Medical

Wound Packing

The technique of inserting hemostatic gauze or plain gauze directly into a wound cavity to compress the source of bleeding from inside the wound. Wound packing is the standard TCCC response for compressible hemorrhage that is not amenable to tourniquet placement, particularly junctional wounds at the groin, axilla, and neck base.

In the Field

Wound packing is more aggressive than most providers expect on first attempt. You drive the gauze in with two fingers, deep into the wound tract, against the bleeding source. Then you pack more gauze on top until the cavity is full. Then you hold three minutes of firm direct pressure. The technique discipline is everything: gauze laid on top of a wound is not packing; gauze stuffed into a hand-deep tract until it contacts the bleeding vessel is. The hemostatic agents (kaolin in QuikClot Combat Gauze, chitosan in Celox or ChitoGauze) only work when the agent reaches the bleeding source.

Common Mistake

Inadequate packing depth. The bleeding vessel is often deeper in the wound than providers want to go. Driving the gauze with two fingers to the bottom of the wound tract, against the source of bleeding, is the correct technique. The other common mistake is insufficient direct pressure after packing. TCCC standard is three minutes of firm pressure after the wound is packed. Cutting that to thirty seconds is the most common reason packed wounds re-bleed.

Technical Detail

TCCC wound packing technique: (1) expose wound and identify the bleeding source; (2) pack gauze directly into the wound cavity using two fingers, working from the deepest point of the wound outward; (3) continue packing until the cavity is completely filled and tamponade pressure is achieved against the source; (4) apply firm direct pressure for a minimum of three minutes (TCCC standard); (5) apply pressure dressing or emergency trauma dressing over the packed wound. Hemostatic agents accelerate clot formation: kaolin-based gauze (QuikClot Combat Gauze) activates the intrinsic coagulation pathway; chitosan-based gauze (Celox, ChitoGauze) provides mucoadhesion. Plain gauze achieves hemostasis through pressure alone and is less effective but acceptable when hemostatic agents are unavailable. XStat (compressed mini-sponge applicator) is an alternative to traditional gauze packing for deep narrow-tract wounds. Wound packing is not appropriate for chest wounds (use chest seal), eye injuries, abdominal evisceration, or open skull injuries.