Essex Partnership University NHS Foundation Trust. South East Essex Community Woundcare Formulary

Transcription

1 Essex Partnership University NHS Foundation Trust South East Essex Community Woundcare Formulary

2 Introduction This Wound Formulary is for use by any healthcare professional prescribing or requesting dressings for the management of in primary care in South East Essex. It has been produced in collaboration with the EPUT Tissue Viability Service in South East Essex, and Southend, and Castle Point and Rochford Clinical Commissioning Groups. The management of complex Burns and Plastics is outside of the scope of this Formulary and requires specialist advice. Any reference to management of burns within the formulary is only for use on superficial, non-complex burn injuries. Should the clinician have any concerns regarding the burn injury, specialist advice should be sought via the Tissue Viability Service or local Burns Unit. Adherence to the Wound Formulary will be audited and monitored. Deviation from recommended products will require clinical justification. Key Messages: Start at appropriate level of management for the wound type and stage of healing. Review the wound regularly and prescribe the most suitable dressing. Generally the wound TYPE and SIZE will change over time. To avoid waste and facilitate prompt wound evaluation do not prescribe excessive quantities or issue as long term repeats. A maximum of 14 days supply should normally be sufficient. prescribed on FP for individual patients must not be used for any other patient or for stock. If wound healing does not progress as expected, seek advice from the Tissue Viability Team. Silver dressings should only be used where there are clinical signs and symptoms of infection, and discontinued if there is no improvement after two weeks. They should not be routinely used for management of uncomplicated leg ulcers. The BNF advises against the use of silver dressings for acute as there is some evidence that they may delay wound healing. Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. Notes for use: The Formulary has been split into two parts a. Which Dressing? intended to guide the clinician to the appropriate dressing type for the wound b. Which? intended to be used once the dressing type has been determined The Formulary contains dedicated sections for use by Tissue Viability Service, Podiatry Service, Leg Ulcer Service and Paediatric Service. These teams are also able to prescribe from the General list Where there is a choice, the most suitable, and cost-effective product should be selected. Seek advice from the Tissue Viability Team if in doubt as to which product is appropriate. Dressing sizes are in cm unless otherwise indicated. Information has been provided by each Wound Care Company and is accurate at the time of print. The clinician is expected to have read and be familiar with all product literature and manufacturers guides before use of the products in this Formulary. For appropriate emollient product selection for use within South East Essex refer to CCG Skin Formulary. Key to cost column: = 1 = 1-3 = 3- = -20 = 20-0 = 0 South East Essex Community Woundcare Formulary Page 2

3 Wound Dressing Formulary Tissue Type Chart Alginate Flat Sheet Biatian Alginate Kaltostat Hydrocolloid Duoderm Extra Thin Hydrogel Sheet KerraLite Cool Border Alginate Rope Kaltostat Honey Algivon ** Activon Tube** Actilite** Hydrofiber UrgoClean UrgoClean Rope Hydrocolloid Duoderm Extra Thin Hydrogel Sheet KerraLite Cool Border Kerralite Cool Absorbants Mepore Mepore Ultra Zetuvit E Sterile Kerramax Care Border Adhesive Adhesive & Non-adhesive Foam AQUACEL Foam Adhesive ConvaTec Lite Kerrafoam Gentle Border UrgoTul Absorb Border Tegaderm Foam Adhesive UrgoTul Absorb Hydrocolloid Duoderm Extra Thin Hydrogel Sheet KerraLite Cool Border Kerralite Cool Alginate Biatian Alginate Hydrofiber AQUACEL Extra AQUACEL Ribbon Non/Low Adherent Atrauman UrgoTul Cadexomer/Povidine Iodines Iodoflex Paste** Inadine ** Honey Algivon ** Activon Tube** Semi-Occlusive Film Hydrofilm Mepitel Film Alginate Gels Algivon ** Activon Tube** Actilite** Charcoal CarboFlex Adhesive & Non-adhesive Foam AQUACEL Foam Adhesive ConvaTec Lite Kerrafoam Gentle Border UrgoTul Absorb Border Tegaderm Foam Adhesive UrgoTul Absorb AQUACEL Foam PHMB ActiveHeal AMD** Antimicrobial Foam disc** ActivHeal PHMB Foam Non-adhesive** ActivHeal PHMB Adhesive** Hydrogel Sheet KerraLite Cool Border Kerralite Cool Silver Atrauman Ag** AQUACEL Ag+ Extra** AQUACEL Ag+Ribbon** UrgoClean Ag** Non/Low Adherent Atrauman UrgoTul DACC Cutimed Sorbact Swab** Cutimed Sorbact Ribbon** Flaminal Forte Gel** Absorbants Mepore Mepore Ultra Zetuvit E Sterile Kerramax Care Border Adhesive Kerramax Care Absorbants Mepore Mepore Ultra Zetuvit E Sterile Kerramax Care Border Adhesive Absorbants Mepore Mepore Ultra Zetuvit E Sterile Kerramax Care Border Adhesive Kerramax Care ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 3

4 HYDROFIBER AQUACEL Extra AQUACEL Ribbon cm x cm cm x cm 1cm x 1cm 1cm x 4cm 2cm x 4cm Wear time up to 7 days where clinically indicated; up to 14 days for burns and donor sites Wear time up to 7 days where clinically indicated Acute and chronic : e.g. leg ulcers, pressure ulcers, diabetic foot ulcers Surgical Partial thickness burns Trauma Primary dressing for moderately to highly exuding cavity Leakage, excessive bleeding or suspicion of infection Can be double layered Leakage, excessive bleeding or suspicion of infection Known sensitivity, or allergy to the dressing or its components Known sensitivity, or allergy to the dressing or its components ALGINATE Biatain Alginate cm x cm cm x cm 1cm x 1cm 3cm x 44cm 30 6 Up to 7 day wear time Not water/shower Can be double layered Moderately to heavily exudating and local haemostasis in pressure ulcers, venous leg ulcers, arterial ulcers, diabetic foot ulcers, donor sites, traumatic, sloughy and cavities When secondary dressing is changed Not intended for controlling heavy or prolonged bleeding Not for use on dry Caution: store at room temperature in a horizontal position away from sunlight South East Essex Community Woundcare Formulary Page 4

5 DESLOUGHING UrgoClean Rope UrgoClean 2.cm x 40cm cm x 40cm 6cm x 6cm cm x cm 1cm x 20cm For low exudating moisten with saline before application if Not water/shower Wear time up to 7 days Can be used as a secondary dressing in combination with other dressings such as alginates, hydrogels Not water/shower Desloughing phase of acute and chronic exudating cavity and sinus Dry to lightly exudating chronic and acute Wear time 1-2 days during desloughing phase, then dependent on exudate levels and wound bed Leakage, bleeding, increased pain, suspicion of infection Do not use in fistula with a diameter smaller than probe diameter Do not use on dry Do not use as a surgical compress or as a surgical sponge for heavily bleeding Known sensitivity to Urgoclean rope Known sensitivity to the dressing or its components Do not use with topical steroids for which occlusion is not indicated HAEMOSTATIC Kaltostat cm x cm 7.cm x 12cm cm x 20cm 1cm x 2cm 2g rope Wear time up to 7 days Not water/shower Can be double layered Moderate to heavily exudating Leakage, increased pain, suspicion of infection Known sensitivity to Kaltostat or its components South East Essex Community Woundcare Formulary Page

6 AQUACEL Foam Adhesive 8cm x 8cm 8cm x 13cm cm x cm cm x 20cm 12.cm x 12.cm 17.cm x 17.cm 21cm x 21cm Heel 19.8cm x 14cm Sacral 20cm x 16.9cm Can be left in place for up to 7 days not Is water/shower Minor abrasions, lacerations, cuts, scalds and burns Chronic Surgical Partial thickness burns Exudate absorption Leakage, bleeding or suspicion of infection, increased pain, suspicion of infection Known sensitivity, or allergy to the dressing or its components FOAM BORDERED ADHESIVE KerraFoam Gentle Border UrgoTul Absorb Border 7.cm x 7.cm cm x cm cm x 20cm 12.cm x 12.cm Sacrum: 17.cm x 17.cm 23cm x 26cm 6.2cm x cm 8cm x 8cm 8cm x 1cm cm x cm 13cm x 13cm 1cm x 20cm 20cm x 20cm sacrum Wear time 1- days not Shower Can go on bone and Wear time is 2-4 days and up to 7 days depending on the exudate levels and condition of wound bed not Is water/shower Adhesive edges can be cut but not the central pad Acute and chronic moderately exudating For exudating acute and chronic Dressing will be enlarged and slightly discoloured, might start to peel up at the edges Every two days and up to seven days depending on exudate levels and wound bed condition Do not use: on eyes, mucous membranes, exposed bone or s, cavity or sinuses, dry, bleeding If known sensitivity or allergy to any of the dressing components Do not cut Tegaderm Foam Adhesive 6.9cm x 7.6cm mini oval cm x 11cm oval 14.3 cm x 1.6cm oval 19cm x 22.2cm oval Wear time up to 7 days not Is water/shower Can be applied on bone or if depending on exudate levels For low to highly exudating acute and chronic Useful for difficult to dress areas e.g. elbows & heels Useful for protecting necrosis to heels When exudate reaches the edge of the moisture control layer (inner square) or every 7 days None known South East Essex Community Woundcare Formulary Page 6

