Classifications

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  • A61L2400/00—Materials characterised by their function or physical properties
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Definitions

• This invention relates generally to hemostatic products, and particularly to the surprisingly improved performance of a novel hemostatic device which includes potassium ferrate and a cationic exchange resin when applied to a bleeding or exudating wound.
• Cook et al. in U.S. Patent No. 2,923,664 disclose a hemostatic tablet formed by the wet granulation and compression of a mixture of cellulose g!ycolic acid ether and its sodium salt.
• Kuntz et al. in U.S. Patent No. 3,368,911 disclose a hemostatic sponge prepared by freeze drying acid swollen collagen fibrils.
• Pawelchak et al. in U.S. Patent No. 4,292,972 disclose a lyophilized hydrocolloid foam possessing hemostatic properties.
• the prior art illustrates the hemostatic tablet or sponge but provide little comparison with the powder or granulation from which the tablet originates from.
• a solid device preferably a tablet, formed from loose hemostatic powder is very dense due to the high compressive force to prepare the tablet.
• a loose powder compressed into a solid intuitively creates a less messy product application, but the compression process results in a reduction in surface area. Therefore, the free loose hemostatic powder would be expected to be faster acting compared to the solid tablet form of this material.
• This invention is directed to a novel hemostatic device (to be marketed by Biolife, L.L.C. under the trademark STATSEAL) and method of arresting the flow of blood from a bleeding wound which is prepared from a powder or powderous mixture that preferably includes an effective amount of an insoluble cation exchange material preferably combined with an anhydrous salt ferrate compound.
• the device as a solid tablet is applied to the wound by pressing the tablet against the wound for a time sufficient to clot the blood to arrest substantial further blood flow from the wound.
• Size enlargement or agglomeration is any process whereby small particles are gathered into larger, relatively permanent masses in which the original particles can still be identified.
• Applications include formation of useful shapes (e.g., brick and tile) and irregular pellets or balls for the industrial beneficiation of finely divided materials. Numerous benefits result from size-enlargement processes and, a wide variety of size-enlargement methods and applications are available, one of which is pressure compaction.
• Equipment used in pressure compaction includes piston or molding presses, tableting presses, roll-type presses, pellet mills, and screw extruders which provide for a wide variety of size-enlargement methods and applications.
• Agglomerate bonding mechanisms may be divided into five major groups: (1) solid bridges; (2) mobile liquid binding; (3) immobile liquid bridges; (4) intermolecular and electrostatic forces; (5) and mechanical interlocking. Robert H. Perry, ed. et al., (Perry's Chemical Engineers' Handbook, 6 ih ed., 8-60-8-61 1984).
• the STATSEAL hemostatic device of this disclosure prepared by pressure compaction, preferably from a powderous mixture of a potassium ferrate/strong acid cation exchange resin, provides improved delivery and control of the application onto the wound site without the messiness associated with loose powder application.
• the dense packing in, for example, a tablet in a topical application on a bleeding wound is expected to be slower acting compared to the free powder form of the same mixture in terms of the control of bleeding due to the reduction in surface area.
• the opposite was found to be true; the hemostatic tablet adhered more tenaciously to the bleeding wound than the powder and stopped bleeding faster.
• the solid hemostatic tablet can either be applied to a wound that is actively bleeding or to a site that may experience bleeding later.
• the solid hemostat may be used to also seal a site that is oozing exudative bodily fluids and create a seal in combination with blood or exudative fluids to keep the wound site dry, preventing maceration, while simultaneously preventing wound desiccation.
• the preferred 1 :7 ferrate hydrogen resin mixed powder, as an adjunct to pressure, creates a nothing-in/nothing-out seal in well-known ways with blood. a.
• the external semi- or non-occiusive vertical pressure is critical to achieving hemostasis. Without pressure, hemostasis is not consistently achieved.
• Range of the physical factors includes particle size, density, hardness, thickness, shape, dryness, and ingredient proportions.
