Sandwell and West Birmingham Community Dressings and Elasticated Garments Formulary 11 th February 2017

Transcription

1 Sandwell and West Birmingham Community Dressings and Elasticated Garments Formulary 11 th February 2017 Utilising products approved within: Area Prescribing Committee - Birmingham, Sandwell Solihull and Environs Joint Formulary Wound management products and elasticated garments Compiled by Lesley McDonagh, Tissue Viability Clinical Lead Nurse Patricia Flaherty, Tissue Viability Clinical Specialist Nurse Louise Johnson, Community Matron SWBH Sara Shakespeare, District Nurse Team Leader Definition of specialist (agreed by the Wound Network) An experienced senior nurse, tissue viability specialist nurse, other specialist nurse (for example lymphoedema specialist nurse) or allied health professional who has responsibility for wound care. It is not a requisite that they have an extra qualification but they must have extensive and current experience in wound care management. 1

2 Contents Pages: 3. Low adherence dressing 4. Absorbent dressings 5. Hydrogel dressings 6. Vapour-permeable films and membranes Soft polymer dressings 7. Hydrocolloid dressings 8. Foam dressings Alginate dressings 9. Odour absorbent dressings Antimicrobial dressings 14. Surgical absorbents Physical debridement pads 15. Topical negative pressure therapy Surgical adhesive tapes 16. Bandages Non-extensible bandages Support bandages 17. Adhesive bandages 18. Compression bandages 19. Multi-layer compression bandaging 20. Medicated bandages Larvae 21. Application aids Limb protectors 22. Irrigation fluid Emollients 23. Emollients 24. Barrier products 25. Foot wear 26. Pressure reducing pads Tissue Adhesive 27. Antibiotic Gel Adhesive remover 2

3 BNF Section APC Version Rationale (developed by TV Team) Basic wound contact dressings A5.1.1 Low adherence dressing 5x5cm 0.27 Atrauman 7.5x10cm 0.28 Hartman 10x20cm x30cm 1.72 For flat granulating and epithelising wound for non to heavy exudate where adherence may occur. To be used as a primary dressing with a secondary for absorption. Up to 7 days 1-7 days, depending on levels of exudate Known product or component sensitivity Used to reduce adherence to wound bed. Most cost effective non adherent dressing. Dressing impregnated with neutral triglycerides to prevent penetration of granulation tissue. Petroleum free. N/A Ultra 9.5x9.5cm x19cm 0.67 Systagenix For flat granulating and epithelising wound for non to heavy exudate levels where adherence may occur. To be used as a primary dressing with a secondary for absorption. 7 days maximum 1-7 days, depending on levels of exudate Known product or component sensitivity eg silicone Use with care if wound is bleeding heavily To be used to reduce adherence to wound bed 3

4 A5.1.2 Absorbent dressings For lightly exuding wounds Softpore Self adhesive 6x7cm 10x10cm 10x15cm 10x20cm 10x25cm 10x30cm 10x35cm st line (Alternative to Cosmopore Richardson Healthcare Low to moderately exuding wounds, superficial wounds (closed), light amounts of exudate. Use alone without other products, also can be used as a protective dressing for sutured post-operative wounds. Can be used as a protective dressing for newly epithelialized wounds. Can be used for minor traumatic wounds. Maximum 7 days, dependent on exudate levels If daily change is required, review dressing type avoid etc) Known product or component sensitivity Sutured/Post-surgical wound for protection. Most cost effective option Can be used as a protective dressing for newly epithelialized wounds Can be used for minor traumatic wounds A5.1.2 Absorbent dressings For moderately to heavily exuding wounds Zetuvit E sterile Non sterile 10cmx10cm 10xcm20cm 20x2cm0cm 20cmx40cm 10cmx10cm 10cmx20cm 20cmx20cm 20cmx40cm Hartman Ltd Absorbent cellulose pad with fluid repellent backing Moderate exuding wounds. Secondary dressing. Available in non-sterile and sterile. Only sterile to be used for wound care. 1-7 days Usually 1-2 days or when wet. If using daily consider Zetuvit Plus Known product or component sensitivity Do not cut or tear Required for absorbency, for moderately exuding wounds Step down from Zetuvit Plus Zetuvit PLUS 10cmx10cm 10cmx20cm 15cmx20cm 20cmx25cm 20cmx40cm Hartman Super absorbent dressing Moderate to heavily exuding acute and chronic wounds. Secondary dressing only 1-7 days 1-3 days, if changing daily, review if needs more highly absorbent dressing, if lasting 7 days step down to Zetuvit E Do not use if sensitivity to dressing or components Do not cut or tear Moderate to heavily exuding wounds, higher absorbency than Zetuvit E. Cost effective 4

