Wound Dressing Formulary

(1)

Wound Dressing Formulary

WOUND DRESSING FORMULARY

The aim of the formulary is to aid all Health Care Professionals (in both primary and secondary care) who care and treat patients with wounds and tissue viability problems in selecting the most appropriate dressings and bandages.

Having a wound dressing formulary means only clinically proven treatments are used, rather than an ad-hoc dressing selection.

Having a wound dressing formulary can save time in nurse decision making and also aid continuity, because whenever a different member of staff deals with a dressing change, the same regime is used.

Rationalisation ensures only proven cost-effective products are used. Wound dressings are often designed to be complementary and an appropriate selection of dressings can help the healing process.

With the formulary consistency is ensured. Dressings will give optimum performance for speedier healing.

This formulary is generated from the previous formularies of Carmarthenshire Local Health Board, Carmarthenshire NHS Trust and

encapsulates the formularies of Pembrokeshire and Ceredigion Trust/LHB to create a combined and consistent formulary for the Hywel Dda Health Board Region.

(2)

GUIDELINES FOR THE USE OF THE FORMULARY Check wound type prior to dressing selection.

If in doubt of wound type, please refer to the Wound Care and Tissue Viability guidelines, seek advice from the Tissue Viability Team or ask the Pharmacist.

All wounds must be assessed and monitored as per Trust guidelines and recorded using the wound assessment documentation. Check the patient for any allergies or intolerance to any of the dressings or components within the dressings.

Follow the companies’ guidelines on dressing application. If in doubt ask the Tissue Viability Team or Pharmacy for advice. Re-assess the wound and change the dressing selection as the wound type indicates.

To order the dressings use the Health Board’s wound management products prescription /supply chart.

In-patient discharge plan needs to be timely. One weeks’ worth of dressings to be sent with the patient. A copy of the wound assessment documentation needs to be sent with the discharge documentation.

If the Patient needs a dressing from outside the formulary, fill in the Additional Dressing Document and state rational. Send to the Tissue Viability Department.

Any new dressing to be used within the Acute and Community divisions an evaluation will be organised by the Tissue Viability Service. Prices on formulary may be subject to alteration

(3)

Dressing Selection

Wound Cleansing Solutions

Wound Cleansing agents are solutions that are used to cleanse wounds prior to the application of a dressing. Wound should only be cleaned when necessary, clean granulating wound do not require cleaning

If appropriate such as with chronic wounds, tap water may be used to cleanse the area If a sterile solution is required then sodium chloride is the only agent suitable for this All solutions should be warmed prior to its use to maintain the surface temperature of the wound

The wound should be irrigated and not wiped during the procedure

Most wound care experts now agree that routine use of antiseptic solutions have little or no place in wound management Antiseptics, particularly those, which contain cetrimide, have marked cytotoxic properties and therefore should be avoided,

unless the wound is contaminated or shows clear evidence of infection.

Formulary Choice Size Price Treatment Advice

Tap water Always warmed but not hot

A bucket lined with a black bag is useful to clean leg ulcers Irripod

20ml pods

£5.50 (25)

Irrigate the wound, do not wipe the wound bed

(4)

ABSORBENT PADS LOW ADHERENT

Indications for use Contra- indications

To dress dry or sutured wounds, superficial cuts and abrasions

To manage light exudate levels

Should not be used on highly exuding wounds as this could result in maceration of the wound bed

Should not be used on necrotic or sloughy wounds

Surface is low adherence rather than non–adherance, therefore may stick to wound bed

Formulary Choice Size Price Treatment Advice Interpose (Non- adhesive)

(Telfa and Release in acute)

Absorbent perforated plastic film faced dressing

5x5 cm 10x10 cm 20x 10 cm £0.09 £0.15 £0.32

Can adhere to wound surface, irrigate off if necessary Non- Adhesive form requires

securing Mepore (Adhesive border

(Cosmopor E/ Primapore acute) Absorbent perforated island dressing

7 x 8cm 10x11cm 11x15cm 9x20cm 9x25cm 9x30cm 9x35cm £0.10 £0.20 £0.34 £0.41 £0.57 £0.65 £0.71

(5)

NON- ADHERENT DRESSINGS Apply Directly to wound bed

Requires secondary dressing or bandage to retain in place

To dress dry or sutured wounds, superficial cuts and abrasions

To manage light exudate levels

To be used as wound bed liners for topical negative pressure therapy and capillary action dressings

Formulary Choice Size Price Treatment Advice N-A Ultra

Silicone coated knitted viscose dressing

9.5 cm x 9.5 cm 9.5 cm x 19 cm

£0.35 £0.66

Ideal under compression or as primary contact with any

wound that requires non adhesion

Atrauman

Knitted Polyester Dressing impregnated with Neutral triglycerides. Fatty triglycerides give soothing feel to the dressing, without maceration of

the surrounding tissue

5 x 5 cm 7.5 x 10 cm 10 x 20 cm £0.24 £0.25 £0.57

Small holes will not damage granulation tissue on removal

secondary dressing will depend on amount of wound

exudate

Mepitel

Soft silicone wound contact dressing for paper thin fragile skin.