• the preferred 1 :7 ferrate: hydrogen resin mixed powder is compressed to at least about 8K psi, a dense solid device is formed.
• the dense solid device preferably as a tablet, is able to withstand significant manuai pressure and such pressure provides a very strong and uniform force to bear on the wound surface.
• manuai pressure provides a very strong and uniform force to bear on the wound surface.
• the same pressure is not easily directed on the loose powder which is scattered unevenly and is relatively thin across the wound bed. Some areas have thicker powder coverage than others and still others with possibly no coverage at all.
• the non-uniform coverage of the loose powder on the wound site results in lower net pressure than the uniform and higher net pressure achievable through the use of a tablet.
• the uniform surface of the solid tablet more evenly displaces blood therebeneath, creating a more uniform seal, and reducing the chance of pooling of blood that may occur with an uneven loose powder application. Consequently, the tablet adheres faster to the bleeding wound and hemostasis is achieved earlier compared to the powder.
• the solid hemostatic device can be made to apply on all conceivable surfaces, including horizontal, vertical and angled surfaces. 5.
• the solid may be compression formed in different shapes or machined into different shapes after tablet formation. Machining may be performed with blades or lasers and may be used to score larger tablets to allow them to be broken into smaller shaped for application.
• the solid may be a extruded or a continuous ribbon of solid material as any form of mechanical compression may be used.
• the solid may be attached to adhesive bandages, swabs, surgical or dental instruments, vacuum devices and magnets, if the proper materials such as magnetite are mixed with the powder.
• the tools attached to the solid hemostat may be straight or bent, rigid or flexible.
• the solid hemostat may be a single uniform powder compressed into a tablet, or the powders may be layered.
• Microbial agents maybe added to the powder as a dry powder, absorbed into the resin, or added after the tablet is formed.
• the solid may be adhered to compression assisting devices such as balloons, compressed foams, mechanical clamps, and compression bandages.
• Additives such as fibrous material may be used to increase strength of the table, allowing it to be made thinner, flexible, moidabie during application, or to improve cosmetic appearance.
• the tablet may be adhered to a backing which may contain a microbial agent, an adhesive to hold the tablet in place protection of the tablet, or as a cosmetic function.
• the tablet may be applied to a bleeding wound after a previous treatment.
• the following embodiments and aspects thereof are described and illustrated in conjunction with systems, tools and methods which are meant to be exemplary and illustrative and not limiting in scope. In various embodiments one or more of the above- described problems have been reduced or eliminated while other embodiments are directed to other improvements. In addition to the exemplary aspects and embodiments described above, further aspects and embodiments will become apparent by reference to the drawings and by study of the following descriptions. BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWS NG ⁇ S)
• Figure 1 is a perspective view of a one-piece tablet embodiment of the invention.
• Figure 2 is a top plan view of Figure 1.
• Figure 3 is a side elevation view of Figure 2.
• Figure 3A is a perspective view of a two-piece tablet embodiment of the invention.
• Figure 4 is a perspective view of an alternate embodiment of Figure 1 showing the addition of a reinforcing foam backing.
• Figure 5 is a reverse perspective view of Figure 4.
• Figure 6 is a section view in the direction of arrows 8-6 in Figure 4.
• Figure 7 to 10 are perspective views showing the deployment of the embodiment of Figure 1 onto a patient's arm as an I.V. catheter is being removed.
• Figure 11 is a perspective view of another two-piece embodiment.
• Figure 12 is a top plan view of Figure 11.
• Figure 13 is a section view of arrows 13-13 in Figure 1.
• Figure 13A is a section view similar to Figure 13 showing the addition of a reinforcing foam backing.
• Figures 14 and 15 are perspective views of other one-piece tablet embodiments.
• Figure 16 is a section view in the direction of arrows 16-16 in Figure 15.
• Figures 17 to 24 are perspective and corresponding section views of hollow specialty configurations of the invention.
