Dressings Formulary Date of issue: June 2015 Review date: June 2017

Transcription

1 Dressings Formulary Date of issue: June 2015 Review date: June 2017 Dressings Formulary, 1 st edition Review date: June 2017 Page 1 of 21

2 Introduction This formulary is based on the CREST Guidelines for Wound Management, 1998 and the NHSSB Wound Care Formulary, January 2004 and was originally developed by a sub-group of community and primary care based professionals involved in wound care. The group included Tissue Viability Nurse Specialists, Podiatrists, Community Nurses and Primary Care Prescribing Advisers. A full review of this formulary was undertaken in March 2015 and shared with stakeholders covering community, primary and secondary care in Coastal West Sussex. All healthcare professionals within Coastal West Sussex that prescribe or request dressings for patients are expected to adhere to this formulary. Primary care practitioners should note that these guidelines do not replace clinical judgement. There may be some occasions when you consider a non-formulary dressing may be appropriate, this however should not be the norm. Products in red text within this formulary are for hospital use only; primary care health care professionals are not expected to prescribe these products. Feedback on the formulary The group who developed this formulary is keen to have your feedback and would genuinely welcome any comments you may have. If there are products you feel should be considered for inclusion when the guidelines are next reviewed, please send them at any time, along with associated evidence-based literature supporting the product(s) to one of the Tissue Viability Nurse Specialists or CWS Medicines Management Team members listed below: Jane Saunders (TVNS, Coastal West Sussex) jane.saunders@nhs.net Louise Scarborough (TVNS, Coastal West Sussex) louise.scarborough@nhs.net ext 6095 Coralia Wukovich (Technician, CWS Medicines Management Team) corawukovich@nhs.net Julie Sadler (Pharmacist, CWS Medicines Management Team) julie.sadler1@nhs.net Pauline Stevens (TVNS, Horsham and Chanctonbury) pauline.stevens@nhs.net ext 7644 Electronic copies of the formulary and order forms These are available on the CWS Local Health Economy Formulary website at: Disclaimer The information contained within is intended for use by healthcare professionals within Coastal West Sussex. We have made every effort to check that the information is correct at the time of publication. Coastal West Sussex does not accept any responsibility for loss or damage caused by reliance on this information. Please read dressing instructions before use. All costs are taken from the March/April 2015 Drug Tariff. Dressings Formulary, 1 st edition Review date: June 2017 Page 2 of 21

3 A GUIDE TO WOUND MANAGEMENT Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004 DESCRIPTION OF WOUND TREATMENT OBJECTIVES EXUDATE LEVEL None Low EXUDATE LEVEL Moderate to High Necrotic Dead/ischaemic tissue, e.g. eschar and slough. In wound care this term tends to be used to describe dead tissue which is black/brown in colour. NB: Keep necrotic toes and heels dry Hydration of eschar, debridement and management of exudate. Be aware of vascular status before any form of debridement is considered on lower limb. Hydrogel (p 6) and Semi-Permeable Film (p 8) (not to be used on ischaemic feet) Low/Non Adherent Dressing (p 8) Hydrocolloid (p 6) Seek podiatry/surgical opinion for necrotic digits. Alginate (p 6) Hydrofibre (p 6) with secondary absorbent dressing (p 7) Treat underlying cause of exudate. Seek podiatry/surgical opinion for necrotic digits. Slough Dead tissue. N.B. Yellow tissue may be tendon or bone. Debridement and management of exudate. Hydrogel (p 6) and Semi-Permeable Film (p 8) /Low/Non Adherent Dressing (p 8) Hydrocolloid (p 6) Alginate (p 6) Hydrofibre (p 6) with secondary absorbent dressing (p 7) Treat underlying cause of exudate. Granulating Process by which the wound is filled with highly vascular fragile connective tissue. Keep warm and moist. Manage exudate. Protect/promote granulation. Low/Non Adherent Dressing (p 8) Hydrocolloid (p 6) Alginate (p 6) Hydrofibre (p 6) with secondary absorbent dressing e.g. Foam (p 7) Absorbent Dressing Pad Low/Non Adherent Dressing (p 8) Red in colour. Treat underlying cause of exudate. Dressings Formulary, 1 st edition Review date: June 2017 Page 3 of 21