5 A5.2 Advanced wound dressings A5.2.1 Hydrogel dressings Hydrogel sheet dressings ActiForm Cool 5x6.5cm 10x10cm 10x15cm Activa Aquaform 8g 1.66 Aspen Medical 15g 2.02 Hydrogel Sheet Necrotic or sloughy wounds that require hydration and cooling pain relief Can be used on dry wounds with the backing left in place Cut to shape of the wound Requires a secondary dressing 1-3 days if dressings become discoloured or opaque or at first signs of exudate strike through If dressing becomes discoloured or opaque or at first signs of exudate strike through. Do not allow to dry out Should not be used as a covering for deep narrow cavities or sinuses Do not use on infected wounds Not suitable for heavily exuding wounds Known product or component sensitivity Not for application on ischaemic wounds Dry necrotic, sloughy or painful wounds For ease of application - sheet gel rather than liquid Primary dressing Can be used prior to larval therapy to maintain moisture levels Hydrogel: Clear viscose sterile gel Aids autolytic debridement and removal of devitalised tissue. Low exuding, necrotic or sloughy wounds Up to 3 days 1-3 days Not suitable for heavily exuding wounds. Caution known product or component sensitivity. Full thickness burns or infected wounds Not for application to ischaemic wounds Required for wound beds that need donation of moisture to rehydrate the wound bed and debride. Cost effective 5

6 A5.2.2 Vapour-permeable films and membranes Vapour-permeable Adhesive Film Dressing (Semi-permeable Adhesive Dressing) Hydrofilm - 1 st line Hartman 6x7cm 10x12.5cm 10x15cm Vapour-permeable adhesive film Dry non infected wounds, retention of lines, fixation of secondary dressings, protection of intact skin, protection of skin against friction, protection of newly epithelialized wounds Up to 7 days Up to 7 days Clinically infected wounds, bleeding or exuding wounds Retention of lines, protection of intact skin, fixation of other dressings. Cost effective Waterproof A5.2.3 Soft polymer dressings Kliniderm- foam silicone border, specialist use 7.5x7.5cm 10x10cm 12.5x12.5cm 15x15cm 10x20cm 15x20cm 18x18cm (sacral) 12.5x20cm (heel) 4x5cm 5x x7.5cm 10x10cm 15x15cm H&R Healthcare Kliniderm Foam silicone lite border H&R Healthcare Soft polymer dressing with absorbent pad Suitable for low to moderately exuding wounds for patients with fragile skin Available in adhesive and non adhesive Up to 7 days 1-7 days Caution/contraindications (when not to use the dressing, patient groups to Known product or component sensitivity eg Silicone Caution under compression where exudate levels are moderate to high Silicone adhesive for patients with fragile skin, can be cut to shape and contour around difficult anatomical areas. Different pre cut shapes and sizes available 5x5cm 10x10cm 10x20cm Kliniderm non border H&R Healthcare Soft polymer dressing with absorbent pad Suitable for low to moderately exuding wounds for patients with fragile skin Available in adhesive and non adhesive Up to 7 days 1-7 days Known product or component sensitivity eg Silicone Caution under compression where exudate levels are moderate to high Silicone adhesive for patients with fragile skin, can be cut to shape and contour around difficult anatomical areas. Different pre cut shapes and sizes available 6

7 A5.2.4 Hydrocolloid dressings Duoderm range - 1st line Convatec 10x10cm 14x14cm 20x20cm 18.5x19.5cm(heel 22.5x20cm (sacral) 11x19cm (oval) 7.5x7.5cm 10x10cm 15x15cm 5x10cm 9x15cm 9x25xm Duoderm-extra thin Convatec Hydrocolloid dressing The adhesive layer forms a cohesive gel when in contact with wound exudate Available as Extra thin or Signal (Bordered) Dry to lightly exuding wounds Non infected Acute or Chronic wounds Up to 7 days maximum 3-7 days Not suitable for infected wounds, full thickness burns or Protect surrounding wounds with exposed bone, muscle or tendon or wounds that are likely to macerate, particularly on plantar surface of foot Not for diabetic foot ulcers Not for ischaemic wounds Known product or component sensitivity Conformable, waterproof, aids autolysis. skin, reduced risk of blistering. Cost effective 6.9x7.6cm(mini oval) 10x11cm(oval) 14.3x15.6cm(oval) 19x22.2cm(oval) 13.9x13.9(heel) 14.3x14.3cm Tegaderm Foam Adhesive 3M Foam dressing Wound management by secondary intention on acute, chronic, full thickness or partial thickness or shallow granulating wounds including pressure ulcers, leg ulcers, diabetic foot ulcers, malignant wounds, surgical wounds, donor sites and fungating ulcers Can be used as a primary or secondary dressing Film border increases adherence Can stay in place up to 3-7 days Dependent on exudate levels Care with fragile skin Can be used for low to moderate exudate levels Different sizes and shapes available Conformability around difficult areas such as heels and elbows Can be used on sacral and buttock wounds where incontinence is an issue due to film backing and border 5x5cm 10x10cm Aquacel extra range 15x15cm 4.78 Convatec 4x10cm x20cm x30cm x45cm x45cm 1.86 Hydrofibre Moderate to heavy exudate, sloughy, necrotic or granulating wounds. Available in rope for cavities Maximum 7 days 1-7 days depends on clinical need Not suitable for dry wounds. Non dissolvable. Known product or component sensitivity Do not cut Aids debridement of slough or necrotic tissue Remains intact so easily removed in one piece Absorbs exudate which aids most wound healing facilitating atraumatic dressing 7

