In the Field
The iTClamp is the most operationally distinctive hemostatic in the TCCC formulary because it eliminates the three minutes of direct pressure that gauze requires. For a scalp laceration, a neck wound, or a groin laceration where you cannot easily pack, the iTClamp closes the wound edges in seconds and the pressure is built into the device. You can then move on to other interventions instead of holding pressure. In TCCC 2026, the iTClamp is specifically called out for head and neck wounds where edges can be re-approximated, and can be used as primary hemorrhage control rather than just adjunct.
Common Mistake
Applying the iTClamp within 1 cm of the eye orbit. The device is contraindicated near the orbit because the needles can cause ocular injury. The other mistake is forgetting to monitor for airway compromise after neck application. The iTClamp does not stop ongoing bleeding under the closed edges, which means a continuing hemorrhage produces an expanding hematoma that can compress the airway. Frequent reassessment of breathing and consideration of definitive airway placement is required for neck applications.
Technical Detail
Manufactured by Innovative Trauma Care (Edmonton, Canada). The device consists of a polymer body with two opposing arrays of four sharp metal needles. Application: position needles on either side of wound (perpendicular to wound edges), squeeze handle to drive needles into intact skin, lock device. The compression generated by the closing handle approximates wound edges and applies pressure to underlying vasculature. CoTCCC-recommended since 2017. May be used alone or in combination with hemostatic gauze or XStat packed into the wound prior to iTClamp closure. TCCC 2026 specifies no direct pressure requirement after application, distinguishing it operationally from kaolin or chitosan dressings. Contraindicated within 1 cm of orbit. Neck applications require airway monitoring for expanding hematoma.