4 Epithelialising DESCRIPTION OF WOUND Process by which the wound is covered with new skin cells. Tissue will be pink in colour. A GUIDE TO WOUND MANAGEMENT (continued) TREATMENT OBJECTIVES Keep warm and moist. Manage exudate. Protect from further damage. EXUDATE LEVEL None Low Low/Non Adherent Dressing (p 8) Hydrocolloid (p 6) EXUDATE LEVEL Moderate to High Alginate (p 6) Hydrofibre (p 6) with secondary absorbent dressing or Foam (p 7) Low/Non Adherent Dressing (p 8) Treat underlying cause of exudate. Cavity A loss of continuity of the skin or mucous membrane with associated tissue loss (epidermal covering) and which involves the dermal layer of the skin. Allow to granulate from bottom up. If sloughy debride. Manage exudate. Do not overpack cavity wounds as this delays healing. Hydrogel (p 6) and semi permeable film (p 8) Alginate (p 6) Hydrofibre (p 6) with secondary absorbent (p 7) or foam dressing Treat underlying cause of exudate. Macerated skin A softening or sogginess of surrounding tissue. Check if present dressing regime is absorbing the exudate. Protect with a barrier ointment e.g. liquid/white soft paraffin mix. Barrier film applicator. Macerated skin does not tend to occur in non- or low exuding wounds unless the dressing has been left in place too long! Alginate (p 6) Hydrofibre (p 6) and secondary absorbent dressing (p 7) Treat underlying cause of exudate. Consider more frequent dressing changes. Infected Occurs when organisms in the wound evoke a reaction from the host, i.e. antigenantibody response. To free patient from infection, pain and discomfort. To promote wound healing. See management information below (p 5) Dressings Formulary, 1 st edition Review date: June 2017 Page 4 of 21

5 Classic signs and symptoms of infection: Pus, exudate increasing, pyrexia >38 C, heat (new or increasing), redness (new or increasing), swelling (new or increasing), tenderness or pain (new or increasing), wound deterioration. Systemic antibiotics and swabs for bacteriology ONLY indicated for INFECTION (exception: admission MRSA screening in bedded units). NOTE Infection may produce different signs and symptoms in wounds of different types and aetiologies. Diabetic patients may not display the usual signs and symptoms of infection. The risk of wound infection is increased by any factors that debilitates the patient, impairs immune resistance or reduces tissue perfusion. (ref. WUWHS 2008). Aseptic technique is essential in acute and chronic wound care. Bacteria are increasingly able to transmit antimicrobial resistance information from one species to another. This incidence of cross infection is increased in chronic wounds. Wound swabbing: Presence of bacteria in a wound alone does not indicate that it is infected. Clinical signs of infection indicate the presence of pathogenic organisms and justify the need for wound swabbing. Technique: If a wound swab is required: Clean the wound first by irrigating with sterile normal saline to remove surface contamination and debris. Moisten the swab with sterile normal saline or sterile water if the wound surface is dry. Using a zigzag motion and simultaneously rotating the swab between the fingers, sample the whole wound surface, to include the deepest part, avoiding the surrounding tissue. 1 Avoid areas of necrosis and slough. Where infection is suspected: Adhere to Standard Infection Control Principles, i.e. hand washing with liquid soap and water, appropriate PPE. Swab wound for organisms and sensitivities and record all appropriate information on microbiology form. Use appropriate SYSTEMIC ANTIBIOTICS. Ensure the prescribed antibiotic is appropriate to the pathogen identified. Avoid occlusive dressing if anaerobic bacteria are suspected. Dress infected wounds as appropriate. Choose wound dressing according to type of tissue on wound bed and level of exudate. Review antimicrobial dressings use after two weeks. INFECTED WOUNDS Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004 FIRST LINE: IODINE Only use if infection or overload of bacteria is suspected. Not recommended: For prophylaxis or routine use in chronic wounds. During pregnancy/lactation. As a standard non-adherent dressing if there is NO infection. Caution: Monitor thyroid function in patients with known thyroid disease. Contra-indicated in patients on lithium. Do: Change dressing when distinctive orange-brown changes to white. Leave on for 3-5 days depending on exudate. Iodoflex 5g, 10g, 17g (use for wounds with increased exudate level). Iodosorb ointment 10g Iodosorb powder 3g sachet (only on wet, infected and difficult to access wounds). Povidone-Iodine dressing (Inadine ) on toes only OTHER OPTIONS: Contained within the specials list in this formulary (p12). SILVER 2,3 Dressings containing silver should only be used when infection is suspected as a result of clinical signs and symptoms. They should not be used on acute wounds or routinely for the management of uncomplicated ulcers (as there is some evidence that they delay healing). Prescriptions for silver dressings should not be written unless documentary evidence of individual patient recommendation by a senior nurse or podiatrist. All prescribing of silver dressings will be closely monitored and audited. Aquacel Ag Extra:,, 15cm x 15cm, 20cm x 30cm (hospital only) Aquacel Ag Ribbon 1cm x 45cm, 2cm x 45cm Atrauman Ag,, Aquacel Ag Foam Non-Adhesive 15cm x 15cm (hospital only), 20cm x 20cm (hospital only) HONEY Activon Tulle:, (Impregnated with manuka honey) Activon Medical Grade Manuka Honey 25g tube Algivon Plus Ribbon (with probe) 2.5cm x 20cm DACC COATED DRESSINGS Antimicrobial ONLY - to be used if iodine, silver or honey is not suitable. To be used under moist wound conditions. NOT to be used with ointments or creams. Cutimed Sorbact Ribbon 2.5cm x 50cm Cutimed Sorbact Swab 4cm x 6cm, 7cm x 9cm Dressings Formulary, 1 st edition Review date: June 2017 Page 5 of 21