8 change, Cost effective A5.2.5 Foam dressings For lightly exuding wounds Activheal Foam 10x10cm 1.46 Trac - Specialist Use A5.2.6 Alginate dressings Advanced Medical Solutions Tracheostomy foam dressing ActivHeal Foam Tracheostomy dressing has a fenestration, which allows the dressing to fit neatly around a tracheostomy tube. The dressing can also be used around intubation and cannula insertion procedures, external bone fixators and appropriately-sized wound drainage tubes. Dependant on clinical need and soiling Up to 7 days, dependant on clinical need and soiling Do not use if reaction to any of its components. Specific dressing shaped and able to cut for tracheostomies. Cost effective Sorbsan flat 5x5cm 10x10cm 10x20cm SORBSAN PLUS Highly absorbent 7.5x10cm 10x15cm 10x20cm 15x20cm Sorbsan plus border 11.5x14cm 14x19cm 14x24cm 19x24cm Sorbsan ribbon 40cm (includes probe) Sorbsan (excluding Ag) range 1st line Aspen Calcium alginate dressing Use in moderate to highly exuding wounds with a sloughy or granulating wound bed. Also helps with haemostasis in wounds with minor bleeding or where blood is present in the exudate. Available in flat and rope dressing Primary dressing only. Secondary dressing will be required. Can be left in place for approximately 4 days 1-4 days dependent on exudate levels Do not use in individuals with a known sensitivity to any of the components of the dressing Do no use on dry or lightly exuding wounds as adherence is an issue Extreme caution if used for tumours with friable tissue Sorbsan can facilitate debridement, absorb exudate and is a haemostat Cost effective. Biodegradable 8

9 A5.2.8 Odour absorbent dressings 10x10cm 3.18 CarboFLEX - specialist use 8x15cm(oval) x20cm 7.23 Convatec 10x10cm 10x20cm Clinisorb - specialist use 15x25cm(boxes 4.05 Clinimed containing 10 each) Odour absorbent wound contact dressings containing activated charcoal For the management of moderate to heavily exuding malodorous wounds including fungating Up to 7 days As exudate level determines Known sensitivity to the dressing or its components As soon as CarboFlex becomes contaminated with exudate, odour control diminishes The underlying cause of wound odour should be identified prior to commencement of product CarboFLEX is a layered dressing to provide higher levels of fluid handling On shallow or cavity wounds with moderate to heavy levels of exudate Odour absorbent charcoal dressing Malodourous wounds such as fungating wounds Up to 7 days 1-7 days dependent on exudate levels Not indicated as a primary dressing in dry wounds Store at room temperature Exudate levels will reduce the effectiveness of the charcoal Clinisorb is an activated charcoal dressing which adsorb toxins removing malodour from the wound Can be cut to size Cost effective 9

10 A5.3 Antimicrobial dressings Consider other recommended antimicrobials. Avoid routine or prophylactic use of antimicrobials on non-infected wounds A5.3.1 Honey 5x5cm 10x10cm Algivon - specialist use Advancis Medical Activon Tulle- 5X5cm 1.80 specialist use 10X10cm 2.97 Advancis Medical Alginate dressing impregnated with 100% Manuka Honey. Primary dressing for infected, shallow cavity wounds, particularly if necrotic or malodorous with moderate exudate. Requires secondary dressing. Max Up to 4 days for chronic infection Daily for acute infection Up to 4 days for chronic infection/depending upon exudate Wounds with active blood loss Known allergy to be venom and honey products Blood sugars should be monitored in diabetic patients Stinging sensation may be experienced discontinue if not tolerated Antimicrobial and de sloughing properties Absorbent Malodour Ease of application and removal in one piece Can be cut to size Available in various sizes Can be shaped to wound size and depth Cost effective Knitted viscose mesh impregnated with 100% Manuka Honey. Creates a moist healing environment effectively eliminates odour. Provides antimicrobial action. Debrides and de-sloughs shallow wounds where the exudate level has started to decrease. Requires secondary dressing Max Up to 4 days Daily in acute infection Up to 4 days for chronic infection depending on exudate Wounds with active blood loss Known allergies to bee Venom and Honey products Blood sugars should be monitored in diabetic patients Stinging sensation may be experienced discontinue if not tolerant. Anti-microbial and de-sloughing properties for wounds with reduced levels of exudate. Control of odours Ease of application and removal in one piece Can be cut to size Available to various size Cost effective 10

11 25g tube Single patient use so can be reused Activon Tubespecialist use Advancis Medical 100% medical grade Manuka Honey. Use as topical treatment for infected sloughy shallow or cavity wounds. Primary or addition to other Activon products. Requires secondary dressing. Max Up to 4 days Daily in acute infection Up to 4 days in chronic infection dependant on exudate Wounds with active blood loss Known allergies to bee Venom and Honey products Blood sugars should be monitored in diabetic patients Stinging sensation may be experienced discontinue if not tolerant. Anti-microbial and de-sloughing properties Control of odours Benefit of adding to other action products and increasing honey Suitable for use in cavities Cost effective More cost effective Previous dressing cost: 20g tube