7 FOAM NON ADHESIVE UrgoTul Absorb AQUACEL Foam 6cm x 6cm cm x cm 1cm x 20cm cm x cm cm x cm cm x 20cm 1cm x 1cm 20cm x 20cm 1cm x 20cm Can go on bone and Can go on bone and Can be left in place for up to 7 days, where clinically indicated not Not water/shower For exudating acute and chronic Acute and chronic Partial thickness burns Exudate management Every 2-4 days depending on exudate levels and condition of the wound bed Up to 7 days under compression therapy not Not water/shower Leakage, bleeding or suspicion of infection, increased pain Known sensitivity, or allergy to the dressing or its components FOAM OTHER Mepilex Transfer 7.cm x 8.cm cm x 12cm 1cm x 20cm Wear time up to 3-4 days Wide range of exudating and difficult-to-dress ; protective layer on non-exudating e.g fungating and/or large areas of fragile skin Known sensitivity to the dressing or its components Do not use on bone or or double layered HYDROCOLLOID Duoderm Extra Thin cm x cm 7.cm x 7.cm cm x cm 1cm x 1cm 9cm x 1cm Wear time up to 7 days. not Is water/shower Dry to lightly exudating chronic and acute Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components With topical steroids for which occlusion is not indicated South East Essex Community Woundcare Formulary Page 7

8 HYDROGEL SHEET KerraLite Cool Border KerraLite Cool 8cm x 8cm 11cm x 11cm 1cm x 1cm 6cm x 6cm 12cm x 8.cm 18cm x 12.cm Can be used on exposed bone and not Is shower Up to 7 day wear time depending on exudate levels Can use on bone and Not shower Up to 7 day wear time but depending on exudate levels Dry-low exudating sloughy or necrotic Dry-low exudating sloughy or necrotic Discoloured and contact layer maybe slightly jellylike, adhesive may start to lift up Discoloured and contact layer maybe slightly jellylike, adhesive may start to lift up Do not use on fullthickness, heavily bleeding, third degree burns, a covering for deep, narrow cavities or sinuses or cut Full-thickness, heavily bleeding, third degree burns, a covering for deep, narrow cavities or sinuses NON/LOW ADHERENT CONTACT LAYER Telfa Non-adhering wound dressing UrgoTul Atrauman 7.cm x cm 7.cm x cm 7.cm x 1cm 7.cm x 20cm cm x cm cm x cm 1cm x 1cm 1cm x 20cm cm x cm 7.cm x cm cm x 20cm 20cm x 30cm / 0 / 0 30 Not water/shower Can use on bone and Not water/shower Not water/shower Can be applied double layered Dry or lightly exudating ; suitable for peripheral and central IV sites Granulating and epithelising acute and chronic Superficial acute and chronic Up to 7 days None known Every 2-3 days Known sensitivity to the product or its components Do not apply to bone or South East Essex Community Woundcare Formulary Page 8

9 ODOUR CONTROL Carboflex cm x cm 8cm x 1cm oval 1cm x 20cm Can use on bone and not Secure with tape or bandage Not water/shower Wear time up to 3 days but increase change if wound infection Malodorous ; primary dressing for shallow or a secondary dressing over deeper When exudate strikethrough to the top layer occurs, or when the odour is no longer absorbed Known sensitivity or allergy to the dressing or its components Do not cut or apply double layered Non/ Low ABSORBANTS Mepore Mepore Ultra 7cm x 8cm 9cm x 20cm 9cm x 2cm 9cm x 30cm 9cm x 3cm cm x 11cm 11cm x 1cm 7cm x 8cm 9cm x 20cm 9cm x 2cm 9cm x 30cm cm x 11cm 11cm x 1cm Border can be cut but not the pad Not water not Not water not Border can be cut but not the pad Low to moderately exudating Low to moderately exudating Dependent on wound type and exudate levels. Remove in direction of hair growth Dependent on the wound type and exudate levels. Remove in direction of hair growth Do not apply under tension particularly when applying over joints, to prevent shearing forces causing damage to the skin Do not use on bone or Do not apply under tension particularly when applying over joints Do not use on bone or Moderate Zetuvit E sterile cm x cm cm x 20cm 20cm x 20cm 20cm x 40cm Wear time depends on exudate levels not Not water/ shower Primary or secondary dressing for moderate to highly exudating Depends on the condition of the wound and exudate levels Known allergy to any of the components or on bone and South East Essex Community Woundcare Formulary Page 9

10 High ABSORBANTS KerraMax Care Border Adhesive 16cm x 16cm 16cm x 26cm 26cm x 26cm not Cannot be applied double layered but primary dressings without backing can be placed underneath Moderate to heavily exudating Dressing will be enlarged and slightly discoloured Border can be cut but not pad Is water/shower Known allergy or hypersensitivity to any of the components On bone or, bleeding, fungating, donor sites, superficial and partial burns Do not use for covering fistulae, post-operative sutured or dehisced the dressing but additional non bordered kerramax care can be added if KerraMax Care cm x cm cm x cm cm x 22cm 20cm x 22cm 30cm x 20cm 20cm x 0cm Wear time 1-3 days is Is not shower Can be double layered and folded Moderate to highly exudating Under compression as single layer Dressing will be enlarged and may be discoloured Do not use on exposed bone or, bleeding, fungating, donor sites Do not use for covering fistulae, for postoperative sutured or dehisced, known allergy or hypersensitivity to any of the components Do not cut South East Essex Community Woundcare Formulary Page

11 Hydrofilm 6cm x 7cm cm x 12.cm cm x 1cm cm x 2cm 12cm x 2cm 1cm x 20cm 20cm x 30cm, 0, 0, 0 2 2, 0 Wear time several days but depending the wound and exudate levels not Is water/shower Apply as a single layer only Dry non-infected ; fixation of lines and secondary dressings Do not use on clinically infected, bleeding or highly exuding, on bones and s If known allergy to any of its components FILMS Mepitel Film 6.cm x 7cm.cm x 12cm.cm x 2cm 1.cm x 20cm Is water not Wear time up to 3-4 days depending on the condition of the wound and surrounding skin Protect fragile and sensitive skin; as a protective cover for open surgical (e.g. abdomen) Fixate primary dressing as a secondary dressing Can be used in combination with gels and ointments Do not use as primary fixation for IV, cannulae, ports or other infusion and/or life sustaining devices Do not use as a wound contact layer Do not use on bone or IV3000 cm x 6cm 6cm x 7cm non-winged peripheral 7cm x 9cm ported peripheral 9cm x 12cm PICC Line cm x 12cm Central Line 11cm x14cm ported Wear time: up to 7 days not Is water/shower On IV/subcutaneous therapy sites Do not cut Do not apply on bone or or double layer South East Essex Community Woundcare Formulary Page 11

12 Antimicrobials Antimicrobial dressings should only be used where there is either an increased risk of, or clinical signs of infection present. Discontinue once infection has resolved. Avoid long term use of antimicrobial dressings; reassess the wound after 2 weeks of antimicrobial dressing use; if no clinical signs of improvements after this consider selecting an alternative antimicrobial dressing and seek tissue viability/medical advice. Avoid indiscriminate use of topical antimicrobial dressings due to concerns around bacterial resistance and toxicity. There is no robust clinical evidence that dressings containing antimicrobials (e.g. silver, iodine or honey) are more effective than un-medicated dressings for the treatment or prevention of wound infection. However, experience and anecdotal case studies indicate they have a place in management of infected and may prevent progression to systemic antibiotics. Do not use antimicrobial dressings routinely for non-infected acute, diabetic foot ulcers or uncomplicated leg ulcers. Evidence for use in infected burns is weak Atrauman Ag** cm x cm cm x cm cm x 20cm Can be applied double layered Wear time 1-3 days Not water/ shower Primary contact layer for contaminated or infected Known allergy to the components or sensitivity to silver Must be removed prior to X ray, MRI, ultrasound or diathermy Do not use on bone or SILVER AQUACEL Ag+ Extra ** AQUACEL Ag+ Ribbon** cm x cm cm x cm 1cm x 1cm 1cm x 4cm 2cm x 4 Can used on bone and Acute and chronic where infection or an increased risk of infection is suspected Wounds prone to bleeding, e.g. that have been mechanically or surgically debrided Exudate management When clinically indicated (e.g. leakage, bleeding) Can be double layered Can be left in place for up to 7 days Known sensitivity or allergy to silver or dressing components UrgoClean Ag** 6cm x 6cm cm x cm 1cm x 20cm Not water/shower Chronic and acute at risk of or with signs of infection 1-2 days during desloughing phase then as and up to 7 days Known sensitivity to silver Not suitable as a surgical sponge for heavily bleeding Do not use on patients undergoing MRI examination Do not use in combination with hydrogen peroxide, organmercuric antiseptics or hexamidine ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 12

13 Cadexomer Iodine: Iodoflex Paste** g g 17g 3 2 Wear time up to 3 days depending on exudate levels or until all the iodine has been absorbed Not water/shower Treatment of chronic exudating To remove excess exudate and slough from the wound bed and reduce bacteria at the wound surface When the dressing has lost its colour Do not use on bone and, dry necrotic tissue, known sensitivity to iodine, children, pregnant or lactating women, if renal impairment or thyroid disorders Do not use concomitantly with mercurial antiseptics or taurolidine Potential risk of interaction with lithium, resulting in an increased possibility of hypothyroidism IODINE Povidone-iodine: Inadine ** cm x cm 9.cm x 9.cm 2 2, Use on bone or is at clinicians discretion Can be folded to fit the wound Chronic, prevention of infection in minor burns and minor traumatic skin loss injuries Suitable for use in adults and children When the dressing turns white Known iodine hypersensitivity/allergy Before and after the use of radio-iodine (until permanent healing) If being treated for kidney problems Pregnant and breast feeding women In cases of Duhring s herpetiform dermatitis Use under medical supervision: If thyroid disease Up to age 6 months To treat deep ulcerative, burns or large injuries. If using for more than one week ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 13

