Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol.

OBJECTIVE Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). PROTOCOL A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. OUTCOMES Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. DISCUSSION To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.

[1]  A. DeAnda,et al.  Development and validation of an intraoperative bleeding severity scale for use in clinical studies of hemostatic agents , 2017, Surgery.

[2]  J. Spin,et al.  Oxidized (non)-regenerated cellulose affects fundamental cellular processes of wound healing , 2016, Scientific Reports.

[3]  F. Sanguedolce,et al.  Surgicel® granuloma mimicking ovarian cancer: A case report. , 2016, Oncology letters.

[4]  W. Chapman,et al.  Fibrin Sealant Patch (TachoSil) vs Oxidized Regenerated Cellulose Patch (Surgicel Original) for the Secondary Treatment of Local Bleeding in Patients Undergoing Hepatic Resection: A Randomized Controlled Trial. , 2016, Journal of the American College of Surgeons.

[5]  G. Moneta,et al.  Randomized trial of a dry-powder, fibrin sealant in vascular procedures. , 2015, Journal of vascular surgery.

[6]  C. Verhoef,et al.  Fibrocaps for surgical hemostasis: two randomized, controlled phase II trials. , 2015, The Journal of surgical research.

[7]  P. Pattyn,et al.  The FINISH-3 trial: a phase 3, international, randomized, single-blind, controlled trial of topical fibrocaps in intraoperative surgical hemostasis. , 2015, Journal of the American College of Surgeons.

[8]  H. Uhara [Skin disorders]. , 2015, Nihon rinsho. Japanese journal of clinical medicine.

[9]  G. Colombo,et al.  Economic and outcomes consequences of TachoSil®: a systematic review , 2014, Vascular health and risk management.

[10]  H. Addison,et al.  Fungating Metastatic Breast Cancer, a Challenging Case Report of Bleeding Control and Palliative Wound Care , 2014 .

[11]  M. Falcou,et al.  A prospective, descriptive cohort study of malignant wound characteristics and wound care strategies in patients with breast cancer. , 2014, Ostomy/wound management.

[12]  H. Mischinger,et al.  Randomized controlled multicenter trial on the effectiveness of the collagen hemostat Sangustop® compared with a carrier-bound fibrin sealant during liver resection (ESSCALIVER study, NCT00918619) , 2014, Langenbeck's Archives of Surgery.

[13]  V. Jarvis The range and role of palliative interventions for locally advanced breast cancer , 2014, Current opinion in supportive and palliative care.

[14]  A. Arber,et al.  Coping with an exulcerated breast carcinoma: an interpretative phenomenological study. , 2013, Journal of wound care.

[15]  G. Bochicchio,et al.  A prospective, randomized, controlled trial of the efficacy and safety of fibrin pad as an adjunct to control soft tissue bleeding during abdominal, retroperitoneal, pelvic, and thoracic surgery. , 2013, Journal of the American College of Surgeons.

[16]  A. Ghasemi,et al.  A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. , 2013, The American journal of emergency medicine.

[17]  J. Green,et al.  Review of patients' experiences with fungating wounds and associated quality of life. , 2013, Journal of wound care.

[18]  H. Schumacher,et al.  Collagen hemostat significantly reduces time to hemostasis compared with cellulose: COBBANA, a single-center, randomized trial. , 2013, American journal of surgery.

[19]  M. Yaşar,et al.  The hemostatic effect of calcium alginate in experimental splenic injury model. , 2013, Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES.

[20]  G. Gethin,et al.  Malignant wound management in advanced illness: new insights , 2013, Current opinion in supportive and palliative care.

[21]  D. Johns,et al.  Hemostatic efficacy and tissue reaction of oxidized regenerated cellulose hemostats , 2013, Cellulose.

[22]  R. Simman,et al.  Bedside bleeding control, review paper and proposed algorithm. , 2012, The journal of the American College of Clinical Wound Specialists.

[23]  N. Otori,et al.  Evaluation of symptoms and QOL with calcium alginate versus chitin-coated gauze for middle meatus packing after endoscopic sinus surgery. , 2012, Auris, nasus, larynx.

[24]  S. Alexander An intense and unforgettable experience: the lived experience of malignant wounds from the perspectives of patients, caregivers and nurses , 2010, International wound journal.

[25]  V. Jones,et al.  Malignant fungating wounds: an analysis of the lived experience. , 2009, International journal of palliative nursing.

[26]  R. Vohra,et al.  Randomized Trial Comparing Quixil Surgical Sealant with Kaltostat Hemostatic Dressing to Control Suture Line Bleeding after Carotid Endarterectomy with ePTFE Patch Reconstruction , 2005, World journal of surgery.

[27]  D. Walsh,et al.  Oxidized cellulose dressings for persistent bleeding from a superficial malignant tumor , 2002, The American journal of hospice & palliative care.

[28]  N. Roland,et al.  Foreign body reaction to calcium alginate fibre mimicking recurrent tumour of the submandibular salivary gland. , 2002, The British journal of oral & maxillofacial surgery.

[29]  M. E. Haisfield-Wolfe,et al.  Staging of malignant cutaneous wounds: a pilot study. , 1999, Oncology nursing forum.

[30]  M. Manning Metastasis to skin. , 1998, Seminars in oncology nursing.

[31]  J. Lawrence,et al.  Alginate dressing as a donor site haemostat. , 1986, Annals of the Royal College of Surgeons of England.

[32]  Major George Blaine EXPERIMENTAL OBSERVATIONS ON ABSORBABLE ALGINATE PRODUCTS IN SURGERY* , 1947, Annals of surgery.

[33]  R. Lattes,et al.  Hemostasis With Absorbable Gauze (Oxidized Cellulose). , 1944, Annals of surgery.