Tissue Viability Service Wound Management Primary Care Formulary 2017 WMPF/TVS: March 2017 Review date: March 2019 Product Group Current Product Sizes Price per Item Hydrogel 1st Activheal Hydrogel 2nd Intrasite Gel 15g 15g (SDT Mar 2017) 1.41 2.44 Indications For Use Contra-indications Acute Product To rehydrate slough and necrotic tissue Dry or minimal exudating May reduce chronic wound pain Not suitable for heavily exudating. Intrasite Gel Hydrogel Sheets 1st Hydrosorb 5cm x 7.5cm 1.58 2.26 As Above As Above Hydrosorb Gel 2nd Actiform Cool 10cm x 15cm 20cm x 20cm 3.83 8.01 Hydrocolloid 1st Hydrocoll Thin 2nd Tegaderm Hydrocolloid 7.5cm x 7.5cm 10cm x 12cm 13cm x 15cm 0.70 1.16 2.61 1.55 2.89 Facilitate debridement and rehydration Minimal exudating Not suitable for clinically infected. Duoderm Extra Thin Foams (Dry to Low Exudate) Non Adhesive Polymem Polymem Adhesive 8cm x 8cm 13cm x 13cm 5cm x 7.6cm 10cm x 13cm 1.59 2.47 4.12 0.52 1.15 2.18 Skin tear Moderately exudating leg ulcers Donor sites Radiation burns Superficial Not suitable for heavily exudating. Not suitable for use with any other wound product. Non Adhesive Polymem Adhesive Polymem
Adhesive Foam (Moderate to Heavy Exudate) Activheal Foam Adhesive 7.5cm x 7.5cm 12.5cm x 12.5cm 1.18 1.63 1.68 exudating Not suitable for superficial or up to surface granular as may encourage overgranulation. N/A Non Adhesive Foam (Moderate to Heavy Exudate) Activheal Non adhesive Foam 20cm x 20cm 0.75 1.13 3.92 exudating Not suitable for superficial or up to surface granular as may encourage overgranulation. Allevyn non adhesive Very High levels of Exudate Zetuvit Plus 0.64 0.88 1.01 High levels of exudating When over saturated will cause redness of peri skin. Zetuvit Plus Silicone Foam Adhesive (Mod/High Exudate) Askina DresSil Border Askina DresSil Sacrum 7.5cm x 7.5cm 20cm x 20cm 16cm x 17.5cm 1.09 1.92 2.88 3.75 4.98 3.65 Pressure ulcers Venous leg ulcers Diabetic foot ulcers Traumatic Surgical 1st and 2nd degree burns Donor sites Skin tears Not suitable for known sensitivity to silicone. Urgotul Absorbent Border Allevyn Life Sacrum Heel Foam Activheal Foam Heel (Non Adhesive) Tegaderm Foam Heel (Adhesive) 18cm x 12cm 13.9cm x 13.9cm 3.48 4.22 exudating heal Not suitable for heel protection. UrgoTul Heel Allevyn Heel Hydrofibre Kerracel Gelling fibre dressing 2.5cm x 45cm (ribbon) 0.60 1.43 2.69 1.90 Leg ulcers, pressure ulcers Surgical Superficial and partial thickness burns Abrasions, lacerations Absorption in oncology Not suitable for surgical implantation. Not suitable to control heavy bleeding. Urgo Clean
Honey (Low Exudate) Actilite 0.57 0.98 1.90 Antibacterial for clinically infected Wounds with signs of infection or increased risk of infection Not suitable for arterial bleeds and heavily bleeding. Not suitable for vascular due to pain experienced. Actilite Honey (Low to Moderate Exudate) Activon Tube 25g 2.05 Antibacterial for adding to honey dressing when honey is washed away by exudates As Above Medi Honey Ointment Wound Contact Layer 1st N-A Ultra 2nd Adaptic Touch 9.5cm x 9.5cm 19cm x 9.5cm 5cm x 7.6cm 7.6cm x 11cm 12.7cm x 15cm 20cm x 32cm 0.33 0.63 1.13 2.25 4.65 12.50 Wounds requiring atraumatic removal of dressing Not suitable for sensitivity to silicone. Silflex Dialkylcarbamoyl chloride (DACC) Cutimed Sorbact Swab 4cm x 6cm 7cm x 9cm 1.67 2.78 exudating Colonised or infected Wounds at increased risk of infection Cutimed Sorbact Swab Charcoal Odour Absorb Clinisorb 15cm x 25cm 1.91 2.54 4.09 Malodorous Clinisorb NB All other sizes available. Please see Scottish Drug Tariff (SDT).