12 A5.3.2 Iodine Inadine - 1st line 5x5cm 9.5x9.5cm Systagenics 5g 4.09 Iodoflex- 1st line 10g 8.17 Smith & Nephew 17g Non-adherent dressing impregnated with povidone iodine (10%) Mild local infection where there is low exudate levels, ischaemic wounds, dry, gangrenous digits with the aim to desiccate and auto-amputate. Dry-manage fixator sites Minor burns or skin trauma with local infection 1-3 days depending on uptake of iodine from dressing 1-3 days depending on uptake of iodine from dressing Look at colour change of dressing (orange initially to white when all used) Iodine allergy or sensitivity Thyroid disorders Renal impairment Not suitable for children, pregnant or lactating women Topical antimicrobial Non-adherent/pain free use No damage to granular or epithelial cells Easy application and removal Drying properties Efficacy against bacteria, fungi and viruses Cost effective. No change Cadexomer dressing containing iodine Iodine paste in mesh form for chronic infected, sloughy wounds with moderate exudate eg pressure ulcers, leg ulcers, diabetic foot ulcers Can be used under compression bandaging MAX Up to 3 days Daily for acute infection Up to 3 days for chronic wounds and infection, depending on exudate levels Allergy or sensitivity to iodine Precaution with large wounds due to absorption. Do not use more than 50g in a single application and no more than 150g in 7 days Dry necrotic wounds Thyroid disorders Renal impairment Not suitable for children, pregnant or lactating mothers Concurrent Lithium therapy Anti microbial, broad spectrum, long acting/high absorption capacity Removes slough and debris to clean the wound bed Can be moulded to shape of the wound Alternative to honey products if allergy to bees No change 12

13 10g ointment 4.51 Iodosorb- 1st line 20g ointment 9.03 Smith & Nephew 3g powder 1.93 Cadexomer powder or ointment with iodine Chronic exuding sloughy wounds eg leg ulcers, pressure ulcers, diabetic foot ulcers. Can be used under compression bandaging Up to 3 days Daily for acute infection Up to 3 days for chronic infection Allergy to iodine products Dry necrotic tissue Not suitable for Children, pregnant or lactating mothers Thyroid disorders Renal impairment Needs at least twice weekly dressings for iodine to be effective Antimicrobial, broad spectrum, long acting De-slough and cleans wound debris Non-adherant. Reduces trauma to wound and pain on dressing changes Easy application. Can fill cavities or awkward shaped wounds Alternative to honey based products if allergy to bees No change A x5cm 0.80 Kytocel 10x10cm 1.92 Aspen Medical 4x10cm x20cm x30cm x45cm 1.94 Absorbent gelling fibre wound dressing Moderate to heavily exuding chronic and acute wounds that are sloughy and clinically infected. Haemostatic properties for minor bleeds in superficial wounds Autolytic debridement properties 1-3 days 1-3 days, dependent on exudate levels Allergy to Shellfish (Chitin) Full thickness burns Heavily bleeding wounds Dry wounds Cost effective Alternative to available antimicrobials Can be used on heavily exuding wounds 13

14 A5.5.1 Surgical absorbents Cotton Sterile Gauze / swabs/ non woven 7.5cm x 7.5com only 10x12cm 0.15 Xupad range 10x20cm 20x20cm Richardson Healthcare A5.5.3 Physical debridement pads Debrisoft Pack of Specialist Activa 7.5cm x 7.5cm only Cleansing wounds via aseptic technique N/A N/A Not to be applied to a wound as a dressing Necessity for wound cleansing Cost effective Included in Sterile wound packs or used to supplement sterile pack Latex free absorbent dressing pad Low exuding closed surgical wounds only 1 7 days depending on exudate 1 7 days depending on exudate Not for moderate or highly exuding wounds. Always consider an interactive dressing. Not suitable for any wound type except for closed surgical wounds Cost effective Various sizes available Debridement pad to cleanse and debride wounds. Acute or chronic wounds with surface debris eg pressure ulcers, leg ulcers, diabetic foot ulcers Hyperkeratosis Not applicable At each dressing change or as required avoid Known sensitivity to polyester Heavy slough and necrotic tissue may require autolytic debridement to soften prior to use Thick hyperkeratosis may take more than one treatment Must be wet with clean warm water prior to use Do not get an emollient on the pad as this blocks the monofilaments Lifts debris, superficial slough and exudate without damaging new granulation or epithelial cells Removes biofilms Lifts hyperkeratosis and dry flaking skin peri-wound Recommended by NICE Treatment well tolerated Convenient, easy to use, disposable single use pad 14

