ChitoGauze with a second X-ray thread: the same gauze, the same packing technique, two radiopaque markers in the wound.
At a glance
10 things to know about ChitoGauze XR2 PRO
What the second thread adds, where ChitoGauze sits in TCCC, and what the ChitoGauze studies found.
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01
XR2 means two X-ray threads
Tricol builds two X-ray-detectable threads into the XR2 PRO gauze; the XR PRO has one.4,7 Both show on an X-ray so the receiving team can find a packed dressing. Tell them it is there.
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02
Same gauze as XR PRO
XR2 PRO is a polyester/rayon blend nonwoven medical gauze coated with chitosan, 3 in. × 4 yd and Z-folded4,7 — the same gauze as ChitoGauze XR PRO, cleared under the same FDA 510(k).5,6
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03
evidence-based standard as ChitoGauze
The TCCC Guidelines name ChitoGauze an alternative hemostatic adjunct; Combat Gauze is the evidence-based hemostatic dressing of choice.1 ChitoGauze was added to the Guidelines in Change 13-05 after a review found chitosan gauze at least as effective as Combat Gauze in animal studies.8
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04
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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05
Hold until the bleeding stops — and at least 3 minutes
Tricol's ChitoGauze instructions: apply pressure until bleeding is controlled.3 The TCCC Guidelines: at least 3 minutes of direct pressure for any hemostatic dressing.1 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 a thread
If you cut the dressing to a smaller size, make sure a radiopaque thread is in the piece you pack, and discard any unused portion.3
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07
FDA-cleared for severely bleeding wounds
XR2 PRO is listed under 510(k) K102546,6 cleared on 17 November 2010 for the external, temporary control of severely bleeding wounds; the gauze is gamma-sterilized to a sterility assurance level of 10⁻⁶.5
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08
The evidence comes from ChitoGauze
The published studies tested ChitoGauze and ChitoGauze XR PRO, the same chitosan-coated gauze. In two Dutch ambulance services, ChitoGauze stopped bleeding in 46 of 66 patients and slowed it in 13; it failed in 7, with user error a factor in 3.9
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09
The animal evidence is mixed
In standard swine femoral-artery models, ChitoGauze performed as well as Combat Gauze, with no statistically significant differences.11,12 In coagulopathic swine, survival with ChitoGauze XR Pro was 71% against 86% for Combat Gauze,10 and in a 24-hour prolonged-field-care model ChitoGauze did not meet the study's 2-hour survival threshold.13
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10
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.14 In a life-threatening bleed, a reported shellfish allergy is not a reason to withhold it.
How to pack ChitoGauze XR2 PRO
Tricol's ChitoGauze 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 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 a thread. If you cut the dressing smaller, a 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 two X-ray threads 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
- Teams whose protocols call for an X-ray-detectable packing gauze
- 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 only3,5
- Practice — train on an inert wound-packing trainer, not a live dressing
The evidence
Every study cited above and the product it tested — XR2 PRO uses the same gauze as ChitoGauze XR PRO.
| Study | Evidence type | What was studied | What it found |
|---|---|---|---|
| Te Grotenhuis et al., Injury 2016 | Human · prospective series | HemCon ChitoGauze (parent product) in 66 patients, two Dutch EMS services, 2012–2014 | 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 (single-thread version) vs Combat Gauze and six other agents, coagulopathic swine, 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 (parent product) vs Combat Gauze and three other dressings, swine femoral artery injury | Survival 70% vs 60% and immediate hemostasis 60% vs 30%; differences not statistically significant |
| Schwartz et al., Prehosp Emerg Care 2011 | Animal · comparative | ChitoGauze (parent product) vs Combat Gauze, 6 mm femoral artery punch, 14 swine | No statistically significant differences; trends favored ChitoGauze |
| Booms et al., Mil Med 2026 | Animal · pilot | ChitoGauze (parent product) 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 |
| Bennett et al., J Spec Oper Med 2014 | Expert review · guideline change | Review of chitosan gauze dressings, including ChitoGauze, 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. Every efficacy study above tested ChitoGauze or ChitoGauze XR PRO; the second X-ray thread is the only difference in XR2 PRO.
How it compares
The packing options a buyer most often weighs against ChitoGauze XR2 PRO.
| ChitoGauze XR2 PRO | ChitoGauze XR 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 XR2 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 — 2 threads | Yes — 1 thread | 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 | Yes — carries the evidence-based-listed NSN | 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
Build the system
The single-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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Returns: Unused, unopened equipment in original manufacturer packaging is eligible for return within 30 days of delivery.
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Return Facility: MED-TAC International Corp., 15757 Pines Blvd, Suite 154, Pembroke Pines, FL 33027.
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