Twelve feet of chitosan-coated gauze that packs like plain gauze, carries the NSN on the evidence-based list, and shows up on the surgeon's X-ray.
At a glance
12 things to know about ChitoGauze XR PRO
What the XR means, where it sits in TCCC, and what the human and animal studies actually found.
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01
XR means X-ray detectable
A radiopaque thread is built into the gauze so a packed dressing shows on an X-ray. FDA cleared the X-ray version of ChitoGauze in 2010; in testing to ASTM F640, its radiopacity matched the standard aluminum reference.3,5 Tell the receiving team it is there.
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02
This is the ChitoGauze on the evidence-based list
The Evidence-Based Standard Devices & Adjuncts list carries ChitoGauze under NSN 6510-01-591-77402 — the NSN Tricol assigns to this item, XR PRO 1090.4 The TCCC Guidelines name ChitoGauze an alternative hemostatic adjunct; Combat Gauze is the evidence-based hemostatic dressing of choice.1 ChitoGauze was added in Guidelines Change 13-05, after a review found chitosan gauze at least as effective as Combat Gauze in animal studies.9
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03
How chitosan stops bleeding
Chitosan carries a positive charge and red blood cells a negative one. Tricol describes the coated gauze drawing red cells to it and forming a tight, adherent seal over the source — a process it states runs separately from the body's own clotting cascade.4
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04
Coated gauze — nothing to pour, no heat
ChitoGauze is a polyester/rayon blend nonwoven medical gauze coated with chitosan, Z-folded and sealed in a foil pouch.5 It contains no powder or granules and generates no heat.8
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05
Hold until the bleeding stops — and at least 3 minutes
Tricol's instructions: apply pressure until bleeding is controlled.3 The TCCC Guidelines: at least 3 minutes of direct pressure for any hemostatic dressing.1 The two do not compete. Hold for at least 3 minutes, and keep holding as long as the wound is still bleeding.
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06
You can cut it — keep the thread
If you cut the dressing to a smaller size, make sure the radiopaque thread is in the piece you pack. Discard any unused portion.3
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07
Four yards, and more than one if needed
The strip is 3 in. wide and 144 in. long.2 Use enough to fill the wound and contact every bleeding surface; a large cavity may take more than one dressing.3
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08
FDA-cleared for severely bleeding wounds
Cleared under 510(k) K102546 on 17 November 2010 as a hemostatic dressing for the external, temporary control of severely bleeding wounds, and gamma-sterilized to a sterility assurance level of 10⁻⁶.5 Tricol labels it for use by trained emergency responders.3
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09
66 real patients in Dutch EMS
Two Dutch ambulance services carried ChitoGauze from 2012 to 2014 and used it when gauze and pressure failed or were unlikely to work. Bleeding stopped in 46 of 66 patients and slowed in 13; it failed in 7, with user error a factor in 3. No side effects were reported.10
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10
The animal evidence is mixed — read all of it
In standard swine femoral-artery models, ChitoGauze performed as well as Combat Gauze, with no statistically significant differences.12,13 In coagulopathic swine, survival with XR PRO was 71% against 86% for Combat Gauze, seven animals per group,11 and in a 24-hour prolonged-field-care model ChitoGauze did not meet the study's 2-hour survival threshold.14 A 24-hour safety study found embolic material in the pulmonary circulation with ChitoGauze PRO, Combat Gauze and Celox Gauze alike.15
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11
Made from shellfish — allergy is rarely the issue
ChitoGauze contains chitosan from shellfish.3 Shellfish allergy is a reaction to shellfish protein; Tricol states its chitosan process removes residual shrimp protein,4 and volunteers with documented shellfish allergy tolerated a HemCon chitosan bandage without reaction.16 In a life-threatening bleed, a reported shellfish allergy is not a reason to withhold it — watch for redness, swelling or other signs of a reaction.3
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12
Store it between 52 and 78 °F
Tricol labels storage at 11–26 °C (52–78 °F), kept dry.3,6 A summer vehicle or a sun-baked aid bag can run hotter than that, so keep kits out of the heat. Do not use a dressing whose seal is broken or whose contents are wet.3
How to pack ChitoGauze XR PRO
Tricol's instructions, in the packing order taught in TCCC, TECC and public bleeding-control courses.
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1Find the source. Expose the wound and find where the blood is actually coming from. Keep direct pressure on it with your hand while you open the foil pouch.
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2Start with a tight wad. Make the first folds into a firm ball — the "power ball" — cover the bleeding source with it and press directly onto it with your fingers.3
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3Feed it in. Work the gauze in one or two folds at a time, keeping pressure on what is already packed.
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4Fill every corner. Pack the gauze completely into the wound track until it fills the wound and touches every bleeding surface. Use a second dressing if the first is not enough.3
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5Cutting it? Keep the thread. If you cut the dressing smaller, the radiopaque thread must be in the piece you pack.3
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6Hold firm pressure. At least 3 minutes per the TCCC Guidelines, and until the bleeding is controlled per Tricol's instructions1,3 — whichever is longer.
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7Lock it in. Wrap and secure the dressing with a pressure bandage to keep pressure on the wound.3
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8If it keeps bleeding, repack. Remove the packing and pack again with a fresh dressing, the same type or another hemostatic.1 Piling more gauze on top of a failed pack does not fix it.