• Figures 25 to 27C are perspective views of other configurations of one or multiple- piece embodiments affixed to an adhesive bandage.
• Figures 28 to 33A are perspective views of other configurations of solid one-piece embodiments affixed to a delivery member.
• Figure 34 is a perspective view of another one-piece embodiment.
• Figure 35 is a section view in the direction of arrows 35-35 in Figure 34.
• Figure 36 is a perspective view of another one-piece embodiment.
• Figure 37 is a section view in the direction of arrows 37-37 in Figure 36.
• Figures 37A to 37E are section views of alternate embodiments of Figure 37.
• Figures 38A and 38B are top plan views of smaller pellets of the invention.
• Figure 39 is a perspective view of another one-piece tablet embodiment.
• Figure 40 is a section view in the direction of arrows 40-40 in Figure 5.
• Figure 41 is a perspective view of the embodiment of Figure 39 packaged with an I.V. cannula inserted through the centra! aperture.
• Figure 42 is a perspective view of the granules of Figure 38B stuck to the surface of a pliable wax-like shape for odd-shaped wounds.
• Figure 43 is a perspective view of the granules of Figure 38B attached to a length of cord, string or rope.
• Figure 44 is a perspective view of a hollow wafer embodiment encasing a foam inner core.
• Figure 45 is a section view in the direction of arrows 45-45 in Figure 44.
• Figure 46 shows a series of three separate pictorial representations of the percentage of whole beads to fragments thereof required to form the hemostatic device of this disclosure.
• Figure 47 is a pictorial view of the effect of thickness in formulating the hemostatic device of this disclosure.
• Figure 48 is a graphic display of hemostatic material density versus formation pressure.
• Figure 49 is a schematic view of a lab test set up to evaluate the ability of the solid hemostatic device versus the powderous form thereof to achieve adhesion to a blood surface.
• Figure 50 is a schematic view of an alternate lab test to that shown in Figure 49 wherein a syringe is utilized to achieve higher static pressure in evaluating the blood adhesion characteristics of a hemostatic tablet versus a free powder hemostatic material.
• Figure 51 is a graphic representation of the hemostatic device disintegration rate versus formation pressure.
• Figure 52 is a scanning electron microscope (SEM) photo of the hemostatic device of Figure 11 having been positioned around a vascular accessed cannula.
• Figure 53 is an enlarged view of area 53 in Figure 52.
• Figure 54 is a SEM side elevation view of the hemostatic device having been applied atop a bleeding wound. Exemplary embodiments are illustrated in reference figures of the drawings. It is intended that the embodiments and figures disclosed herein are to be considered to be illustrative rather than limiting.
• hemostatic body 50 50. hemostatic device 52. hemostatic body
• hemostatic device 102 112, 122, 132, 142, 152, 152'. hemostatic body 104, 114, 124, 134, 154, 154'. handle
• curvilinear body end 158 curvilinear body end 160. hemostatic device
• hemostatic device 210. hemostatic device
• the hemostatic powder composition used to form the hemostatic device of this disclosure marketed by Biolife, L.L.C. (assignee) under the trademark STATSEAL, preferably includes an effective amount of an insoluble cation exchange material preferably combined with an effective amount of an anhydrous salt ferrate compound.
• the hemostatic powder includes a mixture of the hydrogen form of a cation exchange resin (henceforth notated in short as hydrogen resin) and potassium ferrate.
• the hemostatic powder can be converted to a tablet by any known compression method into any size, shape, thickness and configuration.
• hemostatic powder can be incorporated into the hemostatic powder to enhance performance including: antimicrobial agent, zinc oxide, binders and excipsents for aiding tablet formation, magnesium stearate, sodium carboxymethy!cellu!ose, hydroxymethyl cellulose, polyvinylpyrrolidone, medical grade fibers for added strength, natural and synthetic gums.
• STATSEAL solid hemostatic devices are intended for use as a topical dressing for bleeding control associated with minor wounds, including control of minor external bleeding and exudates from sutures and/or surgical procedures.