14 ANTIMICROBIAL ENZYMES Flaminal Forte Gel** Flaminal Hydro** 1g tube 0g tube 1g tube 0g tube 1 1 Can go on bone and Not water/shower Can be left in place for 1-4 days dependent on exudate levels is Can go on bone and Not water/shower Can be left in place for 1-4 days depending on exudate levels Acute and chronic Radiotherapy skin reactions, fungating Complex skin tears, cavity Acute and chronic Do not use on eyes Do not use on eyes HONEY Algivon** cm x cm cm x cm Activon Tube** 2g 12 Sloughy or necrotic To eliminate wound malodour Sloughy or necrotic to remove non -viable tissue; to eliminate wound malodour When no honey is present or after 7 days Can be double layered When no honey is present or after 7 days Can be used double layered although rarely indicated Allergy to bee venom Caution should be taken in patients with diabetes - blood sugars should be monitored. Some patients may experience a stinging sensation when applying the product; discontinue if this does not resolve or patient cannot tolerate Allergy to bee venom Caution should be taken in patients with diabetes - blood sugars should be monitored. Some patients may experience a stinging sensation when applying the product. Discontinue use if this does not resolve or patient cannot tolerate ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 14

15 HONEY Actilite** cm x cm cm x cm cm x 20cm Sloughy or necrotic to remove nonviable tissue To eliminate wound malodour When no honey is present or after 7 days Can be double layered Allergy to bee venom Caution should be taken in patients with diabetes - blood sugars should be monitored. Some patients may experience a stinging sensation when applying the product; discontinue if this does not resolve or patient cannot tolerate DACC Cutimed Sorbact Swab** Cutimed Sorbact Ribbon** 4cm x 6cm 7cm x 9cm but keep cut edges out of the wound Wear time up to 7 days 2cm x 0cm 20 Up to 7 days wear time Not water/shower Do not cut length ways Infected exuding If dressing pores are blocked with exudate or slough Not water/shower Can be double layered except where thick purulent exudate Infected exuding Fungal infection in the groin, in skin folds or between digits. Up to 7 days, may require more frequent change in highly exuding, or sloughy Can be double layered Use a single layer where thick purulent exudate Do not use in combination with ointments or creams In dry to low exudating On bone or Do not use in combination with ointments or creams On dry or low exudating On bone and ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 1

16 Kendall AMD Antimicrobial Foam Disc Dressing** 2.cm disc 7mm centre hole 2.cm disc 4mm centre hole 7 day recommended wear time Cutting not Not water Catheter insertions (e.g. central venous catheters and peripherally inserted central catheters) Tracheostomy sites External fixator pin entry sites G-tubes or J-tubes Penrose drains Chest drains Nephrostomy sites Central venous lines Suprapubic catheters When signs of saturation are evident Full thickness burns Do not apply on bone and PHMB Activheal PHMB Foam non-adhesive** cm x cm 7.cm x 7.cm cm x cm cm x 20cm 1cm x 1cm 20cm x 20cm 7 day maximum wear time Is water/ shower For moderate to heavily exuding chronic and acute that are infected or at risk of infection, sloughy or necrotic Dry or light exuding Known sensitivity to polyurethane foams, films, acrylic adhesive or PHMB Activheal PHMB adhesive** 7.cm x 7.cm cm x cm 12.cm x 12.cm 1cm x 1cm 20cm x 20cm not 7 days maximum wear time Is water/ shower Do not cut Infected with moderate to heavy exudate Sloughy or necrotic Dry or light exuding Known sensitivity to polyurethane foams, films, acrylic adhesive or PHMB ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 16

17 OVERGRANULATION Fludroxycortide Tape 7.cm x 20cm For management of overgranulation, under TVS advice only Maxitrol Eye Ointment (unlicensed use) 3.g For topical application to over granulating Unlicensed use, approved by EPUT MMC provided it has been initiated by Acute Trust Specialists Aproderm Barrier Cream FIRST LINE 30g, 0g Protection against irritants effects of bodily fluids associated with incontinence and nappy rash Suitable from birth Reapply depending on how often skin area is cleansed Do not use on infected skin Do not used with known sensitivity to active ingredients SKIN PROTECTION Cutimed PROTECT Barrier Film and Spray SECOND LINE 1ml Foam Applicator 3ml Foam Applicator 28ml Spray 1 Up to 96 hours wear time Is water/shower Prevention of skin maceration or irritation caused by urinary/faecal incontinence, digestive and wound fluids, removal of adhesives, friction and shear Alcohol and irritant free Reapply every 3rd wash after an incontinent episode & after adhesive dressing or stoma pouch change Do not apply directly to the wound bed Do not use on infected skin or bone and Avoid use of ointments, creams, lotions or pastes SECOND LINE Medi Derma-S Total barrier cream 28g 90g To protect mild to moderately damaged skin from injury to allow restoration of skin integrity. It can be used on intact, injured and at risk skin It is generally recommended that the cream is applied twice daily ADHESIVE REMOVERS Sto-Care Remove Medical Adhesive remover spray Dansak Adhesive Spray Remover 0ml 0ml Please refer to Appendix 2 - Moisture Lesion Pathway South East Essex Community Woundcare Formulary Page 17

18 WOUND CLEANSING Irripod 20ml ampoules 2 For the use of irrigating/ cleansing chronic and acute Octenilin Wound Irrigation Solution 30ml Can be supplied in single bottles On for irrigation, cleansing and promoting a healthy wound bed to facilitate wound healing Do not apply to s and hyaline cartilage or inject, or use in sterile body cavities Light Bandages BANDAGES K-Lite Type 2 Light Support bandage K-soft cm x 3.m cm x 4.m cm x 4.m 16 Can be left in place for up to a week not Not water/shower Can be applied as a double layer Not water/shower Can be double layered Sprains and strains and for the prevention of oedema To secure primary dressings For reducing effect of compression on the skin from compression bandages and orthopaedic casting materials Reshaping the leg around the calf or ankle when applying 4-layer compression Protect bony prominences When soiled Wear time up to one week when used as part of a multi-layer bandaging system Known allergy to any component properties Known allergy to any component properties South East Essex Community Woundcare Formulary Page 18

19 BANDAGES Compression (40mmhg) Only to be applied by appropriately qualified clinicians following holistic assessment including Doppler for management of venous leg ulcer, venous oedema which require full compression ABPI: Do not use on patients with an Ankle Brachial Pressure Index (ABPI) < 0.8 or on diabetic patients with advanced small vessel disease. If ABPI liaise with appropriate clinical specialist. Contraindications: Significant arterial disease (ischaemia) according to vascular assessment Current acute inflammatory episode Acute deep vein thrombosis Patients with diabetes or rheumatoid arthritis unless after specialist referral and under supervision Patients with renal failure unless after specialist referral and under supervision Congestive heart failure, as compression could lead to cardiac overload Sensory disorders of the limb i.e. peripheral neuropathy Known sensitivity to the bandage system Precautions: KTwo If the patient develops pain or pale, cool, or numb extremities below the dressing, remove the bandages promptly. Assess the size and shape of the limb and use appropriate bandage regime Failure to detect significantly reduced arterial flow can result in pressure necrosis, amputation or death. 18cm - 2cm cm 2cm - 32cm cm Profore 4 layer Profore 1 cm x 3.m Profore 2 cm x 4.m Profore 3 cm x 8.7m Profore 4 cm x 2.m Profore + cm x 3m bandages and a wound contact layer Coban 2 One size 1 roll of each of padding foam and bandage Short stretch (Actico ) cm x 6m 12cm x 6m 1 1 not Not water/shower Primary dressings to cover bone and Up to 7 days wear time Not water/shower Up to 7 day wear time when using for management of venous leg ulcers Not water not Not water/shower Treatment of venous leg ulcer, venous oedema and lymphoedema, which require full compression ABPI: Venous and mixed aetiogy leg ulcers For venous leg ulcers with Ankle Brachial Pressure Index (ABPI) Should be left in place both day and night until the next dressing change Should be left in place both day and night until the next dressing Wear time up to 7 days If it becomes loose fitting, or when it no longer conforms to the shape of the bandaged area Cut off excess bandage at the end of application Treatment of venous or mixed leg ulcer, venous oedema and lymphoedema, which require a reduced level of compression Especially useful for mixed aetiology ulceration See above See above See above See above South East Essex Community Woundcare Formulary Page 19

