MO781THE CATIONIC CELLULOSE BASED PAD REDUCE THE HEMOSTATIC TIME AFTER HEMODIALYSIS

Background and Aims In case of prolonged bleeding at the vascular access site after hemodialysis, a nurse must compress the bleeding site longer than usual. This situation causes the risk of intravascular thrombosis and consumes valuable time of both patients and staff. Therefore, effective hemostatic agents are desired. Nowadays, chitosan is considered as one of the strongest hemostatic substance. Nipro Corporation and Artisan-lab co., Ltd found the cationic cellulose could clot blood faster than chitosan in the activated clotting time (Figure). After carefully examining its safety and efficacy, it was approved as medicine by the Japanese Ministry of Health, Labor and Welfare. Then, a trial to verify its clinical efficacy as a hemostat was conducted in the Toshin Clinic. In our clinic, the timer is set on the hemodialysis machine after the needles are removed and pressure is started after hemodialysis. We examined how long the timer should be set to be able to sufficiently stop bleeding in case cationic-cellulose pads are used. Method Of the 150 hemodialysis patients treated at the Toshin clinic; patients who agreed to this trial were enrolled. We set a timer for 5 minutes initially using cationic-cellulose pads for hemostasis, and was shortened in the next trial by 1 minute if the bleeding had been stopped. If the patient did not consent, the timer was not shortened further. from April 15th to December 31st in 2020. We checked the bleeding evidence of the puncture sites at the timing of immediately after relieving their compression. At their following hemodialysis session, we also checked the existence of adverse effects at their puncture sites, such as contact dermatitis or infection. Results Ten patients (9 men and 1 woman, Age 58.5y ±13.1) agreed to participate in this study. In the case of stable hemostasis, we continued to shorten the time by 1 minute each time, and added 1 minute in case of bleeding. After searching for the shortest time to achieve stable hemostasis, we confirmed hemostasis an average of 14.2 times in all cases. The average time to set for the timer was 3.0 ± 0.94 minutes (2-5 minutes). Two patients refused to shorten the time set for the timer, the hemostasis time were 5 and 4minutes respectively. The hemostasis time in all the other cases was equal or less than 3 minutes. In one case, the hemostasis time was reduced to 3 minutes with a cationic cellulose pad, compared to 30 minutes with The Neoplaster hemostatic pad (Nipro Corporation) which is made with the carboxymethyl cellulose. Of the 142 case compressions performed, 1 case resulted in bleeding and required 2 minutes of additional compressions. All cases did not have any adverse effects such as redness, itching or pain of their hemostatic pad attached sites. Discussion This study showed that the average time to set for the timer, when using cationic cellulose pad was 3 minutes on average, without any adverse effects. Cationic cellulose pads can stop bleeding safely, quickly and stably. At present, clinically available strong hemostatic agents are too expensive to be applied for many patients. But the cost to get the cationic-cellulose to make hemostatic pads may be reduced enough to be distributed to many hemodialysis patients because this material is mass-produced for hair conditioner, shampoo, and toothpaste. Conclusion The average time set for the timer was estimated around 3 minutes using the cationic cellulose pad. The cationic cellulose pad can save precious time and efforts of both patients and staff through its quick hemostasis.