15 A5.6 Complex adjunct therapies A5.6.1 Topical negative pressure therapy Tissue Viability Nurse recommendation only, request from Consultants Topical Negative Pressure Therapy Dependent on Trust contract. Specialist use V.A.C. therapy - KCI The use of sub atmospheric pressure to promote or assist wound healing or to remove fluids from a site. Required components: Pump, Dressings foam or gauze, tubing and canister. : Acute, chronic and traumatic wounds. Can be used as a adjunct to surgery and for salvage procedures such as wound dehiscence. Benefits are that it removes excess fluid that may contain bacterial pathogens, reduces soft tissue oedema, promotes granulation and provides a moist wound healing environment. Consider standard interactive dressings first. Every three days Determined by exudate levels. Different canister sizes available It should not be used on: Grossly infected or bleeding wounds Malignancy Exposed blood vessels Organs Unexplored fistulae Extensive necrotic wounds Caution with foam, document the number inserted, ensure all pieces are retrieved. It removes excess fluid that may contain bacterial pathogens, reduces soft tissue oedema, promotes granulation and provides a moist wound healing environment. Both companies products are included due to different contracting arrangements. Can be used on large open wounds to increase speed of wound healing A5.7 Wound care accessories A5.7.3 Surgical adhesive tapes Clinipore 1st line 1.25x5m 2.5x5m 2.5x10m 5cmx5m 10cmx5m Clini Supplies Mefix 2nd line Molnlyke Permeable non woven, synthetic adhesive tape For securing bandages Determined by wound type and dressing change None listed Available on drug tariff, cost effective and evaluated as meeting the requirements of a tape including adherence. Permeable, aperture non woven, synthetic adhesive tape For securing dressings. Determined by wound type and dressing change None listed Available on drug tariff. Different availability of sizes in comparison to Clinipore for difficult to dress areas. Some stretch and flexibility to improve conformity and adhesion. Can be used to secure dressings rather than bandages. 15

16 A5.8 Bandages A5.8.1 Non-extensible bandages Knit-Band A5.8.2 Light-weight conforming bandages 5cmx4m (hand) 7cmx4m 10cmx4m (limb) 15cmx4m (large limb) Red (small limb) 3.5cmx1m Green (medium limb) 5cmx1m 5cmx3m 5cmx1m Blue (large limb) 7.5cmx1m 7.5cmx3m 7.5cmx5m Yellow (child's trunk or very large limbs) 10.75cmx1m 10.75cmx3m 10.75cmx5m Beige (adults trunk) 17.5cmx1m Clini Supplies CliniFast Clini Supplies Cellulose contour bandage used for retention of non adhesive dressing products : Retention bandage Change in line with dressing change Take care to apply joint below to joint above. Always use a primary dressing Most cost effective choice. Elasticated Sub bandage lining : To be used under retention and compression bandages when conformity is required Can be used for wet/dry wrapping. As required As required Ensure the correct size for a limb is selected Cost effective choice when conformity to a limb is required A5.8.4 Support bandages Light support 1.00 K lite bandage. Class 2 Urgo Ltd 10cmx4.5m (stretched) Lightweight knitted bandage Designed for use on sprains/strains Can be used to prevent oedema, would require a wadding bandage to be applied beneath It is the second layer of a four layer compression bandage kit Where there is open skin, a primary dressing must be used Change in line with primary dressing 1-7 days Caution/contraindications (when not to use the dressing, patient groups to Known allergy to any components Not suitable for application of pressure on its own and therefore should be used with other bandage components for the treatment of venous ulcers Caution over bony prominences where the bandage can cause pressure Cost effective Essential for providing support to a limb and as part of a bandage compression therapy kit 16

17 A5.8.5 Adhesive bandages A5.8.6 Cohesive 3.01 Ko-flex bandages Urgo Ltd Compression bandage class 3b cohesive 10cmx6m (stretched) A water resistant vapour permeable cohesive bandage Venous ulceration, oedema, Managing sprains and strains and following orthopaedic surgery Forms part of the K four bandage system 1 to 7 days Dependant on exudate levels if wound present or oedema management. Caution/contraindications (when not to use the dressing, patient groups to Not recommended on those patients with an ABPI lower than 0.8. Contains latex Cohesive bandage that can be used alongside other formulary pro 17

18 A5.8.7 Compression bandages High compression bandages 4cmx6m 2.39 Actico 6cmx6m 2.80 Activa 8cmx6m cmx6m cmx6m cmx5m 8cmx5m 10cmx5m Comprilan - specialist recommendation 12cmx5m 4.11 BSN Medical Sub-compression wadding bandage Cellona - specialist use 5cmx2.75cm 0.47 Activa 7.5cmx2.75m cmx2.75m 15cmx2.75m Cohesive inelastic high compression bandage. Short stretch bandage Venous leg ulceration Lymphoedema Management of chronic oedema Daily to 7 days Dependant on exudate levels if wound present or oedema management. avoid Not recommended on those patients with an ABPI lower than 0.8. Caution in diabetic patients Caution when cardiac overload or renal failure present or suspected. Only cohesive short stretch bandage. Nurses competent in its usage. 100 % cotton short stretch compression bandage Venous leg ulceration Varicosis Management of chronic oedema Management of primary and secondary lymphoedema Deep venous thrombosis Thrombophlebitis 1 to 7 days Dependant on exudate levels if wound present or oedema management. avoid Advanced Peripheral arterial occlusive disease Decompensated cardiac insufficiency Septic phlebitis Phlegmasia coerula doleris Sub compression wadding bandage to pad and shape a limb prior to compression therapy Provides padding for larger limbs under compression. Up to 7 days Daily up to weekly dependant on exudate and oedema management. avoid Advised not to apply directly to skin as can cause irritation. Cost effective for use in larger quantities when used in lymphoedema management. Sub bandage 0.45 K-Soft wadding Urgo 10cmx3.5m (unstretched) An absorbent non woven, sub bandage wadding. Provides padding, shaping and protection of the limb prior to the application of compression bandage therapy. Up to 7 days Daily up to weekly dependant on exudate and oedema management. avoid Advised not to apply directly to skin as can cause irritation. Essential for protecting a limb, padding and shaping Forms part of the compression bandage regime. Suitable for use with other formulary products. 18