TVN Specialist Products Product Group Current Product Sizes Prices Per Item Iodine 1st Povitulle 2nd Iodoflex Paste 9.5cm x 9.5cm 5g 10g 17g 0.28 0.42 4.13 8.25 13.06 Indications of Use Contra- Indications Acute Product Minor burns Ulcerative with pathogens e.g MRSA, yeasts, fungi, Protozoa Sensitivity to iodine. Patient pregnant or breast feeding. Patient being treated for kidney problems Before and after use of radio iodine. Povidone Activated Charcoal Silver Actisorb Silver 220 6.5cm x 9.5cm 10.5cm x 10.5cm 10.5cm x 19cm 1.64 2.58 4.70 Critically colonised malodours Maximum duration of use should not exceed 2 weeks prior to being re assessed Known sensitivity to nylon or Silver.?Actisorb Silver 220 Silver Silvercel Non adherent hydro alginate 11cm x 11cm 2.5cm x 30.5cm (Ribbon) 1.68 4.14 7.68 4.45 Management of infected or signs/ symptom of infection Duration should not exceed 2 weeks prior to being reassessed Known sensitivity to silver or alginate. Silvercell Non adherent hydro alginate Haemostatic Kaltostat 7.5cm x 12cm 0.96 2.10 4.12 7.08 Management of bleeding Debridement UCS Debridement 3.25 Chronic and Acute requiring debridement Cleansing of Peri-lesional area Known sensitivity to kaltostat. Algosteril UCS Debridement
Protease Modulator Urgostart Urgostart Contact 6cm x 6cm 5cm x 7cm 16cm x 21cm 4.45 6.16 11.08 3.00 4.24 10.12 9.95 Low to moderate exuding chronic Recommended treatment duration 12 weeks Non to low exudating chronic Urgostart Contact Bio enzyme Flaminal Forte 15g 50g 7.68 25.42 Clinically infected blind end tracks, sinuses and undermining Wounds which have increased risk of infection e.g pilonidal sinus Known sensitivity to polyethylene glycol. Flaminal Forte Jubilee Method Aquacel + Duoderm Extra Thin Total hip Knee arthroplasty Aquacel + Duoderm extra Thin Paraffin Impregnated Gauze Jelonet Some dermatology conditions Plastic Surgery For specialist monitored use only. Can cause trauma to newly formed granulation tissue. Jelonet Wound Irrigation Solution Prontosan 24 x 40ml 350ml 14.33 4.83 Total hip surgery Knee arthroplasty Topical Negative Pressure Pico Pad size 5cm x 10cm 5cm x 20cm 108 108 Pico Activac Rental Agreement Activac
Barrier Products Product Group Current Product Sizes Prices Per Item Barrier Cream Sorbaderm Barrier Cream 28g 92g Barrier Film Sorbaderm film 28ml 1ml 3ml 2.20 3.20 4.80 2.60 3.90 Indications of Use Contra- Indications Acute Product For intact skin to protect from moisture associated skin damage For intact and broken skin to protect from moisture associated skin damage Broken skin Infected broken skin Sorbaderm Barrier Cream Sureprep Accurate wound assessment is essential before choosing a wound management product. NOTE: Successful treatment of complex requires a holistic review of each patients needs, considering nutrition, pressure off loading or stabilising systemic diseases. Please refer to FirstPort, wound management formulary link for detailed information on products. For enquiries regarding wound management complete E referral and send to:- Hairmyres - TissueViability.HMandlocalities@lanarkshire.scot.nhs.uk Wishaw General - TissueViability.WGandlocalities@lanarkshire.scot.nhs.uk Monklands - TissueViability.MKandlocalities@lanarkshire.scot.nhs.uk MPR.WMPFOR.17_04111.L