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                                                 HEMOSPRAY

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                                                 HEMOSPRAY

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An Innovative Endoscopic Treatment for Gastrointestinal Bleeding

Creators/Credible Source: Cook Medical

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Hemospray is a new method of hemostasis intervention developed by Cook Medical to treat upper gastrointestinal bleeding endoscopically. Babiuc, Purcarea, Sadagurschi, and Negreanu (2013) states that Hemospray has been used to control bleeding during military combat in the past, particularly for irregular shaped bleeding sites. Before Hemospray, the standard methods of treatment for gastrointestinal bleeding was to directly clip, inject, or cauterize a highly vascular bleeding areas such as an angiodysplasias, gastric ulcers, Mallory-Weis tears, gastrointestinal neoplasms, post-polypectomy bleeding, amongst others. Although these interventions are very successful, there is potential for greater bleeding risk because the gastroenterologist makes direct mechanical contact on the bleeding site. Hemospray is an innovate alternative for hemostasis without direct contact at the vascular site. Gastrointestinal bleeding as become an “emerging issue in the light of increasing numbers of disease entities requiring strict anticoagulant therapy with increasing use of new direct oral anticoagulants” (Hagel et. al, 2017, p.1). In light of this recent emergence of chronic and frequent anticoagulant use and multiple comorbidities in patients, a product like Hemospray is crucial to address gastrointestinal bleeding to reduce complications and improve patients’ quality of life.

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Hemospray is a mineral powder that contains no human or animal proteins and currently has no known allergens. When the powder is sprayed directly onto a bleeding site, the powder absorbs water and creates an adhesive mechanical barrier over the bleeding site. “Due to its composition, it is neither absorbed nor metabolized within the mucosa, hence minimizing the risk of systemic toxicity” (Hagel et. al, 2017, p.2). “The delivery device consists of a syringe containing the Hemospray powder (21g per syringe), a delivery catheter that is inserted into the working channel of the endoscope, and an introducer handle with a built-in carbon dioxide canister to propel the Hemospray powder out of the catheter” (Babiuc, Purcarea, Sadagurschi, & Negreanu, 2013, p. 118). According to Hagel et. al (2017), Hemospray is typically applied in bursts, releasing 1–5 g of powder with each application. In order to prevent sticking of the catheter tip in moisture, the catheter tip should be 2-3 cm away from the bleeding source.

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Cook Medical:  Targeting Acute Upper Gastro-Intestinal Bleeding

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-Can be sprayed without directly touching the bleeding area with forceps and other equipment.

-Can stop bleeding without injecting medications such as Epinephrine that causes discomfort and systemic effects for the patient.

-Hemospray is an alternative to leaving metal clips and other metal hemostasis objects that can fall off and cause rebleeding.

-Because Hemospray is not a thermal device, it does not cause direct tissue change

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-Hemospray cannot be used on variceal bleeding

-Because it is a spray, the intervention does not address the bleeding site directly and is mostly used for diffuse bleeding areas.

-Rebleeding rates up to 38.9%, are noted in literature" (Hagel et. al, 2017, p.2).
-Cannot be used for treatment of strong arterial bleeding or severely inflamed gastrointestinal wall (Hagel et. al, 2017, p.7).

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1. Andrew-Activator (Influencing)
2. Carlee-Consistency (Executing)
3. Daisy-Developer (Relationship Building)
4. Randall-Responsibility
5. Sheila-Strategic

My team was chosen to complement my individual strengths to create a cohesive team aiming towards our goal. My strengths are Harmony, Intellection, Empathy, Futuristic, and Relator. With these strengths, I would be able to bring our team together, understand and empathize with each point of view of the team members, be great at planning, and providing strong input. For these reasons, it is vital to have team members that are good at execution and proceeding forward with my ideas and input. For these reasons, I chose Andrew as the Activator to initiate the plans made; Daisy would help build the team and understand each role. Carlee would contribute with execution of our plans and ensure consistency within our project. Sheila would be able note obstacles and patterns as they arise and adjust our plans as needed. Randall, with his Responsibility strength, would make sure that the team is committed and will be loyal to the project.

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Having worked in the Gastrointestinal (GI) lab for the past three years, I have been in multiple procedures treating severely ill patients and addressing their gastrointestinal bleeds. As stated above, the standard method that I have witnessed for treating these bleeds have been injecting the bleeding site with Epinephrine, clipping the area with a metal clip, or cauterizing the vascular area. All these methods involving direct contact with the bleeding site. I have witnessed many patients return to the GI lab due to rebleeding, clips falling off, post-polypectomy bleeding, insufficient cauterization, amongst other reasons. The primary issue for many of the acutely ill patients needing endoscopy is their vast amount of comorbidites, primarily cardiac issues and past cardiac surgeries. With many of the comorbidites, many of these patients are required to be on strict anticoagulant therapy chronically, causing many of their gastrointestinal bleeds. With the aging population, increasing number of comorbidities, and increased use of chronic anticoagulant therapy, more options need to be available for gastroenterologists to address difficult and diffuse GI bleeding. After learning about this new intervention, Hemospray, many of the diffuse GI bleeds can be addressed since Hemospray does not directly contact the bleeding site. Many patients, in my experience, that come in with diffuse bleeding such as gastritis, portal hypertensive gastropathy, or "watermelon stomach" typically do not get their bleeding controlled within one endoscopic procedure. Along with this, many times gastroenterologists have difficulty addressing bleeding areas that are hard to reach with the endoscope. If clips are placed in bleeding areas that are in difficult positions, the clips are prone to falling off sooner than intended, resulting in a rebleed and an additional endoscopic procedure for the patient. For these reasons, the Hemospray's "ease of application to large surface areas, even in difficult positions, without inducing further mucosal damage" allows it to be a valuable tool for gastrointerologists in addressing patients and their gastrointestinal bleeds while managing their comorbidites.

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Babiuc, R. D., Purcarea, M., Sadagurschi, R., & Negreanu, L. (2013). Use of
Hemospray in the treatment of patients with acute UGIB - short review.
Journal Of Medicine And Life, 6(2), 117-119.

Hagel, A. F., Albrecht, H., Nägel, A., Vitali, F., Vetter, M., Dauth, C., & ... Raithel,
M. (2017). The Application of Hemospray in Gastrointestinal Bleeding
during Emergency Endoscopy. Gastroenterology Research & Practice, 1
8. doi:10.1155/2017/3083481

[Royal Society of Medicine]. (2016, April 18). Cook medical: Targeting acute
upper gastro-intestinal bleeding. [Video File]. Retrieved from
https://www.youtube.com/watch?v=q4IROaVhsl8

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Image retrieved from: https://www.cookmedical.com/data/resources/ESC-D43196-EN-F_M3_1528401363290.pdf

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