6 PRODUCT CHOICE DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Alginate Cavity Do not pack tightly into wound. Sorbsan Ribbon (with probe) (1 st line) 40cm 2.04 Change every 2-3 days. If infected change as appropriate. Kaltostat packing rope 2g 3.81 (2 nd line) Alginate Kaltostat has haemostatic properties reduces bleeding in 10 minutes. Cut to size of wound. Irrigate wound to remove. Sorbsan flat (1 st line) Kaltostat (2 nd line) 7.5cm x 12cm Hydrogels Not recommended for heavily exudating wounds. Contra-indicated in anaerobic infection. IntraSite conformable Aquaform hydrogel (7.5g) 8g IntraSite gel 8g 1.80 Hydrocolloids Occlusive dressing. Overlap wound by at least 2cm. Can be left in place for up to 7 days. Avoid in wounds with anaerobic infection and diabetic feet unless under specialist advice. Minimal exudate: Duoderm Extra Thin Light exudate: Comfeel Plus Transparent Dressing 7.5cm x 7.5cm 5cm x 7cm Hydrofibre/cellulose dressings No lateral wicking. Overlap wound by 1cm. Can be left in place for up to 7 days. For highly exuding wounds only: Durafiber (cellulose based) 15cm x 15cm Aquacel Extra 15cm x 15cm Aquacel Ribbon 1cm x 45cm 2cm x 45cm Dressings Formulary, 1 st edition Review date: June 2017 Page 6 of 21

7 PRODUCT CHOICE DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Foams Change when lateral strike through occurs. Can be left in place for up to 7 days. Biatain Non-adhesive Very occasionally patients react to Allevyn/Biatain bordered dressings. Please refer to a TVNS (contact details on p2) if you need to use an alternative product. Biatain Adhesive 5cm x 7cm 15cm x 15cm 12.5cm x 12.5cm Biatain Soft-Hold Biatain Adhesive Sacral Biatain Adhesive Heel Allevyn Non Adhesive Allevyn Adhesive Allevyn Gentle Allevyn Gentle Border Allevyn Anatomically Shaped Sacral Dressing Tegaderm Foam Adhesive Circular (Heel) 15cm x 15cm 23cm x 23cm 19cm x 20cm 7.5cm x 7.5cm 12.5cm x 12.5cm 12.5cm x 22.5cm 15cm x 15cm 7.5cm x 7.5cm 12.5cm x 12.5cm 17cm x 17cm 22cm x 22cm 13.9cm x 13.9cm Dressings Formulary, 1 st edition Review date: June 2017 Page 7 of 21

8 PRODUCT CHOICE DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Films Stretch film parallel to skin to release adhesive and prevent trauma to skin on removal Tegaderm Film (1 st line) Low/Non Adherence Simple low adherent dressings are recommended for venous leg ulcer dressings under compression bandaging. Odour absorbing Charcoal dressing: Change daily in clinically infected wounds. Change when malodour is noted. Carboflex is indicated as a primary dressing for shallow wounds or as a secondary dressing over wound filler for deeper wounds. Metronidazole gel (3 rd line - see specials list p12 - for anaerobic infection) Charcoal is not effective when wet. Not indicated as a primary dressing for dry wounds. Povidone Iodine See notes in infection section. N.B. Inadine dressings the antimicrobial effect from one dressing may not last long enough and may require up to four layers of dressings. Best to use Iodosorb (ointment) or Iodoflex (paste) and cover with N-A Ultra so iodine can stay on wound for longer (up to 7 days). Opsite Flexigrid (2 nd line) Opsite Plus (with absorbent pad) Tegaderm IV with securing tapes Intravenous/Sub-cutaneous Therapy IV3000 Intravenous/Sub-Cutaneous Therapy N-A Ultra (1 st line) Atrauman (2 nd line) Profore Wound Contact Layer CliniSorb (1 st line) Carboflex (2 nd line) Iodoflex (1 st line) Iodosorb ointment (1 st line) Iodosorb powder (only to be used on infected wounds) Inadine (only to be used on toes) 6cm x 7cm 12cm x 12cm 15cm x 20cm 6cm x 7cm 12cm x 12cm 15cm x 20cm cm x 9.5cm 10cm x 15.5cm 10cm x 12cm 9.5cm x 9.5cm 19cm x 9.5cm 7.5cm x 10cm 20cm x 30cm 14cm x 20cm 15cm x 25cm 8cm x 15cm (oval) 5g 10g 17g 10g 3g sachet 9.5cm x 9.5cm Dressings Formulary, 1 st edition Review date: June 2017 Page 8 of 21