19 A5.8.8 Multi-layer compression bandaging Four layer systems K-Four range Urgo Up to 18cm cm cm 6.83 Above 30cm 9.41 Coban Two layer systems Coban M Coban 2 Lite 8.24 Coban Lite (reduced 3M compression) Multi layer compression system Venous and mixed aetiology leg ulcers and associated conditions 1 to 7 days Daily up to weekly dependant on exudate and oedema management. avoid Not recommended for patients with a ABPI of less than 0.8 Contains latex Kit size determined by measuring the ankle after padding with the tape measure pulled taught Compression system consisting of k-soft, k-lite, k plus 3a or K three c (dependent on ankle size) and Ko flex Component bandages available in longer lengths for larger limbs Two layer compression system available in full and reduced compression (Coban Lite). Comprises of a latex free foam padding and cohesive bandage. Treatment of venous and mixed aetiology leg ulcers 1 to 7 days Daily up to weekly dependant on exudate and oedema management. avoid Arterial disease Not to be used with other padding or wadding Two layer compression kit, Once applied the two layers form a band to become a single layer bandage. Bandage technique can be adapted to reduce forefoot oedema (Extra training required) Two layer compression system available in full and reduced compression (Coban Lite). Comprises of a latex free foam padding and cohesive bandage. Treatment of venous and mixed aetiology leg ulcers 1 to 7 days Daily up to weekly dependant on exudate and oedema management. avoid Arterial disease Not to be used with other padding or wadding Two layer compression kit, Once applied the two layers form a band to become a single layer bandage. Bandage technique can be adapted to reduce forefoot oedema (Extra training required) 19

20 A5.8.9 Medicated bandages Viscopaste- 7.5x6m 3.65 specialist use Smith & Nephew Ichthopaste- 7.5x6m 3.68 specialist use Larvae Tissue Viability Nurse recommendation only BioBag 50 at least 50 larvae 25 x 40mm 1 8x8x10 BioBag 100 at least 100 larvae 50 x 40mm 1 12x12x10 BioBag 200 at least 200 larvae 60 x 50mm 1 25x10x10 BioBag 300 at least 300 larvae 120 x 60mm 2 25x10x10 BioBag 400 at least 400 larvae 100 x 100mm 2 25x10x10 Free range larvae larvae and 30 x 30 flat retention net plus kit pack, larvae and 40 x 60cm boot retention net plus Smith & Nephew LarvE (free range or in BioFOAM dressing) - specialist use only Biomond Zinc paste bandage. Venous leg ulcers. Where venous insufficiency exists, the paste bandage should be used under graduated compression bandaging. Chronic eczema Dermatitis Up to 7 days Daily, up to weekly dependant on skin and wound management. avoid Do not use in any cases of sensitivity or allergy to ingredients For treatment of dermatitis and chronic eczema when venous insufficiency is present. Zinc and Ichthammol bandage. Venous leg ulcers Chronic eczema Dermatitis Up to 7 days Daily up to weekly dependant on skin and wound management. avoid Do not use in any cases of sensitivity or allergy to ingredients Zinc and ichthammol bandage. For treatment of dermatitis and chronic eczema when venous insufficiency is present. Free range: Biomonde Larvae 100/200 or BioBag Biosurgical treatment for the debridement and cleansing of wounds consisting of aseptically produced living larvae. The BioBag is presented in the five (5) configurations listed below. The larvae are Lucilia sericata contained in a sterile polyester net bag with a sterile PVA spacer cube, presented in a sterile transport container. The BioMonde Larval Debridement Therapy Products are indicated for debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or postsurgical wounds. and frequency of dressing change: An application of BioBag can be left in place for up to 4 days, dependent on the condition of the wound. If the wound is not sufficiently debrided after 4 days, the treatment can be repeated with a fresh application of BioBag. The treatment should be stopped as soon as the wound is sufficiently debrided or if no improvement is observed after 3 or more applications. The total number of treatment cycles will depend on the characteristics of the wound, the response of the patient to LDT and the aim of the therapy. Most ulcers are completely debrided within 1 to 6 treatment cycles. If exudate production is excessive, the secondary dressing may be changed as required while leaving the BioBag undisturbed. Frequent removal of the outer dressing will also help to control the odour associated with the liquefied necrotic tissue avoid Larvae should not be used in patients with known hypersensitivities to fly larvae, polyester, PVA (polyvinyl alcohol) or the components of the media on which the larvae are raised (including soya protein, yeast protein, potato starch and bovine protein) as this may result in dermatitis or more severe immunological reactions in susceptible individuals. If treatment is undertaken then these patients should be 20

