Oxidized Regenerated Cellulose Versus Calcium Alginate in Controlling Bleeding From Malignant Wounds: A Randomized
Flávia Firmino1, Diana Villela-Castro, Vera Lucia Conceição de Gouveia Santos
1Author affiliations: Palliative Care Unit, National Cancer Institute of Brazil-INCA, Rio de Janeiro (Dr Firmino); and Nursing Department, Continuing Education, AC Camargo Cancer Centre (Dr Villela-Castro); Medical Surgical Department, Nursing School of the University of São Paulo, São Paulo, Brazil; and WCET Education Committee (Dr Santos).
Background:
There is no consensus on the best intervention for topical management of bleeding in malignant wounds. Although surgical hemostatic dressings are recommended, the use of calcium alginate (CA) is frequent among practitioners.
Objective:
The aim of this study was to evaluate the hemostatic efficacy of oxidized regenerated cellulose (ORC) and CA dressing in the management of bleeding from malignant wounds resulting from breast cancer.
Methods:
This was a randomized open clinical trial. The outcomes measured were total time to hemostasis and the number of hemostatic products used.
Results:
Sixty-one patients were potentially eligible for the study, 1 did not consent, and 32 were assessed to be ineligible, resulting in a sample of 28 who were randomized to 2 study groups. Total time to hemostasis was 93.8 seconds in the ORC group, with an average of 30.1 seconds (95% confidence interval, 18.6-189 seconds), and 67 seconds in the CA group, with an average of 30.4 seconds (confidence interval, 21.7 seconds to imprecise upper limit). The main difference was 26.8 seconds. Kaplan-Meier log-rank test, and Cox model showed no statistical significance ( P = 0.894). A total of 18 hemostatic products were used in the CA group and 34 in the ORC group. No adverse effects were identified.
Conclusions:
Although no significant differences were identified in terms of time, more hemostatic products were used in the ORC group, highlighting the effectiveness of CA.
Implications For Practice:
Calcium alginate may be the first choice in the management of bleeding in malignant wounds, favoring nursing in the most immediate hemostatic actions.