9 MISCELLANEOUS PRODUCTS DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Absorbent cellulose dressing (sterile) Primary or secondary dressing for medium to heavily exuding wounds Zetuvit E (sterile) (1 st line) Absorbent simple dressing Low adherence dressing Cleansing agent For irrigating ulcers or wounds, but warm tap water is often appropriate (BNF). Dressing packs Used to provide a sterile working surface. Contains apron, gauze, forceps and tray. Zetuvit Plus (use if higher absorbency required) Mesorb (for moderate exudate) Superabsorbent for very high exudate Kliniderm superabsorbent KerraMaxCare Mepore (1 st line) Cosmopor E (2 nd line) Irripod 20cm x 20cm 20cm x 40cm 20cm x 25cm 20cm x 40cm 20cm x 25cm 20cm x 30cm 10cm x 15cm 20cm x 20cm 20cm x 30cm 10cm x 22cm 20cm x 22cm 20cm x 30cm 7cm x 8cm 10cm x 11cm 11cm x 15cm 9cm x 35cm 5cm x 7.2cm 8cm x 10cm 8cm x 15cm 10cm x 35cm 25 x 20ml Stericlens spray 100mls mls 3.13 Nurse It s/m, m/l 0.54 Dressings Formulary, 1 st edition Review date: June 2017 Page 9 of 21

10 MISCELLANEOUS PRODUCTS continued DRESSING TYPE AND COMMENTS ON PRESCRIBING PRODUCT NAME SIZE COST/ITEM Gauze Gauze Swab Type 13 Light BP 1988, Non 1.43 for 100 A secondary dressing see notes above under low/non adherence dressings. Sterile pads Tape For securing dressings together. Hypafix the apertured structure allows it to be more extensible and conform to the body. Clinipore Scanpor Barrier preparation Cavilon cream can be used on very superficial skin breaks/mild excoriation. Micropore Hypafix Cavilon barrier foam applicator Cavilon durable cream Proshield - For use on intact or injured skin associated with incontinence. Do not use a Proshield Plus Skin Protective dressing over the product. Can be used on partial thickness wounds, moisture lesions and up to a category 2 pressure ulcer. BANDAGES COMPRESSION (Only health care staff who have undergone the specific training should apply compression bandaging) Wool (1 st layer) K-soft long Flexi-Ban Crepe (2 nd layer) K-Lite 2.5cm x 5m 5cm x 5m 2.5cm x 5m 5cm x 5m 1.25cm x 5m 5cm x 10m 10cm x 10m 15cm x 10m 1ml x 5 applicators 28g 92g 115g 10cm x 4.5m 10cm x 3.5m cm x 4.5m cm x 4.5m 1.44 K-Lite long 10cm x 5.25m rd layer K-Plus 10cm x 8.7m th layer Ko-Flex 10cm x 6m 3.00 Short stretch Actico (cohesive) 10cm x 6m 3.33 Kits K-Four multi-layer compression bandage kit < 18cm ankle 18-25cm ankle 25-30cm ankle > 30cm ankle K-ThreeC (for larger limbs) 10cm x 3m 2.81 K Two multi-layer compression bandage kit K Two Reduced multi-layer compression bandage kit 0 (short) 18-25cm (8cm) 25-32cm (10cm) 18-25cm 25cm-32cm Dressings Formulary, 1 st edition Review date: June 2017 Page 10 of 21