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9Hand it off. Tell the receiving team a chitosan hemostatic with an X-ray thread is in the wound, give them the pouch, and keep reassessing.
Where it fits
- Junctional wounds — groin and armpit — where a limb tourniquet cannot be applied
- Neck wounds, packed with care so the airway is not compressed; the lower neck above the collarbone can be packed
- Deep limb wounds where a tourniquet is not possible, or as an adjunct when a trained provider converts a tourniquet1
- Any deep, packable wound with life-threatening external bleeding5
- The chest or abdomen — never pack into the chest or abdominal cavity
- Life-threatening limb bleeding a tourniquet can control — tourniquet first1
- Over the eyes, or near the spine3
- Implanting — it is for external, temporary use only3
- Practice — train with inert trainers, not live dressings
The evidence
Every study cited above, the product it tested, and how strong the evidence is.
| Study | Evidence type | What was studied | What it found |
|---|---|---|---|
| Te Grotenhuis et al., Injury 2016 | Human · prospective series | HemCon ChitoGauze in 66 patients, two Dutch EMS services, 2012–2014, used when gauze and pressure failed or were unlikely to work | Bleeding stopped in 46, reduced in 13, failed in 7 (user error in 3); no side effects reported |
| Gerling et al., J Trauma Acute Care Surg 2023 | Animal · randomized | ChitoGauze XR Pro vs Combat Gauze and six other agents, coagulopathic swine, junctional arterial injury, 7 per group | Survival 71% vs 86% Combat Gauze; blood loss 554 ± 613 mL vs 260 ± 319 mL; authors judged most agents comparable to Combat Gauze |
| Rall et al., J Trauma Acute Care Surg 2013 | Animal · randomized | HemCon ChitoGauze vs Combat Gauze and three other dressings, swine femoral artery injury, 3-minute hold | Survival 70% vs 60% and immediate hemostasis 60% vs 30%; differences not statistically significant |
| Schwartz et al., Prehosp Emerg Care 2011 | Animal · comparative | ChitoGauze vs Combat Gauze, 6 mm femoral artery punch, 14 swine, 2-minute hold | No statistically significant differences; trends favored ChitoGauze; no retained material on histology |
| Booms et al., Mil Med 2026 | Animal · pilot | ChitoGauze and five other dressings, swine junctional wound, followed up to 24 hours | ChitoGauze did not meet the 2-hour survival threshold; Combat Gauze, Celox Gauze, Celox Rapid and Veriset did |
| Otrocka-Domagała et al., Pol J Vet Sci 2016 | Animal · safety | ChitoGauze PRO, Combat Gauze and Celox Gauze left 24 hours in transected femoral artery wounds, 9 swine | Embolic material in the pulmonary circulation; authors judged all three unsuitable for long-term application |
| Bennett et al., J Spec Oper Med 2014 | Expert review · guideline change | Review of chitosan gauze dressings for TCCC Guidelines Change 13-05 | Chitosan gauze at least as effective as Combat Gauze in animal studies; ChitoGauze and Celox Gauze added to TCCC |
| Waibel et al., Mil Med 2011 | Human · safety challenge | HemCon chitosan bandage applied to volunteers with documented shellfish allergy | All subjects tolerated the bandage without reaction |
Strongest to weakest: human studies, then animal studies, then expert review. The Dutch series is real patients without a comparison group; the swine results depend on the injury model, the hold time and whether the animals were coagulopathic.
How it compares
The packing options a buyer most often weighs against ChitoGauze XR PRO.
| ChitoGauze XR PRO | ChitoGauze XR2 PRO | Combat Gauze | Celox Rapid | |
|---|---|---|---|---|
| Active agent | Chitosan coating on nonwoven gauze | Chitosan coating on nonwoven gauze | Kaolin (mineral) | Chito-R™ chitosan granules bonded to gauze |
| How it stops bleeding | Positively charged chitosan draws red cells into an adherent seal (manufacturer) | Same gauze as XR PRO | Speeds the body's own clotting cascade | Forms an adhesive gel that binds blood cells |
| Strip | 3 in. × 4 yd (12 ft) Z-fold | 3 in. × 4 yd (12 ft) Z-fold | 3 in. × 4 yd (12 ft) Z-fold | 3 in. × 5 ft Z-fold |
| X-ray detectable | Yes — 1 thread | Yes — 2 threads | Yes — radiopaque strip | Yes — radiopaque thread |
| Labeled pressure hold | Until bleeding is controlled | Until bleeding is controlled | At least 3 min | 60 s, or until bleeding stops |
| evidence-based standard | Yes — carries the evidence-based-listed NSN | Yes | Yes — hemostatic dressing of choice | Yes |
| Shellfish-derived | Yes | Yes | No | Yes |
Labeled hold times come from each manufacturer's instructions; the TCCC Guidelines set at least 3 minutes of direct pressure for any hemostatic dressing.1 XR PRO and XR2 PRO are the same gauze; XR2 PRO adds a second X-ray thread.
Build the system
The two-thread version, the alternatives, the bandage that holds the packing in, and trainers to practice on.
Questions buyers ask
Package & specifications
Specifications coming soon. Contact us for detailed product information.
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Return Facility: MED-TAC International Corp., 15757 Pines Blvd, Suite 154, Pembroke Pines, FL 33027.
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