• STATSEAL devices are preferably composed of two main components: one part potassium ferrate and seven parts hydrophilic polymer, by weight.
• Potassium ferrate is the oxyacid salt byproduct of the reaction between ferric acid (H 2 Fe0 4 ) and potassium hydroxide (KOH).
• Potassium fusion ferrate is manufactured by the thermal combination of iron oxide (FeaOs) and potassium nitrate (KN0 3 ). Potassium ferrate readily decomposes in water to produce Fe 2 0 3 and KOH as follows:
• the hydrophilic polymer is a strong acid cation ion-exchange resin formed of a sulfonated copolymer of styrene and divinylbenezene (2%) in the hydrogen form.
• the polymer used in STATSEAL devices (PUROLITE C-122 (H); CAS No., 069011-20-7) is purchased fully hydrated and is simply heat-dried to less than 3% moisture in preparation for combination with the potassium ferrate.
• STATSEAL hemostatic devices achieve their principle intended action (hemostasis) by creating a physical barrier or seai to the blood flow.
• the product establishes an environment in which a natural blood clot can build and form beneath the physical seal formed by STATSEAL.
• the hemostatic effect of the device is produced by two simultaneous modes of action:
• the procoagulating iron-based oxyacid salt coagulates the blood protein.
• the hydrophilic polymer rapidly dehydrates the blood and absorbs exudates.
• hydrophilic polymer and oxyacid salt reaction is illustrated below:
• the sea! begins to form immediately.
• the poiymer quickly absorbs the liquid portion of the blood stacking the blood cells beneath.
• the swollen wetted polymer will allow the portion of the solid hemostat that is in contact with the blood to delaminate from the remaining dry material.
• the remaining dry tablet may be either removed or held in place with a covering dressing. A small portion of the tablet materia! remains attached to the surface of the blood or seal. As the wound heals beneath the seal, the remaining material falls off the wound site.
• the extent of the persistent long term action can be designed by the size, shape and thickness of the tablet.
• the foregoing examples of size, shape and thicknesses of the tablet and limitations related therewith are intended to be illustrative and not exclusive.
• the hemostatic device can be made to apply on all conceivable surfaces, including horizontal, vertical and angled surfaces.
• the particle size of the hemostatic powder determines, in part, the integrity of the device, particularly in the absence of a binding agent.
• the preferred particle size range is 80 microns to 500 microns, more preferably, 150 to 300 microns. Below 80 microns, the seal is too thin and weak while above 500 microns, the seal is not uniform and too thick with weak spots.
• any form of insoluble cation exchange material can be selected as a component of the hemostatic tablet.
• the cation exchange material is a cation exchange resin that is crosslinked in the range of 0.25% to 15%.
• the hydrogen form the cation exchange resin is preferred over other cation forms.
• one embodiment of the invention is there shown generally at numeral 10 and includes a circular body 12 formed of hemostatic material, the content, physical properties of which will be described herebeiow.
• the body 12 sometimes referred to as a wafer body, a disc, or a tablet, includes an elongated cannula access slot 14 formed radially inwardly from the perimeter to the center of the body 12, terminating at a slot proximal end 16.
• radiused slot entrance corner 18 forming the inlet end of the cannula access slot 14 are provided.
• the hemostatic device 10 is positionable in the direction of arrow A so that the catheter, needle or cannula access slot 14 slides around the catheter and is positioned against the skin of the arm at the wound site W.
• the skin contact surface 15 of the hemostatic device 10 is then pressed against the skin in the direction of arrow C in Figure 8 for a time sufficient for the hemostatic material of the device 10 to interact with blood and exudate from the wound site W, after which the catheter is removed in the direction of arrow B.
• a transparent dressing is applied thereover to protectively cover and hold the hemostatic device 10 in position over the wound site.