11 OTHER BANDAGING Securing bandages A secondary dressing see notes above under low/non adherence dressings Paste bandages Impregnated woven bandage. Knit-band (4m stretched) Viscopaste PB7 (10%) Steripaste 5cm x 4m 7cm x 4m 10cm x 4m 15cm x 4m 7.5cm x 6m 7.5cm x 6m Elasticated viscose stockinette Lightweight plain-knitted elasticated tubular bandage. One 5m length of the relevant width is sufficient to provide two sets of dressing for a pair of limbs or a trunk. Comfifast blue line large limb Comfifast yellow line 7.5cm x 1m 7.5cm x 5m 10.75cm x 1m 10.75cm x 5m Venous ulcer compression systems treatment stockings N.B. Made-to-measure hosiery should be obtained through your usual route COMPRESSION HOSIERY Eesiban Ribbed Cotton Surgical Tubular Stockinette Activa leg ulcer kit Pack contains 1 stocking and 2 liners - 40mmHg Activa compression liner pack (closed toe) Pack contains 3 liners -10 mmhg 7.5cm x 5m 10cm x 5m 15cm x 5m Small Medium Large Extra large Small Medium Large Extra large Extra extra large Elastic hosiery (Activa) Class I Below knee 7.41 Elastic hosiery (Activa) Class II Below knee Acti-glide hosiery applicator For open/closed toe One size Easy-Slide stocking applicator Open toe hosiery only Medium Large Dressings Formulary, 1 st edition Review date: June 2017 Page 11 of 21

12 SPECIALS LIST The products contained in the table below are for specialist use only. Patients must have had a full wound assessment documented. You must know the indications and contraindications of the products used. Please consult the tissue viability service or senior colleague before use or if you need any further advice. PRODUCT PRODUCT NAME SIZE COST/ITEM Antimicrobial See notes in infection section (p 5) Metronidazole 0.75% gel: 15g 30g Silver: Atrauman Ag Aquacel Ag Extra Aquacel Ag Ribbon 15cm x 15cm 20cm x 30cm (hospital only) 1cm x 45cm 2cm x 45cm Aquacel Ag Foam Non-adhesive only for hypergranulated PEG sites and super pubic catheter sites Aquacel Ag Foam Non-Adhesive Honey: Activon Tulle Activon Medical Grade Manuka Honey Algivon Plus Ribbon (with probe) 15cm x 15cm (hospital only) 20cm x 20cm (hospital only) 25g 2.5cm x 20cm DACC coated dressings Antimicrobial ONLY - to be used if iodine, silver or honey is not suitable. To be used under moist wound conditions. NOT to be used with ointments or creams. Irrigation for sloughy infected wounds NOT for routine use DACC coated dressings: Cutimed Sorbact Ribbon Cutimed Sorbact Swab Irrigation: Prontosan pod Prontosan bottle 2cm x 50cm 4cm x 6cm 7cm x 9cm 24 x 40ml 350ml Dressings Formulary, 1 st edition Review date: June 2017 Page 12 of 21

13 PRODUCT PRODUCT NAME SIZE COST/ITEM Physical Debridement Pad DebriSoft 6.35 For debridement of wounds. Use after cleansing. Remove/wash all creams/emollients from wound and skin. Moisten with tap water or saline. Use light finger pressure and circular motion on the wound. Do not soak, overwet, wring out. Note the unit price. Use weekly or twice weekly maximum. Refer to TVN service if advice needed on debridement. Debrisoft should not be used for the routine removal of hyperkeratotic skin plaques. Do NOT use for routine wound cleaning. Foams Change when lateral strike through occurs. Can be left in place for up to 7 days. Note: Biatain adhesive and Allevyn Gentle are the 1 st choices. Biatain Silicone only to be used for patients with fragile skin. Biatain Silicone 7.5cm x 7.5cm 12.5cm x 12.5cm 15cm x 15cm 17.5cm x 17.5cm Aquacel Foam Adhesive (hospital only) 12.5cm x 12.5cm Hydrogels Not recommended for heavily exudating wounds. Contra-indicated in anaerobic infection. Consider ActiFormCool when pain is a significant factor. Hydrocolloids Occlusive dressing. Overlap wound by at least 2cm. Can be left in place for up to 7 days. Avoid in wounds with anaerobic infection and diabetic feet unless under Aquacel Foam Adhesive Sacral (hospital only) ActiFormCool Granugel Hydrocolloid Gel (hospital only) Minimal exudate: Duoderm Extra Thin (hospital only) 20cm x 16.9cm specialist advice. Soft polymer (for patients who cannot tolerate N-A Ultra, Atrauman or Profore) Urgotul 15cm x 15cm (hospital only) Soft silicone Mepitel One 15g cm x 15cm cm x 7cm 9cm x 10cm 24cm x 27.5cm (hospital only) Mepilex Transfer (hospital only) 15cm x 20cm Dressings Formulary, 1 st edition Review date: June 2017 Page 13 of 21

