Oxidized regenerated cellulose (ORC) is a type of biomaterial derived from cellulose, a natural polymer found in plant cell walls. It is commonly used in medical applications, particularly in surgery, as a hemostatic agent and for tissue reinforcement.

Oxidized Regenerated Cellulose (Surgicel SNoW) is a modified form of cellulose that swells and forms a meshwork when comes in contact with blood. It is used in hemostasis to control bleeding when other measures are not practical.

Oxidized regenerated cellulose Uses:

• Hemostasis:
  • It is used in conjunction with other surgical procedures to control bleeding (from capillaries, veins, or small arteries) when other measures to control bleeding may not be effective or are impractical.

Oxidized Regenerated Cellulose (Surgicel SNoW) Dose in Adults

Oxidized Regenerated Cellulose (Surgicel SNoW) Dose in the Hemostasis:

• When you have a bleeding wound, a small amount of oxidized regenerated cellulose is placed on it or pressed against the bleeding area until the bleeding stops.
• Once the bleeding has stopped, any extra cellulose is removed.
• It's a simple and effective way to control bleeding during surgery or other medical procedures.

Use in Children:

It can be used in children to stop bleeding during surgeries. It has been used in children with epistaxis and following adenoid surgery to control bleeding.

Pregnancy Risk Category: C

• Oxidized regenerated cellulose has been studied for its use in gynecologic surgeries.
• Researchers have looked into its effectiveness and safety in these procedures.

Dose in Renal disease:

No dosage adjustment has been provided in patients with renal disease.

Dose in Liver disease:

No dosage adjustment has been provided in patients with liver disease.

Side effects of Oxidized Regenerated Cellulose (Surgicel SNoW):

It may have local side effects such as erythema, redness, and pruritis.

Neurotoxic side effects have been mentioned when it is placed near nerves for the control of dental procedures-related bleeding.

Contraindications to Oxidized Regenerated Cellulose (Surgicel SNoW):

• If someone is allergic to any part of the substance, it shouldn't be used. It's not for use directly on open blood vessels or for fixing bone breaks.
• Also, it's not suitable for stopping heavy bleeding from big arteries or for situations where there's ooze but no blood.
• And it's not meant to be used to prevent tissues from sticking together after surgery.

Warnings and precautions

Reactions of foreign bodies:

• Sometimes, the body might react to the presence of this substance as if it's a foreign object.
• To minimize this risk, it's important to remove any extra product before closing up the surgical area.
• This helps the substance absorb better and lowers the chances of a reaction happening.

Pain/ numbness/ nerve damage/ paralysis:

• Using this substance near bones or sensitive nerves can lead to problems like pain, numbness, nerve damage, or even paralysis.
• It's especially risky if it's close to the optic nerve or other important nerves in the body.
• To reduce these risks, only use the smallest amount needed to stop bleeding.

Monitoring parameters:

• Monitor the site for hemostasis/ bleeding.
• Monitor CBC, coagulation profile, and the site for infection.
• Monitor for neurotoxicity if the product is placed near a nerve.

How to administer Oxidized Regnerated Cellulose (Surgicel SNoW)?

Topical Application:

• Pad: These pads can be stitched onto or cut without unraveling.
• Powder: The powder form is dry, but it might be tricky to apply exactly where you want it in some situations. Be careful not to trim the applicator tip, and remember it's not designed for use in laparoscopic or other endoscopic procedures.

Mechanism of action of Oxidized Regenerated Cellulose (Surgicel SNoW):

• Oxidized regenerated cellulose works by absorbing blood at the bleeding spot, swelling up into a gel-like mass that helps clot formation.
• When used sparingly, it gets absorbed without causing much irritation to the surrounding tissues.
• Besides stopping bleeding, it also has properties that kill bacteria, as shown in laboratory tests.
• Interestingly, adding thrombin doesn't make its blood-stopping effect stronger.

Absorption:

• After being used, oxidized regenerated cellulose typically gets absorbed by the body within 7 to 14 days.
• During this time, it gradually breaks down and disappears, allowing the treated area to heal naturally.

International Brand Names of Oxidized regnerated cellulose:

• Interceed;
• Surgicel SNoW 1"x2"
• Surgicel SNoW 2"x4"
• Surgicel SNoW 4"x4"

Oxidized regenerated cellulose Brand Names in Pakistan:

Surgicel