• an alternate embodiment of the hemostatic device is there shown at numeral 11 and includes a body segment 25 having a central cannula access hole 19 formed therethrough,
• the body segment 25 includes a segment opening 21 into which a wedge-shaped body 17 may be inserted in the direction of the arrow after the cannula has been placed through the slot access cannula access hole 19.
• An access hole segment 23 completes the cannula access hole 19 surrounding the cannula when it is properly installed.
• FIG. 20 another embodiment of the invention is there shown at numeral 20 and includes the hemostatic device 10 of Figure 1 adhesively attached to a matingly shaped layer of rigid backing 24 which covers one surface of the body 12.
• the proximal surface of the body 12 defines the skin contact surface 15.
• Figure 6A which includes the previously described hemostatic device 10 formed of a body 12, the body 12 being comprised of compressed together hemostatic material 13 as described herebelow.
• Foam backing 22 is provided and includes edges 22a which completely surround the otherwise exposed perimeter edges of body 12, but do not cover the skin contact surface 15.
• a preferred embodiment of the invention is shown generally at numeral 30 in Figures 11 to 13 formed of hemostatic body halves 32 which are mateabie together along proximal mating edges 34.
• Centrally positioned catheter access hole halves 36 are formed into the proximal edges 34 to surround the catheter when the skin contact surfaces 35 or 37 are positioned therearound against the skin. Rounded corners 38 are provided to reduce body breakage.
• FIG. 13A another embodiment of the invention which includes the hemostatic device 30 of Figure 1 1 , also includes a strengthening foam backing 39 adhesively attached to one surface 35 of each of the body halves 32, the skin contact surface 37 remaining free for skin attachment during installation.
• FIG 14. another embodiment of the hemostatic device is there shown at 40 and includes body halves 42 which are connected along fracture line 44 and held together by a groove thickness 46 of hemostatic material.
• the purpose of this embodiment 40 is to facilitate fracture of the body halves 42 along the fracture line 44 to be easily broken to accommodate better skin surface contact in an area of curved skin surfaces.
• the hemostatic device 50 formed of a body 52 having a flat skin contact surface 52 and a convex skin contact surface 56 is provided.
• Each of these hemostatic assemblies 60 and 70 provide a concave curvilinear skin contact surface 66 and 76, respectively, formed of a cup or thimble-shaped hemostatic body 62 and 72, respectively.
• a rigid or semi-rigid outer backing 64 and 74, respectively, having a smooth protective outer surface 68 and 78, respectively, are provided.
• a particular use embodiment may be for a bleeding fingertip or toenail of a dog when trimmed too short.
• hemostatic bandages 80, 80', 90, and 90' are there shown.
• Each of these hemostatic bandages include an elongated strip of flexible adhesive carrier 82 having an adhesive surface 86 thereon.
• a circular tablet-shaped body 84 formed of hemostatic material 85 and having a skin contact surface 88 is centrally positioned and adhesively attached to the adhesive carrier 82,
• the hemostatic bandage 90 includes a rectangular-shaped body 94 formed of compressed together hemostatic materia! 95 as described herebeiow and also having a skin contact surface 98.
• an array 94' of thin, smaller hemostatic bodies are attached to the adhesive surface 88, each of which are formed of hemostatic material 95' and having a skin contact surface 98'.
• This embodiment 90' provides for flexibility of the skin contact surfaces 98' over an irregularly or curve-shaped skin surface.
• the embodiment 80' in Fig. 27B includes a body array 92 of thin, small hexagonally-shaped hemostatic bodies, each of which is formed of hemostatic material 97 and having a skin contact surface 96.
• This body array 92 provides alternative ability to conform to curved and irregular skin surfaces.
• embodiment 80" provides the adhesive carrier 82" having spaced transverse tear or cut lines 98 to easily adjust the length of the adhesive carrier 82'.
• the individual hemostatic bodies provide great flexible adaptability over a contoured skin surface.