14 PRODUCT PRODUCT NAME SIZE COST/ITEM Barrier preparation For cleaning and moisturising intact and broken skin associated with incontinence. Proshield Foam & Spray skin cleanser 235ml 6.51 Gauze dressing (impregnated) For use following Podiatry recommendation only Chlorhexidine Gauze Dressing BP (Syn: Chlorhexidine Tulle Gras) 0.29 Topical Negative Pressure dressings Patients must be referred for Renasys pump or PICO through the TVN service. PICO is a negative pressure wound therapy pump connected to a dressing. The dressing may improve blood flow to the wound which will help it to heal. Renasys G Gauze dressing kit with soft port Renasys Go canister kit Small Medium Large 300ml with solidifier PICO 10cm x 30cm 15cm x 15cm 15cm x 20cm Foam wound dressing (pack of 5) 10cm x 12.5cm x 1.5cm 7.63 Gauze wound dressing (pack of 2) 15cm x 17cm Dressings Formulary, 1 st edition Review date: June 2017 Page 14 of 21

15 TREATMENT F HYPERGRANULATION 10,11 Please note: This is a very brief guide; please contact the Tissue Viability Service if further information is needed. Hypergranulation (overgranulation) or proud flesh presents as a raised mass of granulation tissue beyond the height of the wound surface. It can occur in a wide range of wounds such as leg ulcers, pressure ulcers and burns. Hypergranulation can be a problem because it impedes wound healing by preventing the migration of epithelial cells across the wound surface. Causes of hypergranlation Little is known about the causes of hypergranulation. The following factors have been identified as being as possible causes: Inflammation: Wound infection, irritants from foreign bodies, friction from external devices such as gastrostomy tubes, allergies and sensitivities. Use of occlusive dressings such as hydrocolloids Cellular imbalance of some kind Treatment There is no consensus on the best way to manage hypergranulation and often the clinician s anecdotal experience is used. You must exclude malignancy and infection as a cause. Sometimes a wait and see option is helpful and the problem resolves without any interventions. If the cause can be identified, one or more of the following approaches may be helpful: For inflammation: Treat any infection (consider antimicrobials), consider removal of irritants, secure external devices, consider use of topical steroids (i.e. fludroxycortide/haelan tape to treat the inflammation. Licensed usage of steroids must be checked. Occlusive dressings: Change to a more permeable product (i.e. foam dressings), apply moderate pressure to the wound (don t constrict blood supply). Cellular imbalance: If you feel that external factors are the cause, then exclude inflammation and occlusion as above. However, if you feel that internal factors are the cause then this can be more difficult; seeking further advice may be necessary. Fludroxycortide / Haelan 4mcg/cm 2 tape 7.5cm x 0.5m = cm x 2m = Dressings Formulary, 1 st edition Review date: June 2017 Page 15 of 21

16 FOOT CARE - Management of diabetic foot ulcers: These should be referred immediately to the local diabetic foot team. They require specialist intervention as per NICE and NSF guidelines on diabetic management. Staff should be aware of local diabetic foot care pathways (see links on page 16) If ulceration is discovered it should be dressed with a non-adhesive foam dressing and hypafix or miropore used to secure. Do not use hydrogels or hydrocolloids unless specifically under the guidance of the diabetic foot team or a TVNS. NB: Arterial ulcers and diabetic foot ulcers are not to be washed unless under specialist advice. For further information on types of diabetic foot ulcers, see link on page 16. Contact details for diabetic podiatric leads in Coastal West Sussex: Mark Ashby Tel: (01243) Diabetes Centre, St Richard s Hospital, Spitalfield Lane, Chichester, PO19 6SE mark.ashby@wsht.nhs.uk Alison Hesling Tel: (01903) ext Diabetes Centre, Worthing Hospital Or: (01903) Podiatry Department, Littlehampton Health Centre, Fitzalan Road, Littlehampton alison.hesling@wsht.nhs.uk MANAGEMENT OF VARICOSE ECZEMA Objective is to return skin to normal through excellent skin care using the following steps: 1. Bath in a bath oil 2. Use of topical steroids 3. Emollients 1. Bath in bath oil wash legs using bath oil with added anti-microbial. NB: Arterial ulcers and diabetic foot ulcers are not to be washed unless under specialist advice. Dermol 600 bath emollient Dermol 500 (this may be used as soap substitute but is not intended as a bath additive) 2. Use of topical steroids - if skin is showing signs of redness (erythema), warmth as well as dryness (xerosis) and itching consider using a topical steroid, prescribed by a GP. Remember to consider differential diagnosis such as cellulitis first. Betamethasone 0.025% cream/ointment (Betnovate RD ), or Clobetasone 0.05% cream/ointment (Eumovate ). 3. Emollients - if skin is very dry consider using: 50/50 white soft paraffin/liquid paraffin If emollients other than the above products are to be used under bandages consider using: Cetraben cream first-line, or Doublebase gel. If the varicose eczema is not controlled by group 2 topical steroids refer to community dermatology nursing service for further advice on management (where available). Apart from 50/50 WSP/LP and Dermol 600, all product choices on this page are in line with the current Coastal West Sussex Dermatology Formulary available at: Dressings Formulary, 1 st edition Review date: June 2017 Page 16 of 21