21 kit pack. Additional 100 or 200 larvae available. under strict medical supervision for the duration of the treatment with immediate access to care. Patients with life or limb-threatening, rapidly advancing infections should not be treated with as LDT may interfere with the close and frequent observation that these patients require. Should not be used as first line therapy of infected tendon and bone. These wounds should be treated surgically and/or with antibiotics before using LDT. Should not be used to treat wounds which are not directly exposed to the outside. Wounds should never be allowed to close over the larvae either intentionally or unintentionally. Should not be used on wounds with an inadequate blood supply as this ultimately reduces the ability of the wound to heal. LDT will enlarge the wound as necrotic tissue is debrided but the resulting clean wound is at risk from re-infection. Although some mild bleeding is common during LDT, larvae should not be used on wounds that have a tendency to bleed or wounds close to an exposed major blood vessel, especially if considered to be necrotic as this can lead to rupture of the blood vessels which could be life-threatening. If LDT is attempted, the patient must remain under strict medical supervision for the duration of the treatment. Should not be used on patients with an inborn or medication-induced coagulopathy or in patients being treated with anticoagulants. If these patients are treated with LDT, they should remain under strict medical supervision for the duration of the treatment. Should never be used in sterile body cavities. Should be used with caution on wounds over adjacent exposed organs or leading to a body cavity, and only under close medical supervision for the duration of the treatment. Data are not available concerning the antibiotic / antiseptic activity of maggots and therefore any infected wound should receive standard antibiotic care. Only available larval therapy on prescription. Rapid debridement of chronic wounds Can be utilised in the community All sizes Short Long Seal-Tight Woundcare Protector Autonomed Small Medium Large X-Large Measuring guide should be used Small Medium Measuring guide should be used EasY-Slide (application aid for open toe stockings ) Credenhill Magnide (application aid for closed toe stockings) Credenhill Waterproof protector, non slip latex free Used to keep leg and foot dressings dry, can be fully submerged in water. N/A N/A N/A Multiple sizing for leg including extra large limb No adjustments required Compression hosiery garments applicator for open toe Application of open toe compression garments N/A N/A N/A Applicator for open toe hosiery Application aid for closed toe stockings Application of closed toe compression garments N/A 21

22 Irripod Wound Irrigation x20ml CD Medical Emulsifying Soap Substitutes 2.10 Ointment 500g Emollients Based on Chapter 13 - APC approved 500g 6.09 Liquid paraffin / white soft paraffin 50:50 Ennogen 75ml 200ml Flexitol Heel Balm Podiatry requests Dermatonics N/A N/A Effective applicator for closed toe hosiery Sterile sodium chloride solution Wound cleansing, for topical irrigation of the eye As required As required Single use External use only Cost effective Cleansing of wounds Emollient ointment containing emulsifying wax, white soft paraffin and liquid paraffin For treatment of dry skin conditions Reapply daily Daily Allergy or hypersensitivity to any of the ingredients Treatment of dry skin. Dermatologu approved. Emollient ointment containing liquid paraffin and white soft paraffin To assist the skin in retaining moisture For use on all dry skin conditions including eczema and psoriasis NA Daily or more frequently if required Allergy or hypersensitivity to any of the ingredients Treatment of dry skin conditions. Dermatology approved Cream containing 25% urea To moisturise dry skin on the soles of feet For use on adults and children over 12 years of age Reapply daily Daily Allergy or hypersensitivity to any of the ingredients, contains beeswax and lanolin Not to be used on children under 12 Treatment of dry skin conditions of the foot. Dermatology approved 22

23 Zerocream 50g 500g Thornton & Ross Emollient ointment containing liquid paraffin, to moisturise dry or chapped skin Symptomatic treatment of dry or chapped skin Can be used as a pre bathing emollient for dry skin to alleviate drying effects NA Daily or more frequently if required Allergy or hypersensitivity to any of the ingredients Dermatology approved Zeroderm ointment 500g g 2.41 Thornton & Ross Zeroguent 100g g (tube) 6.99 Thornton & Ross Zerobase 50g (tube) g (pump) 5.26 Thornton & Ross Emollient ointment containing liquid paraffin and white soft paraffin To assist the skin in retaining moisture For use on all dry skin conditions including eczema and psoriasis Can be used as a soap substitute/skin cleanser NA Daily or more frequently if required Allergy or hypersensitivity to any of the ingredients Treatment of dry skin conditions. Dermatology approved Free from fragrance and colours, sodium lauryl sulphate, additives and preservatives. Rich emollient ointment containing light liquid paraffin, white soft paraffin and soya bean oil To assist the skin in retaining moisture For use as a barrier and moisturiser for symptomatic treatment of dermatitis, ichthyosis, eczema and psoriasis Can be used as a pre bathing emollient for dry skin to alleviate drying effects NA Daily or more frequently if required Allergy or hypersensitivity to any of the ingredients Dermatology approved Emollient ointment containing liquid paraffin, to moisturise dry or chapped skin Symptomatic treatment of dry or chapped skin Can be used as a pre bathing emollient for dry skin to alleviate drying effects NA Daily or more frequently if required Allergy or hypersensitivity to any of the ingredients Dermatology approved 23