• an array of a plurality of hemostatic devices 100, 110, 120, 130, 140, 150 and 150' are there shown, each having a solid uniquely configured hemostatic body 102, 112, 122, 132, 142, 152 and 152' providing skin contact surfaces 106, 116, 126, 136, 146, 156 and 156' attached to an elongated handle 104, 114, 124, 134, 144, 154 and 154'.
• Each of the configurations of the solid hemostatic bodies may be adapted to deal with bleeding wounds at various body sites.
• the flexible cord handle 144 of embodiment 140 provides an additional adaptation for replacement and withdrawal of the hemostatic body 142, while the curved handle 154' facilitates manipulation and positioning of the contoured irregular hemostatic body 152'.
• hemostatic device 160 is there shown formed of a body 162 having outwardly extending curvilinear skin contact surfaces 164 and 166. These surfaces 164 and 166 may be identical or may be of differing curvature to enhance versatility in the application of this embodiment 160.
• the body 162 is formed of hemostatic material 163 as described herebeiow.
• FIGs 36 and 37 another one-piece embodiment of the invention is there shown generally at numeral 170 having reinforcing fibers blended with the hemostatic material 1 6 prior to the body 172 being pressure formed. Opposing skin contact surfaces 174 are provided.
• the reinforced hemostatic material 176 of body 172 is further reinforced by a screen backing 177 adhesively attached to one of the skin contact surfaces 174.
• the body 172 is reinforced by a thicker reinforcing foam backing 178
• the body 180 is formed having a mesh material blended with the hemostatic material 184.
• a very open foam filled rigid or semi-rigid hemostatic powder 190 is utilized to form the hemostatic body 186.
• various additives may be blended with the hemostatic material 196 to form the hemostatic body 192 having skin contact surfaces 194.
• the additives 196 blended with the hemostatic materia! may be in various forms, including binding additives, lubricants and antimicrobials.
• arrays 200 and 204 of miniature solid hemostatic bodies 202 and 206 are provided which are compression formed of the powderous hydrostatic material, but, although smaller in size, nonetheless reduce the mess associated with the loose granular hydrostatic powder material.
• Hemostatic bodies 202 and 206 may be in a form and size similar to KITTY LITTER which, again, reduce the messiness associated with the powderous hemostatic material used to press form these hemostatic bodies 202 and 208.
• a completely circular tablet-shaped hemostatic device 210 formed of an annular-shaped hemostatic body 212 is there provided.
• a central hole 214 is formed there through sized to receive the cannula of a catheter slidably inserted therethrough and which may be packaged as shown in Figure 41 ready for use.
• a plurality of small solid hemostatic irregular bodies 226 are attached to a pliable, resilient inert carrier 222 having an adhesive surface 224 to form the hemostatic assembly 220 there shown.
• This embodiment 220 facilitates applying pressure of the hemostatic bodies 226 against various irregular skin surfaces.
• Figure 43 shows an embodiment 230 of irregular hemostatic bodies 234 which have been strung along the length of a string or wire 232. Then, in Figure 43A, a plurality of these hemostatic assemblies 230 may be woven together to form a hemostatic mat 236.
• a hollow hemostatic body 242 encasing a foam insert 244 form the hemostatic assembly 240.
• the hemostatic composition for the powder is preferably 1 :7 weight mixture of ferrate: hydrogen resin, although this ratio has a range of 1 :3 to 1 :12.
• the hydrogen resin is. preferably, the hydrogen form of the 2% crosslinked, sulfonated poiy(styrene) resin.
• the hydrogen resin is available in whole insoluble beads in the range of 500 microns or can be ground into much finer fragments averaging in size from 80 microns to 200 microns.
• Device formation is based, in part, on the percent of resin fractured to whole beads.
• the crosslinked hydrogen ion exchange resin will not melt as temperature is increased nor will it cold flow with pressure. Therefore whole resin beads alone cannot be formed into a tablet with pressure.
• All or some portion of the fragments may be resin atone or may be replaced with other additives to fill the voids between the whole resin beads.