17 OTHER USEFUL INFMATION AND LINKS GNISATION / INFMATION European Wound Management Association Wounds UK World Wide Wounds Wound Infection Institute European Pressure Ulcer Advisory Panel Leg Ulcer Forum National Institute of Health and Clinical Excellence (NICE) Types of diabetic foot ulcers World Union of Wound Healing Societies DESCRIPTION The European Wound Management Association (EWMA) was founded in 1991, and the association works to promote the advancement of education and research into native epidemiology, pathology, diagnosis, prevention and management of wounds of all aetiologies. Provides general, very helpful, wound care information including access to journals, best practice statements and lots more. The premier online resource for dressing materials and practical wound management information. Up-to-date clinical information on international developments in wound care infection. Started in 1996 to lead and support all European Countries in the effort to prevent and treat pressure ulcers. Provides a forum for healthcare professionals working within the field of leg ulcer management. An independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Summary of types of diabetic foot ulcers including appearance, common sites and management. Co-ordinates a world-wide exchange of information between wound societies and other relevant stakeholders, including international and global agencies as well as personal-level friendship exchanges. LINK / WEB ACCESS Dressings Formulary, 1 st edition Review date: June 2017 Page 17 of 21

18 GLOSSARY OF TERMS Anaerobes Debridement Epithelialisation Eschar Exudate Granulation Haemostasis Infection Maceration Necrosis Pus Slough Strike through Strike through (lateral) organisms which do not need oxygen to survive the removal of devitalised tissue and foreign matter from a wound the process by which the wound is covered with epithelial cells dead tissue that is hard, black and dehydrated a fluid produced in wounds, made up of serum, leucocytes and wound debris the process by which the wound is filled with highly vascular connective tissue. Granulation tissue is red and moist and has an uneven, granular appearance arrest of haemorrhage damage to body tissues by micro-organisms or by poisonous substances released by the organism a softening or sogginess of the tissue surrounding a wound edge the death of previously viable tissue a fluid produced in infections, made up of exudate, bacteria and phagocytes which have completed their work accumulation of dead cellular debris on the wound surface, which tends to be yellow in appearance due to the presence of leukocytes exudate visible on the outer surface of the dressing exudate visible at the edges of the dressing Dressings Formulary, 1 st edition Review date: June 2017 Page 18 of 21

19 REFERENCES 1. Cooper, R. (2010). Assessment and diagnosis, Infection, Ten top tips for taking a swab. Wounds International. Accessed on 25/05/10 at 2. International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, Accessed on 25/03/13 at: 3. British National Formulary. 64 th Edition. London: BMJ Group &RPSGB; September Available online at 4. Thomas, ST. (2009). Formulary of wound management products. A guide for health care staff. 10 th Edition. UK, Euromed Communications Ltd. 5. Surgical Dressing Manufacturers Association (SDMA) Includes the Code of practice for promotion of surgical dressings to healthcare. Available at 6. Palfreyman SSJ, Nelson EA, Lochiel R, Michaels JA. Dressings for healing venous leg ulcers. Cochrane Database of Systematic Reviews 2006, Issue 3. Available at: <accessed on 30/06/10> 7. Chaby G, Senet P, Vaneau M, Martel P, Guillaume J, Meaume S, Teot L, Debure C, Dompmartin A, Bachelet H, et al. Archives of Dermatology. Dressings for acute and chronic wounds: a systematic review 2007, 143 (10), pp Available at: <accessed on 30/06/10> 8. East & South East England Specialist Pharmacy Services. Medicines Use and Safety. Top Tip QIPP messages for prescribing dressings. 9. Surgical Dressings and Wound Management. Stephen Thomas. Medetec 2010 Elsevier. 10. McGrath, A. Overcoming the challenge of overgranulation. Wounds UK 2011, Volume 7, No. 1. Accessed on 22/03/13 at: Vuolo J. Hypergranulation: exploring possible management options. British Journal of Nursing 25 th March-7 th April :19(6):S4, S6-8. Accessed on 22/03/13 at: Dressings Formulary, 1 st edition Review date: June 2017 Page 19 of 21

