topical epinephrine for wound hemostasis?

22 May

So your next patient has a good sized avulsion off the pad of his finger that’s still oozing despite his attempts at direct pressure.  

You also can’t find your Surgicel, and your patient hates needles.  You still have the lidocaine with epi in your pocket from when you thought you’d get to stitch something up, though.  Can we use this another way?

 

THE CONCEPT:

soak something (cotton ball/tip, gauze, etc) in epi, then mash it against the thing that’s bleeding

 

THE LOGIC:

epi (which also comes handily pre-mixed with lidocaine anesthetic in nice dilute doses) is a vasoconstrictor

-> better opportunity for platelets to not get swept away and form clot

dilute concentrations applied topically would seem to have less risk for harm than direct infiltration

 

SUPPORT?

quick Pubmed/internet biopsy is interesting, if with limited data:

one big review: 

  • delivery methods included epi + KY, epi-spray, sub-cut infiltration
  • epi achieved hemostasis faster than thrombin, saline, or mineral oil

 

other random discoveries:

  • lido + epi cotton balls shorted time to hemostasis in rabbit epistaxis
  • epi-soaked gauze reduced mean # of packings, cautery use, and procedure time in kids getting adenoidectomies
  • gauze-soaked epi used for tissue and gallbladder fossa hemostasis during a lap chole
  • suggested for hemostasis in circumcision (just don’t leave it on too long)
  • epi-soaked cotton products for dental procedures (just search the interweb “cotton epinephrine hemostasis”)

 

BOTTOM LINE:

mostly studied for ENT uses, but seems to help wound hemostasis

probably worth a shot.  keep it in your toolbox.

 

 

References: review articlerabbit epistaxisadenoidectomy; lap chole; circumcision; picture

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One Response to “topical epinephrine for wound hemostasis?”

  1. eystonvh May 22, 2015 at 08:15 #

    I’ve also seen Tranexamic Acid used in this way. Seemed very effective! Thoughts?

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