• Those additives may be one or a combination of: potassium ferrate (preferred), binders (stearates, waxes), solid lubricants, microbial agents, other amorphous solid materials (calcium carbonate), other non-spherical absorbent materials that are dissimilar in size to the resin, to increase the packing density and contact surfaces to allow a strong tablet to be formed.
• the hemostatic powder preferably of 1 :7 potassium ferrate: hydrogen resin
• Preliminary tablet formation testing of tablet thicknesses from about .5mm to 30mm established a minimum thickness of about 0.5mm for compressing the hemostatic powder into a solid device.
• the photos in Figure 47 indicate that at least 0,5mm thickness is needed to create a complete usable tablet.
• the material was ground to ⁇ 250pm. However, changing the grind size may affect the minimum thickness of powder needed to create a complete tablet.
• the thin (0.53 mm) 20mm diameter tablet created with 45K psi (#3) had more integrity than did the thin tablet at 29K psi formation pressure. In Test #1 , 29K psi was not sufficient to form a .428mm thick tablet, but in Test #2, a fragile and unstable tablet having a thickness of 0.535mm was formed.
• a Tablet Density Test was used to determine the relationship of solid density (ml/g) to formation pressure (psi), from 8K to 45K psi. Above 45K psi, the density increase appears to flatten with respect to press pressure.
• the pressure of 45K psi is the maximum pressure rating for the 20mm round table die used for testing, to determine the amount of force needed to form a solid tablet.
• the tablet integrity was determined by measuring harness and wetting rate, in addition, manual breakage of multiple tablets was also used in selecting the appropriate tablet parameters.
• the Tablet Friability Test is based on the following FDA Guidance for tablets:
• Friability is a determination of mass loss during a tumbling test. A tablet is dropped 100 times from a specific height and measurement is taken to determine how much mass is lost. The mean loss should be no more than 1 % for tablets, per USP, unless otherwise specified by dosier.
• a modified Tablet Friability Test was designed by pouring tablets through a 2" PVC tube from a beaker into a catch beaker. The height from the top of the PVC to the surface of the catch beaker was set at 150mm (based on the USP Friability Protocol). The Tablet Friability Test showed that the average loss was 2.5%. This amount of loss is acceptable because the tablet is externally/topically applied to the wound surface and, breakage is mitigated through unitized protected packaging.
• a blood seal test was employed as follows:
• the free powder created an uneven blood seal with moderate adhesion and upon scrapping, provided moderate strength in terms of the lifted seal.
• the excess portion of the unused free powder had been exposed to and deactivated in the atmosphere and has lost most of its capacity for further use.
• the 20mm diameter tablet broke open into two parts, the first part revealed a thicker blood seal with excellent adhesion and strength and, the second part having a significant portion of the tablet unused and intact.
• the second portion constituting the used tablet remains as a reservoir to stop bleeding and absorption of exudates.
• the 20mm diameter tablet and the free powder prepared from the same composition consisting of 1 :7 potassium ferrate: hydrogen resin were tested for hemostasis efficacy using a low pressure gravity flow system.
• the results showed that for a low pressure gravity flow system, there were no impact on hemostasis efficacy by mechanically compressing the powder versus using the powder itself.
• testing at high pneumatic pressure distinctly demonstrate that the tablet surprisingly outperforms the free powder.
• a 60 ml syringe is filled with approximately 25 ml of blood.
• the test block formed from a 1.5" clear acrylic block. Assuming the entry hole designed to fit a barbed fitting to connect to 1 ⁇ 2" flexible vinyl tubing and a 1/8" diameter outlet hole.
• the syringe is elevated to 30cm above the top of the test block, creating a pressure of 30cm water which equated to 20mm Hg (mercury).
• the valve was opened and the blood was allowed to surface.
• the valve was closed and the blood was spread over an area approximately 0.5" from the outlet.