20 INDEX OF PRODUCTS Actico 10 ActiFormCool 13 Acti-glide hosiery applicator 11 Activa compression liner pack 11 Activa leg ulcer kit 11 Activon Medical Grade Manuka Honey 5,12 Activon-tulle 5, 12 Algivon Plus Ribbon 5,12 Allevyn adhesive 7 Allevyn Anatomically Shaped Sacral Dressing 7 Allevyn gentle 7 Allevyn gentle border 7 Allevyn non adhesive 7 Aquacel Ag Extra 5, 12 Aquacel Ag Foam Non-Adhesive 5,12 Aquacel Ag Ribbon 5, 12 Aquacel Extra 6 Aquacel Foam Adhesive 13 Aquacel Foam Adhesive Sacral 13 Aquacel ribbon 6 Aquaform hydrogel 6 Atrauman 8 Atrauman Ag 5,12 Betnovate RD 15 Biatain adhesive 7 Biatain adhesive heel 7 Biatain adhesive sacral 7 Biatain non adhesive 7 Biatain Silicone 13 Biatain soft hold 7 Carboflex 8 Cavilon barrier foam applicator 10 Cavilon durable cream 10 Cetraben 15 Chlorhexidine Gauze Dressing BP 14 Clinipore 10 CliniSorb 8 Comfeel plus 6 Comfifast 11 Cosmopore E 9 Cutimed Sorbact Ribbon 5,12 Cutimed Sorbact Swab 5,12 Debrisoft 13 Dermol Dermol Doublebase 15 Duoderm extra thin 13 Durafiber 6 Easiband stockinette 11 Easy-slide stocking applicator 11 Elastic hosiery Class I 11 Elastic hosiery Class II 11 Eumovate 15 Flexi-Ban 10 Fludroxycortide 4mcg/cm 2 tape 15 Foam Wound Dressing 14 Gauze Wound Dressing 14 Granugel Hydrocolloid Gel 13 Hypafix 10 Inadine 5, 8 Intrasite conformable 6 Intrasite gel 6 Iodoflex 5, 8 Iodosorb ointment 5, 8 Iodosorb powder 5, 8 Irripod 9 IV Kaltostat flat 6 Kaltostat packing rope 6 KerramaxCare 9 K-Four kit 10 Kliniderm superabsorbent 9 K-Lite 10 K-Lite long 10 Knit-Band 11 Ko-Flex 10 K-Plus 10 K-Soft long 10 K-ThreeC 10 K-Two kit 10 K-Two Reduced 10 Mepilex Transfer 13 Mepitel One 13 Mepore 9 Mesorb 9 Metronidazole gel 0.75% 12 Micropore 10 N-A ultra 8 Non-sterile gauze swabs 10 Nurse It 9 Opsite Flexigrid 8 Opsite Plus 8 PICO 14 Povidone-iodine 5, 8 Profore Wound Contact Layer 8 Prontosan 12 Proshield plus 10 Proshield Foam & Spray skin cleanser 14 Renasys G Gauze dressing kit with soft port 14 Renasys Go canister kit 14 Scanpor 10 Sorbsan flat 6 Sorbsan packing ribbon 6 Stericlens spray 9 Steripaste 11 Tegaderm Film 8 Tegaderm Foam Adhesive Circular (Heel) 7 Tegaderm IV 8 Urgotul 13 Viscopaste PB /50 WSP/liquid paraffin 15 Zetuvit E (sterile) 9 Zetuvit Plus 9 Dressings Formulary, 1 st edition Review date: June 2017 Page 20 of 21

21 RECOMMENDATIONS F SUSSEX COMMUNITY NHS TRUST STAFF ON MANAGING CONTACT WITH COMPANY REPRESENTATIVES Staff must only see companies with products on the formulary and must rotate these companies. Community teams must only see one company per month. Staff should not see the same company representative more than once a year. Do not allow cold calling by company representatives. Please ask company representatives to talk only about their products on the formulary and make them aware that they should not discuss other company s products. Please refer to Sussex Community NHS Trust policy on managing contact with company representatives All other staff are reminded to refer to their local organisational policy on managing contact with company representatives Dressings Formulary, 1 st edition Review date: June 2017 Page 21 of 21