20 BANDAGES Reduced Compression Only to be applied by appropriately qualified clinicians following holistic assessment including Doppler for management of venous leg ulcer, venous oedema which require reduced compression ABPI: Liaise with appropriate clinical specialist prior to commencing regime. Contraindications: Significant arterial disease (ischaemia) according to vascular assessment Current acute inflammatory episode Acute deep vein thrombosis Patients with diabetes or rheumatoid arthritis unless after specialist referral and under supervision Patients with renal failure unless after specialist referral and under supervision Congestive heart failure, as compression could lead to cardiac overload Sensory disorders of the limb i.e. peripheral neuropathy Known sensitivity to the bandage system Precautions: If the patient develops pain or pale, cool, or numb extremities below the dressing, remove the bandages promptly. Assess the size and shape of the limb and use appropriate bandage regime Failure to detect significantly reduced arterial flow can result in pressure necrosis, amputation or death Coban 2 lite One size 1 roll of each of padding foam and bandage KTwo Reduced Tubifast with Two way Stretch Technology 18cm - 2cm cm 2cm - 32cm cm Red line: 3.cm x 1m Green line: cm x 1m; cm x 3m; cm x m Blue line: 7.cm x 1m; 7.cm x3m; 7.cmx m Yellow line:.7cm x 1m;.7 x 3m;.7 xm; Purple line 20cm x 1m; 20cm x m 1 1 Single Single Roll Single Roll Single Roll Single Roll Up to 7 day wear time when using for management of venous leg ulcers Not water Cut off excess bandage at the end of application Wear time up to 7 days not Not water/shower Retention Bandage Not water/shower not Can be applied double layered Change if soiled or dirty Does not contain natural rubber latex For mixed aetiology leg ulcers Ankle Brachial Pressure Index (ABPI) >0. Treatment of venous or mixed leg ulcer, venous oedema and lymphoedema, which require a reduced level of compression: ABPI: As a dressing retention and skin covering for any part of the body For patch wrapping As an under-cast stockinette; for holding dressings in place on difficult areas such as amputation stumps If it becomes loose fitting, or when it no longer conforms to the shape of the bandaged area Should be left in place both day and night until the next dressing change See above See above None listed South East Essex Community Woundcare Formulary Page 20

21 Toe Bandage BANDAGES Easifix Only available via NHS supplies cm x 4m 7.cm x 4m cm x 4m 1cm x 4m Comfitube Comfinette not Not water/shower Tubular Bandage Suitable under k soft as protection Suitable for securing toe dressings Fixation of dressings on all parts of the body, especially on joints None known Effective assessment including ABPI and measurement of limbs is necessary to ensure correct selection of hosiery. Compression hosiery class selected should be the highest that the patient will tolerate. It is desirable that pressures delivered via bandaging are maintained when switching to hosiery. Contraindications: Patients with diabetes, unless under medical supervision Significant arterial disease (ischaemia) according to vascular assessment Congestive cardiac failure, as compression can lead to cardiac overload Known sensitivity to the fabric of the stocking HOISERY Activa Hoisery kit Sigvaris range Jobst range S, M, L, XL, XXL and made to measure XXS-XL PLUS Dependant on range and made to measure Dependant on range and made to measure Dependent upon patient need/preference/fit - Dependent upon patient need/preference/fit Dependent upon patient need/preference/fit Other products are available as and dependent upon patient need/preference/fit Hoisery Aids Actiglide One size Order in single units Ezy-as Small, Medium, Large Handles Order in single units Sock Aid One size Order in single units South East Essex Community Woundcare Formulary Page 21

22 OTHER MEDICAL THERAPIES KerraPro Pressure Reducing Pads Sheets: cm x cm x 0.3cm cm x cm x 1.2cm Sacrum/Ankle Strip: 0cm x 2.cm x 0.3cm 30cm x cm x 0.3cm Can be left in place for 24 hours but must be removed, washed, dried and reapplied at least twice in 24 hours will last for 3-6 months Not water/ shower Prevention of pressure ulcers in at-risk patients as part of pressure ulcer prevention To reduce pressure in bony areas where pressure damage can occur in at-risk patients. Only use on intact skin (grade 1 or at-risk skin) Visible signs of splitting or cracking Do not use on bone or If known sensitivity to silicone TAPE Scanpore Chemifix 2.cm x m 2.cm xm 2.cm x m 2.cm x m Adhesive tape for retention of bandages, dressings, tubing Adhesive tape for retention of bandages, dressings, tubing Burns MISCELLANEOUS Locally infected superficial burn 1st line UrgoTul SSD cm x 12cm 1cm x 20cm 16 2 Can go on bone and Not water/shower Local treatment of acute and chronic and particularly partial thickness burns where there is a risk of infection Every 1-2 days depending on the wound Known sensitisation to sulphonamides and other ingredients Patients with renal or hepatic impairment, pregnant or breastfeeding women, newborn/premature babies Patients undergoing MRI examination Medihoney HCS 6cm x 6cm 11cm x 11cm 20cm x 20cm not Wear time depends on exudate levels Dry to moderately exudating 1st and 2nd degree burns 3rd degree burns Known sensitivity to honey South East Essex Community Woundcare Formulary Page 22

23 Post Radiotherapy Flamigel 40g 0g Singles Singles not Shower Wear time from onset of treatment 2-4 weeks post treatment or until pain & erythema have subsided To prevent incidence & onset of radiotherapy induced skin reactions Apply 3-6 times daily Known allergy to any of the ingredients On eyelids or eyes or bone and Foam Border Adhesive Biatain Adhesive 17cm x 17cm 23cm x 23cm Wear time up to 7 days Can be applied to bone and Not shower Moderately to highly exudating acute and chronic Slight loss of colour but no more than 7 days Known sensitivity or allergy to the dressing or its components With oxidising solutions such as hydrogen peroxide MISCELLANEOUS KerraContact Ag* cm x cm cm x 12.cm 1cm x 1cm Antimicrobial Up to 7 days wear time Not water/shower Clinically infected Only overlap the dressing at the edges Permanent skin discoloration may occur after cumulative where the dressing contacts the skin Slight loss of colour Known sensitivity or allergy to the dressing or its components With oil-based products, such as petrolatum If undergoing MRI procedures With electrode and conductive gels during electronic measurements (e.g. EEG/ECG) Biatian Alginate Ag cm x cm cm x cm 1cm x 1cm 3cm x 44cm rope 30 Can be used under compression bandages Contains alginate, and may assist in supporting the control of minor bleeding in superficial Not water Up to 7 day wear time All heavily infected exuding including cavity Dependent on exudate level Can be double layered Dry or lightly exuding Known sensitivity to alginates or silver Do not use to control heavy bleeding South East Essex Community Woundcare Formulary Page 23

24 Tissue Viability Approved Use Only MISCELLANEOUS Debrisoft Lolly cm x 2.7cm (monofilament fibre head of lolly; core width of head is 1.9cm) Wound Cleaning Wash emollients off before using Can be used to clean around bone and s Fully moisten Debrisoft Lolly with tap water or saline before use. May be necessary to use on more than one occasion. Larger areas may take longer to treat, depending on the amount of slough, debris or hyperkeratosis present Use for 3 - mins to clean/debride acute and chronic, Hyperkeratosis and peri-wound skin, cavity, and between digits and skin folds UCS Wipes Pack of Single use only Cleansing and wound debridement of acute and chronic Effective at removing hyperkeratosis Octenilin Antimicrobial Mitts Medi Derma-Pro Foam and Spray Incontinence Cleanser Medi Derma-Pro Skin Protectant Ointment Pack of 24 packs of mitts each or in single packs or whole cases As part of MRSA decolonisation pathway for washing skin - either whole-body washing or for cleaning the periwound area For bed bound patients only 20ml For external use only Removal of urine and faeces For breakdown and removal of stubborn dry bodily fluids e.g. faeces and blood Skin Protection 11g For external use only Protection of intact, injured and as risk skin from severe irritation due to incontinence Do not use as a wound dressing Do not cut Do not introduce into with an opening smaller than the size of the head: core width of the Debrisoft Lolly head is 1.9cm Known sensitivity to any components of the product None listed Do not use if known allergies / sensitivities to the any of the ingredients Do not use with adhesive dressings or appliances. Do not use if known allergies / sensitivities to the any of the ingredients Do not use with adhesive dressings or appliances Please refer to Appendix 2 - Moisture Lesion Pathway South East Essex Community Woundcare Formulary Page 24

25 Protease Inhibitor UrgoStart Contact (tulle) cm x 7cm cm x cm 1cm x 20cm Can go on bone and Not water/shower Exuding acute and chronic For lining cavities and for wicking deep Up to 7 days Do not use in not likely to heal e.g. malignancy, fistulas which may reveal a deep abscess If known sensitivity to the dressing MISCELLANEOUS UrgoStart (Foam non border) UrgoStart Border 6cm x 6cm cm x cm 1cm x 20cm 8cm x 8cm cm x cm 13cm x 13cm 1cm x 20cm 20cm x 20cm (sacrum) Can go on bone and not Not water/shower Can go on bone and not Is water/shower Exuding chronic and long standing acute Exuding chronic and long standing acute Up to 7 days Do not use in which are not likely to heal e.g. malignancy, fistulas may reveal a deep abscess If a known sensitivity to the dressing Up to 7 days Minimum 8 weeks treatment duration Adhesive edges can be cut but not the central pad Do not use in not likely to heal e.g. malignancy, fistulas which may reveal a deep abscess If a known sensitivity to the dressing Bandages Alternative compression systems Jobst FarrowWrap Juxta CURES JuxtaLite THESE PRODUCTS SHOULD NOT BE PRESCRIBED AS FIRST LINE OPTION Dependent on individual limb assessment and measurement Specialist TVN/ Leg Ulcer specialist recommendation/use only Apply according to Manufacturers guidance Oedema needs to be reduced first before applying these systems South East Essex Community Woundcare Formulary Page 2

