Is CELOX Z-Fold Hemostatic Gauze CoTCCC recommended?
Yes. Celox Gauze was added to the TCCC guidelines as a CoTCCC-recommended alternative in 2014 (TCCC Guideline Change 13-05) alongside ChitoGauze. Both chitosan-based products were added as alternatives to the primary recommendation of QuikClot Combat Gauze, particularly for patients where anticoagulation or hypothermia may impair the clotting cascade. CoTCCC recommends these products — it does not 'approve' or 'certify' them. For the primary CoTCCC recommendation, QuikClot Combat Gauze remains the hemostatic dressing of choice for the U.S. Department of Defense.
How does CELOX Z-Fold differ from CELOX RAPID?
The CELOX Z-Fold uses the original Celox chitosan granule formulation and requires 3 minutes of compression to achieve hemostasis. CELOX RAPID uses the upgraded Chito-R™ bioadhesive formulation — combining chitosan with a pharmaceutical-grade bioadhesive — that reduces compression time to just 60 seconds. The Z-Fold 10 ft. provides more total gauze material than either the Celox RAPID (5 ft.) or Celox RAPID Ribbon (5 ft. × 1 in.), making it better suited for large wounds or high-volume scenarios. For most active trauma kit configurations, CELOX RAPID is preferred for faster hemostasis.
Why does CELOX work on anticoagulated patients?
Celox chitosan does not rely on the body's coagulation cascade — it works through direct electrostatic interaction between the positively charged chitosan and the negatively charged red blood cell membranes, causing aggregation and gel-plug formation at the wound site. This mechanism is independent of clotting factors, platelets, or enzyme cascade activity. As a result, it continues to work effectively in patients on heparin, warfarin, or direct oral anticoagulants (DOACs), and in hypothermic patients where enzyme activity is significantly reduced.
What is the difference between the 5 ft. and 10 ft. CELOX Z-Fold?
MED-TAC carries the 10 ft. CELOX Z-Fold (3 in. × 10 ft., NSN 6510-01-623-9594, 2.1 oz packaged). A 5 ft. version also exists (NSN 6510-01-623-9910, 1.1 oz packaged). The 10 ft. provides more material for large wounds, high-volume hemorrhage, or multiple-site injury scenarios. A single 5 ft. gauze has been tested and confirmed to stop bleeding from a major artery; the 10 ft. is better suited for larger wound cavities requiring more packing material. For standard IFAK configurations, the 5 ft. variant is more compact.
How is CELOX Gauze removed from a wound?
Celox gauze is removed at definitive care by irrigating the wound with sterile saline solution. The chitosan forms a gel-like structure that dissolves with saline irrigation, allowing the gauze to be gently peeled away from the wound surfaces without trauma. Celox does not embed itself into tissue permanently — unlike kaolin and zeolite minerals. After irrigation, any remaining Celox gel is easily rinsed out. In clinical case reports, Celox has been safely left in wounds for up to 24 hours with no re-bleeding, infection, or adverse events when removed with saline.
