precautions.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Interceed: (10 ea)
Surgicel Fibrillar: (10s, 24s)
Surgicel Nu-Knit: (10s, 24s)
Surgicel SNoW 1"x2": (10 ea)
Surgicel SNoW 2"x4": (10 ea)
Surgicel SNoW 4"x4": (10 ea)
Surgicel: 3 g (5 ea)
Topical: Note: Also refer to manufacturer's labeling for detailed administration instructions.
Adhesion barrier (Interceed): Place into surgical area as directed.
Pad (Surgicel): May be sutured or cut without fraying.
Powder (Surgicel): Powder is dry; precise delivery under certain circumstances may be difficult. Do not trim applicator tip (applicator tip not intended for laparoscopic or other endoscopic use).
Hemostasis (Surgicel): Adjunctive use in surgical procedures to control capillary, venous, or small arterial hemorrhage when ligation or other conventional methods of control are impractical or ineffective.
Pelvic adhesion reduction (Interceed): Adjuvant in open (laparotomy) gynecologic pelvic surgery for reducing the incidence of postoperative pelvic adhesions after meticulous hemostasis is achieved consistent with microsurgical principles.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Silver Nitrate: May diminish the therapeutic effect of Cellulose (Oxidized Regenerated). Risk X: Avoid combination
Information related to the use of topical hemostatic agents in gynecologic surgery is limited and use should be restricted to situations where preferred interventions are not ideal or are unsafe (ACOG 2020).
Interceed is approved for use as an adjuvant in open (laparotomy) gynecologic pelvic surgery to reduce the incidence of postoperative adhesions. Pelvic adhesions may be associated with pain and infertility; however, it is not clear if use of cellulose (oxidized regenerated) improves fertility or decreases pain (Ahmad 2020; ASRM/SRS 2019).
Surgicel is approved to control hemostasis associated with surgery and may be useful in gynecologic surgeries such as conization of the cervix, hysterectomy, and oophorectomy.
Information related to the use of topical hemostatic agents in gynecologic surgery is limited and use should be restricted to situations where preferred interventions are not ideal or are unsafe (ACOG 2020). Interceed has been evaluated for the prevention of intraperitoneal adhesions associated with cesarean delivery (Chapa 2011; Rottenstreich 2020). Use of Surgicel as adjunctive treatment of hemorrhage at the cesarean incision site has been described (Sharma 2006).
Cellulose, oxidized regenerated is saturated with blood at the bleeding site and swells into a brownish or black gelatinous mass which aids in the formation of a clot. When used in small amounts, it is absorbed from the sites of implantation with little or no tissue reaction. In addition to providing hemostasis, oxidized regenerated cellulose also has been shown in vitro to have bactericidal properties. Its hemostatic effect is not enhanced by the addition of thrombin.
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