26 Leg Ulcer Service List HYDROFIBRE AQUACEL Extra cm x cm cm x cm 1cm x 1cm Wear time up to 7 days where clinically indicated Leg ulcers Leakage, excessive bleeding or suspicion of infection Can be double layered Known sensitivity, or allergy to the dressing or its components ALGINATE Biatain Alginate cm x cm cm x cm 1cm x 1cm 30 Wear time up to 7 days Can be used as a secondary dressing in combination with other dressings such as alginates, hydrogels Is water/shower Dry to lightly exuding chronic and acute Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components With topical steroids for which occlusion is not indicated DESLOUGHING UrgoClean 6cm x 6cm cm x cm 1cm x 20cm Wear time up to 7 days. Can be used as a secondary dressing in combination with other dressings such as alginates, hydrogels Is water/shower Dry to lightly exuding chronic and acute Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components With topical steroids for which occlusion is not indicated South East Essex Community Woundcare Formulary Page 26

27 HAEMOSTATIC Kaltostat cm x cm cm x 20cm Wear time up to 7 days Not water/shower Can be double layered Moderate to heavily exudating, local management of bleeding minor Leakage, increased pain, suspicion of infection Known sensitivity to Kaltostat or its components FOAM BORDERED ADHESIVE AQUACEL Foam Adhesive Kerrafoam Gentle Border 8cm x 8cm cm x cm 12.cm x 12.cm 7.cm x 7.cm cm x cm 12.cm x 12.cm Up to 7 day wear time not Is water/shower Wear time 1- days not Is shower Chronic Exudate absorption Acute and chronic moderately exudating Leakage, bleeding or suspicion of infection, increased pain, suspicion of infection Dressing will be enlarged and slightly discoloured, might start to peel up at the edges Known sensitivity, or allergy to the dressing or its components Do not use: on eyes, mucous membranes, exposed bone or s, cavity or sinuses, dry, bleeding If known sensitivity or allergy to any of the dressing components Do not cut South East Essex Community Woundcare Formulary Page 27

28 FOAM NON ADHESIVE UrgoTul Absorb AQUACEL Foam 6cm x 6cm cm x cm 1cm x 20cm cm x cm 1cm x 1cm 1cm x 20cm 20cm x 20cm Can go on bone and Not water/shower Can be left in place for up to 7 days Is water/shower Exudating acute and chronic Moderately exudating acute and chronic Every 2-4 days depending on the exudate levels and condition of wound. When prescribed for use under compression therapy can be changed every 7 days if not Leakage, bleeding or suspicion of infection, increased pain Known sensitivity or allergy to the dressing or its components HYDROCOLLOID Duoderm Extra Thin 7.cm x 7.cm cm x cm 1cm x 1cm Wear time up to 7 days not Is water/shower Dry to lightly exuding chronic and acute Either alone or with topical steroids in the management of psoriasis or other recalcitrant conditions when recommended by the physician Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components Do not use with topical steroids for which occlusion is not indicated South East Essex Community Woundcare Formulary Page 28

29 HYDROGEL SHEET KerraLite Cool Border KerraLite Cool 8cm x 8cm 11cm x 11cm 1cm x 1cm 6cm x 6cm 18cm x 12.cm Can be used on exposed bone and not Is shower Up to 7 day wear time depending on exudate levels Can be used on exposed bone and Is shower Up to 7 day wear time depending on exudate levels Dry- low exudating sloughy or necrotic Dry-low exudating sloughy or necrotic Discoloured and contact layer may be slightly jellylike, adhesive may start to lift up Discoloured and contact layer maybe slightly jellylike, adhesive may start to lift up Do not use on fullthickness, heavily bleeding, third degree burns, a covering for deep, narrow cavities or sinuses or cut Do not use on fullthickness, heavily bleeding, third degree burns, a covering for deep, narrow cavities or sinuses or cut NON/LOW ADHERENT CONTACT LAYER N-A Ultra UrgoTul Atrauman 9.cm x 9.cm 9.cm x 19cm cm x cm 1cm x 1cm 1cm x 20cm 7.cm x cm cm x 20cm 20cm x 30cm 40 2, 0 30 Use on bone or at clinician s discretion Change as often as necessary Not water/shower Can go on bone and Not water/shower Not water/shower Can be applied double layered Wound contact layer for use on leg ulcers Management of granulating and epithelising acute and chronic Superficial acute and chronic Depends on clinical presentation of wound Every 2-4 days but can be left if appropriate for up to 7 days South East Essex Community Woundcare Formulary Page 29 None Up to 7 days Sensitivity to the product or its components Do not apply to bone or

30 ODOUR CONTROL CliniSorb cm x cm cm x 20cm 1cm x 2cm Either primary or secondary dressing All malodorous including fungating Heavy exudate reduces dressing effectiveness Known sensitivity to the product or its components Non/Low Mepore 7cm x 8cm cm x 11cm 11cm x 1cm Not water not Low to moderately exudating Dependent on the wound type and exudate levels. Remove in direction of hair growth Do not apply under tension particularly when applying over joints, to prevent shearing forces causing damage to the skin Do not use on bone or or double layer ABSORBANTS Mepore Ultra Kerramax Care 7cm x 8cm cm x 11cm 11cm x 1cm cm x cm cm x 22cm 20cm x 22cm 20cm x 30cm Not water not Border can be cut but not the pad High Wear time 1-3 days Not shower Can be double layered and folded Low to moderately exudating Moderate to highly exudating Under compression as single layer Dependent on the wound type and exudate levels. Remove in the direction of hair growth Dressing will be enlarged and may be discoloured Do not apply under tension particularly when applying over joints Do not use on bone or or double layer Do not use on exposed bone or, bleeding, fungating, donor sites Do not use or covering fistulae, for postoperative sutured or dehisced If known allergy or hypersensitivity to any of the components Do not cut South East Essex Community Woundcare Formulary Page 30

31 Silver Atrauman Ag** cm x cm cm x 20cm Can double layer Primary contact layer for contaminated or infected Must be removed prior to X ray, MRI, ultrasound or diathermy ANTIMICROBIALS AQUACEL Ag+ Extra ** UrgoClean Ag** cm x cm 1cm x 1cm 6cm x 6cm cm x cm 1cm x 20cm Can used on bone and Can double layer Wear time up to 7 days Can go on bone and is Not water/shower Infection or an increased risk of infection Chronic and acute at risk of or with signs of infection Should be changed when clinically indicated (e.g. leakage, bleeding) 1-2 days during desloughing phase then as and up to 7 days If known sensitivity or allergy to silver or the dressing components Known sensitivity to silver Not suitable as a surgical sponge for heavily bleeding Do not use on patients undergoing MRI examination Do not use in combination with hydrogen peroxide, organmercuric antiseptics or hexamidine Acticoat** SECOND LINE ONLY cm x cm cm x 20cm Use on bone and at clinicians discretion For infected Change at least every 3 days or depending on exudate levels and condition of wound Known sensitivity to silver During MRI examination ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 31

32 Iodine ANTIMICROBIALS Cadexomer Iodine Iodoflex Paste** Povidone-iodine Inadine** g g cm x cm 9.cm x 9.cm 3 2 Wear time up to 72 hours depending on exudate levels or until iodine has been absorbed Not water/shower Use on bone or at clinicians discretion Can fold to fit the wound Treatment of chronic exuding To remove excess exudate and slough from the wound bed Reduce bacteria at the wound surface Chronic, ulcerative and prevention of infection in minor burns and minor traumatic skin loss injuries When dressing has lost its colour When the dressing turns white indicating loss of antiseptic efficacy Do not use on bone and, dry necrotic tissue, patients with known sensitivity to iodine, pregnant/ lactating women, renal impairment or thyroid disorders Do not use concomitantly with mercurial antiseptics or taurolidine Do not apply double layered Potential risk of interaction with lithium, resulting in an increased possibility of hypothyroidism Known iodine hypersensitivity /allergy Before and after the use of radio-iodine (until permanent healing) If being treated for kidney problems Pregnant and breast feeding women In cases of Duhring s herpetiform dermatitis Use under medical supervision: If thyroid disease To treat deep ulcerative, burns or large injuries If using for more than one week ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 32

33 Honey Actilite** cm x cm cm x 20cm Sloughy or necrotic to eliminate wound malodour When no honey present or after 7 days Can be used double layered although rarely indicated Allergy to bee venom Caution should be taken in patients with diabetes - monitor blood sugars Some patients may experience a stinging sensation when applying the product; discontinue use if this does not resolve or patient cannot tolerate ANTIMICROBIALS Cutimed Sorbact Swab** 4cm x 6cm 7cm x 9cm DACC but keep cut edges out of the wound. Wear time to 7 days but usually 1-3 days Not water/shower All types of contaminated, colonised or infected exuding Prophylactically in high risk patients for prevention of infection in all wound types If dressing pores are blocked with exudate or slough Can be double layered except where thick purulent exudate Do not use in combination with ointments or creams In dry to low exudating On bone or Cutimed Sorbact Gel** 7.cm x 7.cm 7.cm x 1cm but keep cut edges out of wound Wear time 1-3 days depending on wound condition and exudate levels Not water/shower Use single layer only All types of infected chronic or acute Can be used prophylactically for the prevention of infection in all wound types When the gel dries out Do not use in combination with ointments or creams or on bone or ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 33