• the test material was placed over the blood covering the outlet hole. Contact pressure was held with a 100 gram mass for 60 seconds. After the 60 seconds the 100 gram mass was removed and the vaive was opened for 30 seconds. If no blood exits the hole sealing of the hole occurred and the test sample passed the test.
• the apparatus is schematically represented in Figure 50.
• the tablet creates a significantly stronger seal capable of stopping higher pressure bleeding than the free powder that defies expectation. This surprising finding implies that the uniform surface of the tablet enables a much greater manual pressure to be exerted on the blood than the free powder which provides a non-uniform and irreproducible force on the blood.
• the dense nature of the tablet surface in contact with the blood and the huge reservoir of the composition concentrated in the tablet enable rapid dehydration and significantly better adhesion than for the loose and low density powder.
• the much greater surface area of the loose powder would lead to the expectation that the powder would perform significantly better than the tablet where less surface is in contact with the blood.
• a test block is created from a 1.5" clear acrylic block.
• the test block has an entry hole designed to fit a barbed fitting to connect to 1 ⁇ 4" flexible vinyl tubing and a 1/8" diameter outlet hole.
• the first step is to pull back the syringe plunger, power up the manometer and set the manometer to record the maximum value.
• the syringe plunger is compressed to pressurize the system until the biood seal fails.
• the manometer records the maximum pressure created just prior to the seal failure.
• biood is placed around the 1/8" outlet hole.
• the tablet is then placed over the blood. Care is taken to ensure that the blood completely encircles the hole, and that the tablet completely covers the hole as well.
• a gloved finger is used to apply slight manual pressure to the tablet. The pressure forces the liquid blood from beneath the tablet.
• the tablet is allowed to set for -15 seconds and then the plunger is compressed.
• the tablet was tested 15 times and all consistently reached the end point of 500mm Hg without failure of the seal. In contrast, the free powder only reached an end point of 100mm Hg demonstrating the superior and unexpected performance of the tablet.
• Comparatively loose powder reached an average hold pressure of 310mm Hg in the same test.
• a small foil disk was used to prevent the powder from filling and occluding the hold in the loose powder testing.
• the powder also required a 75g mass to maintain the seal integrity. Surprisingly the solid preformed better than did the loose powder with no addition mass holding the solid in place above the simulated wound.
• a test is designed to measure the amount of oxygen generated by a mass of PRO QR powder vs. a similar mass of powder compressed into a solid tablet upon wetting. For this test 45K psi was applied to 2-3 grams of powder in a 20mm diameter tablet die using a lab press. In manufacturing typically 29K psi will be required to produce a 20mm diameter tablet. This test is using excessive force to further exacerbate any potential for decomposition of potassium ferrate due to mechanical compression of the powder.
• the potassium ferrate decomposed releasing oxygen As the powder or tablet is wetted, the potassium ferrate decomposed releasing oxygen.
• the test material is placed in the dry bottle in the closed system. A syringe is used to inject water into the bottle, in this test 15ml of water was injected each time. This volume of water was accounted for in the calculations. Also the graduated cylinder was replaced with a 50ml burette for more accurate reading of the results. The starting point for the gas measurements was the displacement point created by injecting 15ml of water into the empty bottle in the closed system.
• the tablet is composed of manually compressed powder composed of a hydrophilic polymer that swells as it absorbs water and potassium ferrate. As the polymer wets and swells it causes disintegration of the tablet. This wetting rate is dependent upon the pressure at which the tablet is pressed.
• the pump is turned on.
• the disc is dropped into the tube with the water running and a stopwatch is started.
• the disc is observed and, when there is no longer any material above the screen the time recorded.
• Disintegration rate is shown to be linear with respect to press pressure for tablets between 8K (disintegration time: 40 seconds) and 45K psi (disintegration time: 180 seconds) for a 20mm diameter round tablet. Therefore, wetting or disintegration rate is a relationship of the closeness of particles and capillary action to wet the "next" layer of material and minimum preferred disintegration time of 40 seconds is achieved at 8K psi formation pressure.

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