P1364CATIONIC CELLULOSE BASED PAD STOPS BLEEDING WITHIN FIVE MINUTES AFTER HEMODIALYSIS

Background and Aims In case of prolonged bleeding at the vascular access site after hemodialysis, a nurse must compress the bleeding site longer than usual. This situation causes the risk of intravascular thrombosis and consumes valuable time of both patients and staff. Therefore, the method that can surely stop bleeding from the puncture site in short time is desired. Nowadays, chitosan is considered as one of the strongest hemostatic substance. Nipro Corporation and Artisan-lab co.,Ltd found the cationic cellulose could clot blood faster than chitosan in the activated clotting time (ACT). After carefully examining its safety and efficacy, it was approved as medicine by the Japanese Ministry of Health, Labor and Welfare. Then, a trial to verify its clinical efficacy as a hemostat was conducted in the Yokohama Minami Clinic. Method 150 hemodialysis patients treated at the Yokohama Minami Clinic excluding those using catheters or having with good hemostasis were selected as candidates for this study. 127 patients (64 men and 63 women) among them agreed to participate in this study after our explanation. 547 times of 5 minutes’ compression hemostasis were performed to the patients using cationic-cellulose pads for hemostasis from December 29th in 2019 to January 3rd in 2020. We checked the bleeding evidence of the puncture sites at the both timing of immediately after relieving their compression and the start of the following session. At their following session starting, we also checked the existence of adverse effects at their puncture sites, such as contact dermatitis or infection. Results Five of 547 cases (0.9%) had bleeding immediately after their compression relieving, and they needed to prolong their compression (the average of prolongation time was 3.0 minutes). But the other 542 cases (99.1%) successfully stopped bleeding within 5 minutes. All cases except two cases with redness at the adhesive tape attached site did not have any adverse effects such as redness, itching or pain of their hemostatic pad attached sites, including one case who forgot to remove his hemostatic pad until 48 hours later. The nurses could reduce their efforts to check the patients’ hemostasis and work smoother than usual, throughout this study period. Discussion In most cases of this study, the cationic-cellulose pad could stop bleeding within 5 minutes without any adverse effects. This result suggests that this material has sufficient performance for clinical use. The cationic-cellulose used for the hemostatic pads in this study had already had high enough quality for clinical use and it was produced by Kao Corporation. At present, clinically available strong hemostatic agents are too expensive to be applied for every patient. But the cost to get the cationic-cellulose to make hemostatic pads may be reduced enough low to be distributed to all hemodialysis patients because this material is mass-produced for hairdressing agent. Conclusion The cationic cellulose pad can save precious time and efforts of both patients and staff through its quick hemostasis. Figure The cationic cellulose pad

Self-propelled particles that transport cargo through flowing blood and halt hemorrhage

Delivering therapeutics deep into damaged tissue during bleeding is challenging because of the outward flow of blood. When coagulants cannot reach and clot blood at its source, uncontrolled bleeding can occur and increase surgical complications and fatalities. Self-propelling particles have been proposed as a strategy for transporting agents upstream through blood. Many nanoparticle and microparticle systems exhibiting autonomous or collective movement have been developed, but propulsion has not been used successfully in blood or used in vivo to transport therapeutics. We show that simple gas-generating microparticles consisting of carbonate and tranexamic acid traveled through aqueous solutions at velocities of up to 1.5 cm/s and delivered therapeutics millimeters into the vasculature of wounds. The particles transported themselves through a combination of lateral propulsion, buoyant rise, and convection. When loaded with active thrombin, these particles worked effectively as a hemostatic agent and halted severe hemorrhage in multiple animal models of intraoperative and traumatic bleeding. Many medical applications have been suggested for self-propelling particles, and the findings of this study show that the active self-fueled transport of particles can function in vivo to enhance drug delivery.

Blood Thinners: From Heparin to Plavix

Three types of blood cells exist in the human body: red blood cells, white blood cells, and platelets, in addition to plasma, which takes up 55 percent of the blood’s volume. Red blood cells take up approximately 45 percent of the blood’s volume. They transport oxygen from the lungs to other body parts. White cells defend us against bacterial and viral invasions. Platelets (less than 1 percent of the blood), the third type of blood cells, are sticky little cell fragments that are involved in helping the blood clot, a process known as coagulation. Without platelets (even though they constitute less than 1 percent of blood), our blood would not be able to clot, and we would have uncontrolled bleeding. However, formation of blood clots is a double-edged sword. Clots are beneficial because they heal cuts and wounds; blood clots in the bloodstream are harmful because they block coronary arteries, constrict vital oxygen supplies, and cause heart attacks and strokes, more and more frequent modern maladies as the baby boomers get older. Whenever the body is cut or injured and blood comes into contact with cells outside the bloodstream, a tissue factor on these cells encounters a particular protein within the blood, which triggers the clotting process. In the same vein, a series of other blood factors then come into action and amplify one another to quickly form a jelly-like blood clot. Blood clots form when an enzyme called thrombin marshals fibrin (a blood protein) and platelets (tiny cells that circulate in the blood) to coagulate at the site of an injury. Individuals with no ability to clot have a genetic condition called hemophilia; such people are also known as “bleeders.” Queen Victoria was hemophilic, and she passed on her genes to her many heirs who ruled Europe for over a century. This is why hemophilia is sometimes known as the royal disease. Symptoms of hemophilia manifest only in male offspring. People with hemophilia must periodically administer a clotting factor to their blood to prevent constant bleeding.