34 PHMB Activheal PHMB non-adhesive** 1st line cm x cm 7.cm x 7.cm cm x cm cm x 20cm 1cm x 1cm 20cm x 20cm 7 day maximum wear time Is water/ shower For moderate to heavily exuding chronic and acute that are infected or at risk of infection, sloughy or necrotic Dry or light exuding Known sensitivity to polyurethane foams, films, acrylic adhesive or PHMB ANTIMICROBIALS Activheal PHMB foam adhesive** 1st line Kendall AMD Foam** 2nd line 7.cm x 7.cm cm x cm 12.cm x 12.cm 1cm x 1cm 20cm x 20cm cm x cm cm x cm 1cm x 1cm 20cm x 20cm 2 not 7 days maximum wear time Is water/ shower Up to 7 day wear time Not water/shower Infected with moderate to heavy exudate Sloughy or necrotic Acute and chronic Donor sites Superficial burns or cover dressing for packed Exudate management for tracheostomy, G-tube, J-tube, Penrose drain, chest tube, nephrotomy tube or sump drain When signs of saturation are evident Can be double layered Dry or light exuding Known sensitivity to polyurethane foams, films, acrylic adhesive or PHMB Do not cut Full thickness burns Do not apply on bone or ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 34

35 OVERGRANULATION Fludroxycortide Tape 7.cm x 20cm For management of overgranulation Maxitrol Eye Ointment (Unlicensed use) 3.g For topical application to over granulating Unlicensed use, approved by EPUT MMC provided it has been initiated by Acute Trust Specialists SKIN PROTECTION Cutimed PROTECT Barrier Film and Spray SECOND LINE Aproderm Barrier Cream FIRST LINE Medi Derma-S cream SECOND LINE 1ml Foam Applicator 3ml Foam Applicator 28ml Spray 28g 90g 1 Foam applicator Wear time up to 96 hours Is water/shower Prevention of skin maceration or irritation caused by wound fluids, removal of adhesives, friction and shear Alcohol and irritant free To protect mild to moderately damaged skin from injury to allow restoration of skin integrity. It can be used on intact, injured and at risk skin It is generally recommended that the cream is applied twice daily Do not apply directly to the wound bed Do not use on infected skin or bone and Avoid use of ointments, creams, lotions or pastes WOUND CLEANSING Octenilin Wound Irrigation Solution 30ml Can be supplied in single bottles UCS wipes Pack of Single use only On for irrigation, cleansing and promoting a healthy wound bed to facilitate wound healing Cleansing and wound debridement of acute and chronic Effective at removing hyperkeratosis Do not apply to s and hyaline cartilage or inject, or use in sterile body cavities None listed Please refer to Appendix 2 - Moisture Lesion Pathway South East Essex Community Woundcare Formulary Page 3

36 BANDAGES K-Lite Type 2 Light Support bandage K-Soft cm x 3.m cm x 4.m Light Bandages cm x 4.m 16 Can be left in place for up to a week not Not water/shower Can be applied double layered Not water/shower Can be double layered Compression (40mmhg) Sprains and strains and for the prevention of oedema To secure primary dressings For reducing effect of compression on the skin from compression bandages and orthopaedic casting materials Reshaping/protection of leg with 4 layer/ktwo and actico bandages Protect bony prominences When soiled Wear time up to one week when used as part of a multi-layer bandaging system Known allergy to any component properties Known allergy to any component properties Only to be applied by appropriately qualified clinicians following holistic assessment including Doppler for management of venous leg ulcer, venous oedema which require full compression ABPI: Do not use on patients with an Ankle Brachial Pressure Index (ABPI) < 0.8 or on diabetic patients with advanced small vessel disease. If ABPI liaise with appropriate clinical specialist. Contraindications: Significant arterial disease (ischaemia) according to vascular assessment Current acute inflammatory episode Acute deep vein thrombosis Patients with diabetes or rheumatoid arthritis unless after specialist referral and under supervision Patients with renal failure unless after specialist referral and under supervision Congestive heart failure, as compression could lead to cardiac overload Sensory disorders of the limb i.e. peripheral neuropathy Known sensitivity to the bandage system Precautions: If the patient develops pain or pale, cool, or numb extremities below the dressing, remove the bandages promptly. Assess the size and shape of the limb and use appropriate bandage regime Failure to detect significantly reduced arterial flow can result in pressure necrosis, amputation or death. South East Essex Community Woundcare Formulary Page 36

37 BANDAGES UrgoKTwo 18cm - 2cm cm 2cm - 32cm cm Profore 4 layer Profore 1 cm x 3.m Profore 2 cm x 4.m Profore 3 cm x 8.7m Profore 4 cm x 2.m Profore + cm x 3m bandages in the kits and a wound contact layer (Bandages also available as individual components if kit not ) Coban 2 One size 1 roll of each of padding foam and bandage Short stretch (Actico) cm x 6m 12cm x 6m 1 1 not Not water/shower Primary dressings to cover bone and Up to 7 days wear time. Not water/shower Up to 7 day wear time when using for management of venous leg ulcers Not water not Not water/shower Treatment of venous leg ulcer, venous oedema and lymphoedema, which require full compression ABPI: Venous and mixed aetiology leg ulcers For venous leg ulcers with Ankle Brachial Pressure Index (ABPI) Treatment of venous or mixed leg ulcer, venous oedema and lymphoedema, which require a reduced level of compression Especially useful for mixed aetiology ulceration Should be left in place both day and night until the next dressing Wear time up to 7 days If it becomes loose fitting, or when it no longer conforms to the shape of the bandaged area Cut off excess bandage at the end of application Should be left in place both day and night until the next dressing change See above See above See above See above South East Essex Community Woundcare Formulary Page 37

38 BANDAGES Reduced Compression Only to be applied by appropriately qualified clinicians following holistic assessment including Doppler for management of venous leg ulcer, venous oedema which require reduced compression ABPI: Liaise with appropriate clinical specialist prior to commencing regime. Contraindications: Significant arterial disease (ischaemia) according to vascular assessment Current acute inflammatory episode Acute deep vein thrombosis Patients with diabetes or rheumatoid arthritis unless after specialist referral and under supervision Patients with renal failure unless after specialist referral and under supervision Congestive heart failure, as compression could lead to cardiac overload Sensory disorders of the limb i.e. peripheral neuropathy Known sensitivity to the bandage system Precautions: If the patient develops pain or pale, cool, or numb extremities below the dressing, remove the bandages promptly. Assess the size and shape of the limb and use appropriate bandage regime Failure to detect significantly reduced arterial flow can result in pressure necrosis, amputation or death Coban 2 lite One size 1 roll of each of padding foam and bandage KTwo Reduced Tubifast with Two way Stretch Technology 18cm - 2cm cm 2cm - 32cm cm Blue line: 7.cm x 1m; 7.cm x 3m; 7.cm x m Yellow line:.7cm x 1m;.7cm x 3m;.7cm x m Purple line: 20cm x 1m; 20cm x m 1 1 Single Roll Single Roll Single Roll Up to 7 day wear time when using for management of venous leg ulcers Not water Wear time up to 7 days not Not water/shower Retention Bandage Not water/shower not Can be applied double layered Change if soiled or dirty For mixed aetiology leg ulcers Ankle Brachial Pressure Index (ABPI) >0. Treatment of venous or mixed leg ulcer, venous oedema and lymphoedema, which require a reduced level of compression: ABPI: Dressing retention and skin covering for any part of the body For patch wrapping As an under-cast stockinette; for holding dressings in place on difficult areas such as amputation stumps Does not contain natural rubber latex if it becomes loose fitting, or when it no longer conforms to the shape of the bandaged area. cut off excess bandage at the end of application Should be left in place both day and night until the next dressing change See above See above None listed South East Essex Community Woundcare Formulary Page 38

39 BANDAGES Easifix Only available via NHS supplies cm x 4m 7.cm x 4m cm x 4m 1cm x 4m Comfitube Comfinette Toe Bandage not Not water/shower Tubular Bandages Suitable under k soft as protection Suitable for securing toe dressings Fixation of dressings on all parts of the body, especially on joints None known Effective assessment including ABPI and measurement of limbs is necessary to ensure correct selection of hosiery. Compression hosiery class selected should be the highest that the patient will tolerate. It is desirable that pressures delivered via bandaging are maintained when switching to hosiery. Contraindications: Patients with diabetes, unless under medical supervision Significant arterial disease (ischaemia) according to vascular assessment Congestive cardiac failure, as compression can lead to cardiac overload Known sensitivity to the fabric of the stocking HOISERY Activa Hoisery kit S, M, L, XL, XXL and made to measure Dependent upon patient need/preference/fit Sigvaris range XXS-XL PLUS Dependant on range and made to measure - Dependent upon patient need/preference/fit Jobst range Dependant on range and made to measure Dependent upon patient need/preference/fit Other products are available as and dependent upon patient need/preference/fit South East Essex Community Woundcare Formulary Page 39

40 ALTERNATIVE COMPRESSION SYSTEMS Jobst FarrowWrap Dependent on individual patient limb assessment and sizes Specialist TVN/ LU specialist recommendation/use only Apply according to Manufacturers guidance Juxta Cures Short, standard, long Specialist TVN/ LU specialist recommendation/use only Apply according to Manufacturers guidance Juxtalite Haddenham Toe caps S, M; MxW, L, LxW, XL XL-XW XXl in both short and long options Specialist TVN/ LU specialist recommendation/use only Apply according to Manufacturers guidance XS, S, M,L Specialist TVN/ LU specialist recommendation/use only Apply according to Manufacturers guidance Jobst toe caps Made to measure Specialist TVN/ LU specialist recommendation/use only Apply according to Manufacturers guidance HOISERY AIDS: SELECTION DEPENDS ON PATIENT CHOICE Actiglide One size Order in single units Ezy-as Small, Medium, Large Handles Order in single units Sock Aid One size Order in single units Sigvaris Rolly One size Order in single units South East Essex Community Woundcare Formulary Page 40

