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Note: Use minimum amount of product necessary to produce hemostasis; once hemostasis attained, excess product should be removed. Dental sponge: Insert rolled sponge (dry or wet) into cavity or socket; apply light finger pressure for 1-2 minutes Sponge: Apply appropriate size (dry or wet) with moderate pressure directly to bleeding site until bleeding stops; if first application does not stop bleeding, additional applications may be used with a new sponge Powder: Apply paste to bleeding surface; remove excess paste when bleeding has stopped. Consult manufacturer’s labeling for additional information.

Neurosurgery, thoracic, or ocular surgery (Gelfilm®): Use as directed per manufacturer’s labeling. Dosing: Pediatric Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosage Forms: U.S. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Film, ophthalmic: Gelfilm®: (6s) Film, topical: Gelfilm®: (1s) [100 mm x 125 mm] Powder, topical: Gelfoam®: (1 g) Sponge, oral topical [dental]: Gelfoam®: (12s) [Size 4] Sponge, topical: Gelfoam®: (6s) [Compressed-Size 100] Gelfoam®: (6s) [Size 100] Gelfoam®: (12s) [Size 12-7 mm] Gelfoam®: (6s) [Size 200] Gelfoam®: (4s) [Size 50] Generic Equivalent Available: U.S. No Administration Sterile technique should be used when removing product from package. Sponge (Gelfoam®): Cut sponge to required size; dry or wet sponge may be applied to bleeding site. Dry sponge: Manually compress dry sponge prior to application to bleeding site; hold in place with moderate pressure until bleeding stops Wet sponge: Immerse sponge in sterile saline, remove from solution, squeeze between gloved fingers to remove air bubbles, and return to saline solution until needed. Sponge should return to original size after air is expelled. Wet sponge may be blotted to dampness on gauze prior to application and may be held in place with a small gauze sponge until bleeding stops. Remove gauze from sponge by wetting with a few drops of sterile saline. Powder (Gelfoam®): Prepare a puttylike paste by placing the powder into sterile beaker and adding ~3-4 mL of sterile saline. Use Adjunct to provide hemostasis in surgical procedures; adjunct in neuro, thoracic, or ocular surgeries to promote tissue repair and/or prevent adhesions (Gelfilm®) Adverse Reactions Significant Frequency not defined: Central nervous system: Fever Local: Abscess and infection formation Miscellaneous: Foreign body reactions, encapsulation of fluid and hematoma Adverse events reported when used in various surgical procedures (Gelfoam®): Cardiopulmonary bypass surgery: Atrial fibrillation (13%), wound infection (6%), heart failure (4%), atrial flutter (2%), peripheral vascular disorder (2%), pneumothorax (2%), respiratory arrest (2%), respiratory failure (2%), ventricular tachycardia (2%), fever (1%), heart block (1%) Implant in brain: Compression of brain and spinal cord, giant-cell granuloma

Cardiopulmonary bypass surgery: Atrial fibrillation (13%), wound infection (6%), heart failure (4%), atrial flutter (2%), peripheral vascular disorder (2%), pneumothorax (2%), respiratory arrest (2%), respiratory failure (2%), ventricular tachycardia (2%), fever (1%), heart block (1%) Implant in brain: Compression of brain and spinal cord, giant-cell granuloma Laminectomy operations: Arachnoiditis, bladder and bowel dysfunction, cauda equine syndrome, headaches, impotence, meningitis, pain, paresthesias, spinal stenosis Nasal surgery: Toxic shock syndrome Tendon repair: Fibrosis, fixation of tendon prolonged Tympanoplasty: Failure of absorption, hearing loss Contraindications Gelfilm®: There are no contraindications listed in the manufacturer’s labeling. Gelfoam®: Hypersensitivity to porcine collagen; intravascular placement (embolus risk); closure of skin incisions (interferes with healing) Warnings/Precautions

Disease-related concerns: • Infection: Do not use in the presence of infection; if signs or symptoms of infection or abscess develop in an area where placed, reoperation may be necessary to remove material and allow drainage. • Postpartum bleeding/menorrhagia: Do not use to control postpartum bleeding or menorrhagia.

Other warnings/precautions: • Appropriate use: Products are not a substitute for surgical technique or conventional hemostasis procedures and should not be used for primary treatment of coagulation disorders. Use minimum amount necessary; remove once hemostasis is attained whenever possible following laminectomy procedures and from foramina in bone. Do not overpack cavities; Gelfoam® expands by absorbing fluid and may interfere with normal function of neighboring structures. It is not recommended to saturate product with an antibiotic solution or dust with antibiotic powder. Do not use in conjunction with methylmethacrylate adhesives. • Sterilization: Products cannot be resterilized; unused, opened products should be discarded. Metabolism/Transport Effects None known. Drug Interactions (For additional information: Launch Lexi-Interact™ Drug Interactions Program ) There are no known significant interactions. Pregnancy Implications When administered topically, gelatin is completely absorbed; however, the amount of gelatin available systemically following topical application is unknown. Pricing: U.S. (Medi-Span®)

Misc (Gelfoam Sponge External) 12-7 mm (12): $123.77 Mechanism of Action Arrests bleeding by forming artificial clot and producing mechanical matrix which facilitates clotting Use of UpToDate is subject to the Subscription and License Agreement . Topic 8947 Version 30.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [0604-115.66.252.144-6ED53622C5-S244013.14]