How do I apply Surgicel (oxidized cellulose)?

How to Apply Surgicel (Oxidized Cellulose)

Apply Surgicel directly to the bleeding surface using the minimum amount necessary to achieve hemostasis, ensuring the wound bed is dry and clean before application. 1

Pre-Application Preparation

• Ensure the bleeding area is dry and clean before applying Surgicel, as moisture prevents proper adherence and reduces hemostatic effectiveness 1
• Remove any debris, blood clots, or necrotic tissue from the wound site to create optimal contact between the hemostatic agent and bleeding tissue 1
• De-epithelialize the area if applying to epithelial surfaces to improve adherence 1

Application Technique

• Use one of three methods to apply Surgicel: a 30-gauge needle, the wooden end of a cotton applicator, or a micropipette 1
• Apply the least amount of Surgicel that will seal or support the bleeding site - excessive amounts increase infection risk and complications 1, 2
• Place Surgicel directly onto the bleeding surface with gentle pressure, allowing it to conform to the wound 1, 3
• For difficult-to-access bleeding areas (such as deep surgical sites or parenchymal injuries), Surgicel is particularly useful as an adjunct to traditional surgical techniques 1, 3

Critical Dosing Considerations

The amount of Surgicel used directly correlates with infection risk - studies show that 5-10 mg does not promote infection, but 20-30 mg significantly increases infection rates (45-90% infection with higher doses) 2, 4

Post-Application Management

• Leave Surgicel in situ after achieving hemostasis, as it is designed to be absorbed over 4-8 weeks 5, 6
• Consider applying a non-adherent dressing over the Surgicel if needed for wound protection 1
• Do NOT use Surgicel when autotransfusion is planned, as it has specific contraindications in this setting 1

Important Clinical Considerations

• Surgicel is recommended for venous or moderate arterial bleeding, particularly in parenchymal injuries where access is difficult 1, 3
• The mechanism works through physical absorption and creation of an artificial clot rather than direct coagulation cascade activation 3, 6
• Surgicel demonstrates superior hemostatic effectiveness compared to other agents like microfibrillar collagen, with better infection profiles when used in appropriate amounts 2, 4
• Consider patient factors including coagulation status, severity of bleeding, and type of surgical procedure when selecting Surgicel 1, 3

Common Pitfalls to Avoid

• Never apply excessive amounts - more is not better and significantly increases complication risk including infection and foreign body reactions 2, 5
• Do not apply to wet or actively bleeding surfaces without first achieving some degree of hemostasis through pressure or other means 1
• Avoid using Surgicel as a substitute for proper surgical technique - it should complement, not replace, traditional hemostatic methods 1, 3
• Be aware that retained Surgicel can rarely cause complications including pseudocyst formation, though this typically occurs only with excessive amounts left in situ 5