41 Diabetic Foot Ulcers (DFUS) Diabetes is the most common cause of foot ulcers this can lead to disability and in some cases amputation. Diabetic Foot Ulcers precede more than 80% of amputations. Patients with diabetes are twice as likely to have subsequent amputations after the first amputation than people without diabetes. Wound infection can be a complication of a diabetic foot ulcer and can be devastating for a patient; it can lead to either minor or major amputation, and even death. The body s immune system may fail to respond to bacterial invasion. There may be an absence of tenderness or fever, there may be no pain or redness around the wound. Pain may be a significant warning sign in a neuropathic patient. Infection can very quickly spread and lead to gangrene. Aggressive and quick treatment is. Quick action: is vital as the wound presentation may be a medical emergency Urgent referral: this may be to TVNs or Wound Management Team as potential revascularisation may be Antibiotic therapy: this is vital as should not be delayed if infection is suspected. Take a swab to ensure prescribed antibiotics are appropriate Complete a Podiatry referral Prescribe: antimicrobial dressing if clinically indicated Check: glycaemic control and liaise with GP or Diabetes Nurse Specialists for support DIABETIC FOOT ULCERS Do not use the following dressing products Hydrocolloids Hydrogel sheets South East Essex Community Woundcare Formulary Page 41

42 Podiatry Service List Hydrofibre AQUACEL Extra cm x cm cm x cm 4cm x cm Up to 7 days where clinically indicated Management of acute and chronic : e.g. diabetic ulcers Surgical Partial thickness burns Trauma Leakage, excessive bleeding or suspicion of infection Can be double layered Known sensitivity, or allergy to the dressing or its components Desloughing PODIATRY SERVICE PRODUCT LIST UrgoClean 6cm x 6cm cm x cm Wear time up to 7 days Can be used as a secondary dressing in combination with other dressings such as alginates, hydrogels Is water/shower Haemostatic Dry to lightly exuding chronic and acute Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components With topical steroids for which occlusion is not indicated Kaltostat cm x cm 7.cm x 12cm 2g rope Wear time up to 7 days Is water/shower Can be double layered Moderate to heavily exudating, local management of bleeding minor Leakage, increased pain, suspicion of infection Known sensitivity to Kaltostat or its components South East Essex Community Woundcare Formulary Page 42

43 Foam Bordered Adhesive Kerrafoam Gentle border 7.cm x 7.cm cm x cm cm x 20cm not Is shower Acute and chronic moderately exudating Dressing will be enlarged and slightly discoloured, might start to peel up at the edges Do not use on eyes, mucous membranes, exposed bone or s, cavity or sinuses, dry, bleeding Known sensitivity or allergy to any of the dressing components Do not cut Foam Non Adhesive PODIATRY SERVICE PRODUCT LIST UrgoTul absorb AQUACEL Foam (non border) 6cm x 6cm cm x cm cm x cm cm x cm cm x 20cm Can go on bone and For up to 7 days where clinically indicated Is water/shower Exudating acute and chronic Cuts, scalds and burns Chronic Surgical Partial thickness burns Exudate management Every 2-4 days depending on the exudate levels and condition of the wound bed Notwater/shower Leakage, bleeding or suspicion of infection, increased pain Known sensitivity, or allergy to the dressing or its components Known sensitivity, or allergy to the dressing or its components Non/Low Adherent Contact Layer Telfa 7.cm x cm 7.cm x cm 0 0 Not water/shower Dry or lightly exudating Suitable for peripheral and central IV sites If known sensitivity to product or components Atrauman cm x cm 7.cm x cm in box/0 in pack Not water/shower Can be applied double layered The management of superficial acute and chronic Every 2-3 days but can be left for up to 7 days Known sensitivity to the product or its components Do not apply to bone or South East Essex Community Woundcare Formulary Page 43

44 Absorbants PODIATRY SERVICE PRODUCT LIST KerraMax Care cm x cm cm x cm Wear time 1-3 days Not shower Can be double layered and folded Moderate to highly exudating Dressing will be enlarged and may be discoloured Do not use on exposed bone or, bleeding, fungating, donor sites Do not use or covering fistulae, for postoperative sutured or dehisced If known allergy or hypersensitivity to any of the components Do not cut Silver ANTIMICROBIALS AQUACEL Ag+ Extra ** UrgoClean Ag** cm x cm cm x cm 6cm x 6cm cm x cm Not water/shower Chronic and acute at risk of or with signs of infection Chronic and acute at risk of or with signs of infection Should be changed when clinically indicated (e.g. leakage, bleeding) 1-2 days during desloughing phase then as and up to 7 days Known sensitivity to silver Not suitable as a surgical sponge for heavily bleeding Do not use on patients undergoing MRI examination Do not use in combination with hydrogen peroxide, organmercuric antiseptics or hexamidine Known sensitivity to silver Not suitable as a surgical sponge for heavily bleeding Do not use on patients undergoing MRI examination Do not use in combination with hydrogen peroxide, organmercuric antiseptics or hexamidine ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 44

45 Iodine ANTIMICROBIALS Inadine ** Flaminal Forte Gel** cm x cm 9.cm x 9.cm 1g tube 0g tube 2 or 2 1 Can be folded to fit the wound Antimicrobial Enzyme Can go on bone and Not water/shower Can be left in place for 1-4 days depending on exudate levels To manage chronic, ulcerative and prevention of infection in minor burns and minor traumatic skin loss injuries Suitable for use in adults and children Acute and chronic Cavity When the dressing turns white indicating loss of antiseptic efficacy Known iodine hypersensitivity /allergy Before and after the use of radio-iodine (until permanent healing) If being treated for kidney problems Pregnant and breast feeding women In cases of Duhring s herpetiform dermatitis Use under medical supervision: if thyroid disease; To treat deep ulcerative, burns or large injuries If using for more than one week Do not use on eyes Honey Actilite** cm x cm cm x cm Sloughy or necrotic ; to eliminate wound malodour When no honey is present or after 7 days Can double layer Allergy to bee venom Caution should be taken in patients with diabetes - blood sugars should be monitored. Some patients may experience a stinging sensation when applying the product; discontinue if this does not resolve or patient cannot tolerate. ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 4

46 ANTIMICROBIALS Cutimed Sorbact Swab** Activheal PHMB foam adhesive** Non adhesive DACC 4cm x 6cm but keep cut edges out of the wound Wear time up to 7 days but usually 1-3 days 7.cm x 7.cm cm x cm cm x cm 7.cm x 7.cm cm x cm PHMB Non-adhesive foam can be cut, adhesive foam cannot be cut not for adhesive foam Maximum wear time 7 days Is water/ shower All types of infected exuding Can be used prophylactically for prevention of infection types For moderate to heavily exuding chronic and acute that are infected or at risk of infection, sloughy or necrotic If the dressing pores are blocked with exudate or slough Not water/shower Can be double layered except where thick purulent exudate Do not use in combination with ointments or creams, in dry to low exudating, on bone or Dry or light exuding If known sensitivity to polyurethane foams, films, acrylic adhesive or PHMB BANDAGES K-Lite type 2 Light support bandage Light Bandages cm x 4.m 16 Wear time up to a week not Not water/shower Can apply as double layer K-Soft cm x 3.cm 26 Not water/shower Can be double layered Sprains and strains and for the prevention of oedema To secure primary dressings For use under orthopaedic casting materials To protect bony prominences When soiled Wear time up to one week Known allergy to any component properties Known allergy to any component properties ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 46

47 BANDAGES BANDAGES Tubifast with Two way Stretch Tecnology Available via NHS supplies only Paediatric List Blue line: 7.cm x 1m 7.cm x 3m 7.cm x m Yellow line:.7cm x 1m.7cm x 3m.7cm x m Comfitube Comfinette Single Roll Roll Single Roll Roll - - Retention Bandages Not water/shower not Can be double layered Tubular Bandages Suitable under K soft as protection As a dressing retention As an under-cast stockinette For holding dressings in place on difficult areas such as amputation stumps Does not contain natural rubber latex If soiled or dirty None listed HYDROFIBRE AQUACEL Extra AQUACEL Ribbon cm x cm cm x cm 1cm x 4cm 2cm x 4cm Wear time up to 7 days where clinically indicated Up to 14 days for burns and donor sites Can be double layered Wear time up to 7 days where clinically indicated Up to 14 days for burns and donor sites Management of acute and chronic : e.g. Pressure Surgical Partial thickness burns Trauma Primary dressing for moderately to highly exudating cavity Leakage, excessive bleeding or suspicion of infection Leakage, excessive bleeding or suspicion of infection Known sensitivity, or allergy to the dressing or its components Known sensitivity, or allergy to the dressing or its components South East Essex Community Woundcare Formulary Page 47

