There are two sizes of the XStat delivery system. The original is larger, but the applicator may not fit into very narrow wound tracks, while the newer, smaller version has fewer sponges and may require more applicators. It is common to need more than one applicator. In fact, in one of the animal studies just mentioned, the average number of the larger applicators needed to achieve results was six.

To insert the injectable hemostatic agent, the wound should be exposed and direct pressure applied while preparing the device. Each device has a slightly different process to prepare for delivery, so become familiar with both of them when you train prior to and during deployments. Then insert the applicator tip into the wound tract and depress the plunger, deploying the sponges. You may need to begin to withdraw the applicator to continue to deploy additional sponges, until you have a mound that sits 1-2 inches above the level of the wound, as you would with standard wound packing. In a study comparing XStat to standard gauze (Kerlix) in a gel model of a simulated wound cavity, XStat was applied eight times faster (8 seconds versus 67 seconds) than packing the cavity with standard gauze. This study also found that XStat applied pressure more symmetrically throughout the wound cavity than did standard gauze.

The TCCC Guidelines state that direct pressure with XStat is optional;74 but although the expansion of the sponges within the wound cavity is designed to create internal pressure at the bleeding site, when tactically feasible it is still good practice to apply direct pressure to the wound for 3 minutes after application. And a pressure dressing should be placed over the wound to secure the agent, as well. It is important to document use of injectable hemostatic agents as the sponges are only for temporary use and will need to be removed surgically at a higher level of care.