24 ZeroAQS cream 500g 3.29 Thornton & Ross Emollient cream that occludes and moisturises the skin. For external application for use a s an emollient and as a skin cleanser/soap substitute in the management for dry skin conditions. NA Daily or more frequently if required Allergy or hypersensitivity to any of the ingredients Dermatology approved Does not contain sodium lauryl sulphate (SLS) Barrier Preparations Metanium ointment Barrier cream 30g 2.06 : For relief of the symptoms of nappy rash Frequency of change Spread the ointment thinly so the skin texture can be clearly seen through it. Repeat at each nappy change. Not to be used on adults in conjunction with containment products for incontinence due to the inclusion of light liquid and white paraffin in the ingredients, which will repel urine/faeces back onto the skin. Any allergy to the listed ingredients Overdose is unlikely when Metanium Nappy Rash Ointment is used as instructed for treating nappy rash. However, as this product contains titanium salicylate, accidental ingestion or excessive topical application could lead to symptoms of salicylate poisoning. Dermatology approved Cavilon Durable Barrier Cream 1st line 2g sachets x 20 28g (tube) 92g (tube) M Skin protectant Intact skin As a barrier against bodily fluids, prevention of skin damage associated with incontinence Can be used alongside containment products Can be used to prevent friction to vulnerable areas of skin Reapply Twice daily Reapply sparingly twice daily Do not use on infected skin Not be used as an emollient Not to be used around the peri wound Can increase adherence of some dressing products and therefore care should be taken when adhesive products are being used in conjunction with the cream on people with fragile skin The only barrier cream that can be used in conjunction with containment products without blocking the absorption of the pad Cost effective, does not require reapplication at every episode of hygiene 24

25 1ml foam applicators x 5 28ml pump spray Cavilon No Sting Barrier Film Pump Spray and applicators 1st line 3M Multi-use Boot Kerraped Uk shoe size Crawford Healthcare Protective transparent barrier film Superficial broken skin and abrasions As a barrier against bodily fluids, prevention of skin damage associated with incontinence Can be used alongside containment products Can be used to prevent friction to vulnerable areas of skin Can be used on superficial abrasions caused by incontinence Can be used to protect peri wound from exudate Can be used to protect against aggressive adhesive products Can be used to protect the skin surrounding stoma sites Up to 72 hours Every 72 hours Do not use on infected skin Allow product to dry before applying the containment products, dressings or clothing (30 seconds) Too many layers can make the area of skin feel stiff Can affect electrode readings in the treated area Available in a foam applicator and spray to aid application Non sticky after use Can be used on broken areas of skin Cost effective, does not require reapplication at every episode of hygiene A shoe to accommodate bandages and offload pressure from the front of the foot Neuropathic foot ulcers or patients with bulky bandages who cannot wear there own footwear As required As required Ensure correct size is selected Only footwear available for patients with neuropathic ulcers or bulky bandages 25

26 Pressure reducing Kerra Pro pads Sheet Crawford Healthcare 10cmx10cmx0.3cm cmx10cmx1.2cm Strip 50cmx2.5cmx0.3c 5.26 m 30cmx5cmx0.3cm 6.32 Sacrum/ankle one size Heel-one size Skin tissue adhesive 5.50 Liquiband Optima 0.5g Advance Medical Solutions Silicone pads designed to redistribute pressure from bony prominences. Prevention and treatment of category (Stage/Grade) 1 pressure ulcers As required. Check skin daily. As required, check skin daily. Pads will last up to 3 months avoid Must only be used as part of a pressure ulcer prevention programme Not to be used on a grade 2, 3 4, unstageable or deep tissue injury pressure ulcer unless directed by a clinical specialist Known sensitivity to silicone Do not use as a wound dressing Do not apply directly onto broken skin If skin macerates beneath, ensure the area is being checked and washed daily and consider utilising a cotton stockinette to reduce humidity Cost effective Available in a large range of shapes and sizes Accessible pressure ulcer prevention medical device Reusable on the same patient for up to 3 months by washing with soap and water and thoroughly drying Tissue Adhesive Closure of minor skin wounds from surgical incisions and simple traumatic lacerations Single application should be sufficient to close the wound. If this does not maintain the wound edges, refer to a medic for consideration of other wound closure As necessary avoid May cause skin sensitivities Do not use on any wound with evidence of active infection, gangrene or wounds of pressure aetiology Do not use on mucosal surfaces or on skin that may be regularly exposed to bodily fluids or with dense natural hair Do not use on patients with a known sensitivity to formaldehyde or cyanoacrylate Necessary for closure of minor wounds 26

27 Anabact Antibiotic Gels Infection 15g 30g (metronidazole gel- specialist use Cambridge Healthcare Supplies Appeel Sachet:5ml 1.13 Adhesive Wipes(x30) Remover Clinimed Pale yellow, clear gel containing 0.75% metronidazole Malodourous fungating wounds Requires a secondary dressing Apply 1-2 times daily following cleansing 1-2 times daily for a maximum of 8 weeks. avoid Avoid exposure to strong sunlight or UV light Not to be used on a patient with known sensitivity to any components Avoid contact with eyes Not for use of any other aetiology of wound as odour control. Odour control for fungating tumours Adhesive remover available in 4 different applications Adhesive dressing or appliance removal where skin stripping, loss of skin integrity and pain is a concern Sachet suitable for larger dressing removal Wipes ideal for adhesive around tubes Foam applicator ideal for infants or use of the face Spray, single patient, multiple use product for all dressings and/or urinary sheath removal Use at each dressing change N/A avoid Should not be used when there is a known sensitivity to any of the ingredients If in doubt, patch test a small area, prior to use The product is flammable and should be used in a well ventilated area Avoid use around, flames and sources of ignition For pain free removal of dressings where fragile skin is a concern 27

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