48 DESLOUGHING UrgoClean 6cm x 6cm cm x cm Wear time up to 7 days Can be used as a secondary dressing in combination with other dressings such as alginates, hydrogels Is water/shower Dry to lightly exuding chronic and acute Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components With topical steroids for which occlusion is not indicated FOAM BORDERED ADHESIVE AQUACEL Foam Adhesive KerraFoam Gentle Border 8cm x 8cm 8cm x 13cm cm x cm 7.cm x 7.cm cm x cm Wear time up to 7 days not Is water/shower Wear time 1- days not Is shower Minor abrasions, lacerations, cuts, scalds and burns Chronic Surgical Partial thickness burns Exudate absorption Acute and chronic moderately exudating Leakage, bleeding, suspicion of infection or increased pain Dressing will be enlarged and slightly discoloured, might start to peel up at the edges Known sensitivity, or allergy to the dressing or its components Do not use: on eyes, mucous membranes, exposed bone or s, cavity or sinuses, dry, bleeding If known sensitivity or allergy to any of the dressing components or cut South East Essex Community Woundcare Formulary Page 48

49 FOAM BORDERED ADHESIVE UrgoTul absorb border 6.2cm x cm 8cm x 8cm cm x cm 13cm x 13cm Wear time is 2-4 days and up to 7 days depending on the exudate levels and the wound bed not Is water/shower The central pad cannot be cut but the adhesive edges can be cut if For exudating acute and chronic Every two days and up to seven days depending on exudate levels and wound bed condition HYDROCOLLOID PAEDIATRIC PRODUCT LIST Duoderm Extra Thin cm x cm 7.cm x 7.cm cm x cm Wear time up to 7 days not Is water/shower Dry to lightly exuding chronic and acute Either alone or with topical steroids in the management of psoriasis or other recalcitrant conditions when recommended by the physician Leakage, bleeding, increased pain, suspicion of infection Known sensitivity to the dressing or its components With topical steroids for which occlusion is not indicated HYDROGEL SHEET KerraLite Cool Border 8cm x 8cm 11cm x 11cm Can be used on exposed bone and not Is shower Up to 7 day wear time depending on exudate levels Dry-low exudating sloughy or necrotic Discoloured and contact layer maybe slightly jellylike, adhesive may start to lift up Do not use on fullthickness, heavily bleeding, third degree burns, a covering for deep, narrow cavities or sinuses or cut South East Essex Community Woundcare Formulary Page 49

50 NON/LOW ADHERENT CONTACT LAYER Atrauman PAEDIATRIC PRODUCT LIST Atrauman Silicone cm x cm 7.cm x cm cm x 20cm 7.cm x cm cm x 20cm, 0, 0 30 Not water/shower Can double layer Wear time up to 7 days but this will depend on the wound Not water/ shower Superficial acute and chronic Treatment of fragile, painful, acute and chronic e.g. skin tears Every 2-3 days but up to 7 days Known sensitivity to the product or its components Do not apply to bone or Known allergy of its components Do not use on bone or FILMS Mepitel Film IV cm x 7cm.cm x 12cm cm x 6cm 6cm x 7cm non winged peripheral 7cm x 9cm ported peripheral 9cm x 12cm PICC Line cm x 12cm Central Line 11cm x14cm ported Is water not Wear time up to 3-4 days depending on the condition of the wound and surrounding skin Wear time up to 7 days Secondary dressing not Is water/shower Protect fragile and sensitive skin; as a protective cover for open surgical (e.g. abdomen) Fixate primary dressing as a secondary dressing Can be used in combination with gels and ointments On IV/subcutaneous therapy sites Do not use as primary fixation for IV, cannulae, ports or other infusion and/or life sustaining devices Do not use as a wound contact layer Do not use on bone or Do not cut Do not apply on bone or or double layer PAEDIATRIC PRODUCT LIST South East Essex Community Woundcare Formulary Page 0

51 BANDAGES K-Lite type 2 light support bandage Light Bandages cm x 4.m 16 Can be left in place for up to a week not Not water/shower Can apply as double layer K-soft cm x 3.m 26 Not water/shower Can double layer K-soft 7cm x 4m 20 not Not water/shower Retention Bandages Sprains and strains and for the prevention of oedema To secure primary dressings For use under orthopaedic casting materials To protect bony prominences For the fixation of dressings on all parts of the body, especially on joints When soiled Wear time up to one week Up to a week or at the discretion of the clinician Do not use if known allergy to any component properties Known allergy to any component properties None known Tubifast with Two way Stretch Tecnology Red line: 3.cm x 1m Green line: cm x 1m cm x 3m, cm x m Blue line: 7.cm x 1m 7.cm x 3m, 7.cm x m Single Single Roll - - Not water/shower not Can apply double layered As dressing retention and skin covering for any part of the body; for patch wrapping; as an undercast stockinette; for holding dressings in place on difficult areas such as amputation stumps Does not contain natural rubber latex If soiled or dirty None listed Tubular Bandages Both only available via NHS supplies Comfitube Comfinette Suitable under k soft as protection Suitable for securing toe dressings PAEDIATRIC PRODUCT LIST South East Essex Community Woundcare Formulary Page 1

52 Non/Low Mepore 7cm x 8cm cm x 11cm 11cm x 1cm Not water not Remove in direction of hair growth Low to moderately exudating Dependent on the wound type and exudate levels. Remove in direction of hair growth Do not apply under tension particularly when applying over joints, to prevent shearing forces causing damage to the skin Do not use on bone or or double layer ABSORBANTS Mepore Ultra 7cm x 8cm cm x 11cm 11cm x 1cm Not water not Border can be cut but not the pad Low to moderately exudating Dependent on the wound type and exudate levels. Remove in direction of hair growth Do not apply under tension particularly when applying over joints Do not use on bone or Moderate Zetuvit E sterile PAEDIATRIC cm x cm cm x 20cm 2 2 Wear time depends wound assessment and exudate not Not water/ shower Primary or secondary dressing for moderate to highly exudating Depends on the condition of the wound and exudate levels Known allergy to any of the components or on bone and South East Essex Community Woundcare Formulary Page 2

53 OVERGRANULATION Fludroxycortide Tape 7.cm x 20cm For management of overgranulation, under TVS advice only Maxitrol Eye Ointment (unlicensed use) Cutimed PROTECT Barrier Film and Spray SECOND LINE APRODERM FIRST LINE MEDI DERMA-S TOTAL BARRIER CREAM SECOND LINE ml For topical application to over granulating. Unlicensed use, approved by EPUT MMC provided it has been initiated by Acute Trust Specialists 1ml Foam Applicator 3ml Foam Applicator 28ml Foam Applicator 28g 90g Wear time up to 96 hours Is water/shower Can be double layered Prevention of skin maceration or irritation caused by urinary/faecal incontinence, digestive and wound fluids, removal of adhesives, friction and shear. Alcohol and irritant free To protect mild to moderately damaged skin from injury to allow restoration of skin integrity. It can be used on intact, injured and at risk skin Reapply every 3rd wash after an incontinent episode & after adhesive dressing or stoma pouch change It is generally recommended that the cream is applied twice daily Do not apply directly to the wound bed Do not use on infected skin or bone and Avoid use of ointments, creams, lotions or pastes Please refer to Appendix 2 - Moisture Lesion Pathway South East Essex Community Woundcare Formulary Page 3

54 ANTIMICROBIALS AQUACEL Ag+ Extra ** AQUACEL Ag+ Ribbon** Flaminal Forte Gel** Cutimed Sorbact Swab** Cutimed Sorbact Ribbon** cm x cm cm x cm 1cm x 4 2cm x 4 1g tube 0g tube 4cm x 6cm 7cm x 9cm 1 ** P Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page 4 Silver Can used on bone and Can go on bone and Not water/shower Can be left in place for 1-4 days but depending on exudate levels DACC but ensure cut edges are kept out of the wound Wear time up to 7 days but usually 1-3 days depending on wound condition Not water/shower Can be double layered except where thick purulent exudate 2cm x 0cm 20 but not length ways and ensure one end of the dressing is left outside the body Up to 7 days Wear time usually 1-3 days depending on wound condition Not water/shower Infection or an increased risk of infection Wide range of acute and chronic Radiotherapy skin reactions Complex skin tears, cavity All types of acute and chronic infected exuding, after excision of fistulas and abscess; postoperative dehisced ; traumatic Can be used prophylactically for prevention of infection types All types of infected deep or cavity Fungal infection in the groin, in skin folds or between digits Should be changed when clinically indicated (e.g. leakage, bleeding) AQUACEL Ag+ Extra can be double layered Can be left in place for up to 7 days If the dressing pores are blocked with exudate or slough Up to 7 days, may require more frequent change in highly exuding, or sloughy Can double layer Use a single layer where thick purulent exudate Do not use if known sensitivity or allergy to silver or the dressing components Do not use on eyes Do not use in combination with ointments or creams, in dry to low exudating, on bone or Do not use in combination with ointments or creams Do not use on dry or low exudating Do not use on bone and

55 PHMB ANTIMICROBIALS Kendall AMD Antimicrobial Foam Disc Dressing** 2.cm disc 7mm centre hole 2.cm disc 4mm centre hole 7 day recommended wear time Cutting not Not water Catheter insertions (e.g. central venous catheters and peripherally inserted central catheters) Tracheostomy sites External fixator pin entry sites G-tubes or J-tubes Penrose drains Chest drains Nephrostomy sites Central venous lines Suprapubic catheters When signs of saturation are evident Full thickness burns Do not apply on bone and PAEDIATRIC ** Please refer to Appendix 1 - Infection Prevention and Tissue Viability Wound Swabbing and Antimicrobial Dressing Pathway. South East Essex Community Woundcare Formulary Page

56 Appendix 1 South East Essex Community Woundcare Formulary Page 6