Expensive option, try the above options first To be cost effective the dressing is to remain in

place for up to two weeks

5 x 7 cm 8 x 10 cm 12 x 15 cm 20 x 30cm £1.52 £3.05 £6.17 £16.94

Irrigate holes at each dressing change to keep patent

(6)

SEMI- PERMEABLE ADHESIVE FILM DRESSING

Allow passage of water vapour and oxygen but not water and micro-organisms Waterproof and impermeable to bacteria

Comformable and convenient Allow observation of the wound

Clean granulating /epithelialising wounds

Superficial wounds such as post operative wounds, pressure ulcers and minor injuries

Can be used to protect skin at risk from friction or maceration

Can be used to retain primary dressing

Deep wounds Heavily exuding wounds

Infected wounds

Can damage fragile skin on removal if not careful Fluid accumulation can cause maceration under the dressing

Formulary Choice Size Price Treatment Advice Opsite Flexigrid

Vapour permeable adhesive film dressing This dressing is more cost effective

6 x 7 cm 12 x 12 cm 15 x 20 cm £0.36 £1.04 £2.62

Film dressings are useful tools for measuring wound size Do not stretch the film over the required area as this may cause

blistering

Tegaderm

Vapour permeable adhesive film dressing

6 x 7 cm 12 x 12 cm 15 x 20 cm £0.38 £1.23 £2.34

Easy to apply, useful when teaching relatives in the community

(7)

SEMI PERMEABLE ADHESIVE FILM DRESSING WITH ABSORBANT PAD

Allow passage of water vapour and oxygen but not water and micro-organisms Provides a moist wound environment

Clean granulating /epithelialising wounds

Superficial wounds such as post operative wounds, pressure ulcers and minor injuries

Deep wounds Heavily exuding wounds

Infected wounds

Can damage fragile skin on removal if not careful Formulary Choice Size Price Treatment Advice

Opsite Plus

Vapour permeable film dressing with absorbent pad 5 x 5 cm 8.5 x 9.5 cm 10 x 12 cm 10 x 20 cm 35 x 10 cm £0.29 £0.81 £1.10 £1.85 £3.07

Useful for slightly exuding superficial wounds eg. Post

operative or post biopsy

Tegaderm Plus Pad

Vapour permeable film dressing with absorbent pad 5x7 cm 9x10 cm 9x15 cm 9x20 cm 9x25 cm 9x35 cm £0.25 £0.62 £0.92 £1.34 £1.51 £2.50

Useful for slightly exuding superficial wounds eg. Post

(8)

(9)

HYDROGEL DRESSING

Amorphous cohesive material that takes the shape of the wound Re-hydrates necrotic tissue and encourages autolytic debridement

Requires a secondary dressing Compatible with larvae

Sloughy and necrotic wounds Light to moderate exudate levels

Gels can be a means of delivering medicines if advised All stages of wound healing

Heavily exuding wounds Suspected presence of infection

Active haemostasis

Formulary Choice Size Price Treatment Advice Purilon Gel

Amorphous cohesive material

8 gms £1.61 Change every 1-3 days

Daily if wound infected Use a secondary dressing to retain

(10)

HYDROGEL SHEET DRESSING

Non-Adhesive, high water content hydrogel sheet formed around a supporting blue polyethylene matrix Provides a moist environment at the surface of the wound

Permeable to water vapour, gases and small protein molecules, but impermeable to bacteria Rehydrates dry, devitalised tissue and encourages autolysis

Absorbs large amounts of exudate, turning “lumpy” and opaque Sheet dressing can be used for burns, scalds and radiation therapy damage

Needs to be secured with tape, a secondary dressing or a bandage

Painful Wounds

Sloughy and necrotic wounds Lightly to heavily exuding wounds

All stages of wound healing

Under compression if this is indicated on lightly exuding wounds

Sheet dressing should not be used for covering deep, narrow cavities or sinuses

Actively bleeding wounds

Actiform Cool

Two sided clear transparent hydrogel formed around a

supporting matrix 5x 6.5 cm 10 x 10 cm 10x15 cm £1.65 £2.43 £3.49

Change every 1-7 days depending on the condition of the wound Daily changes are necessary if the

wound is infected

Increased odour may result as bacteria are drawn into the dressing.

If this occurs, increase dressing changes until odour subsides Secure with appropriate secondary

dressing or bandage

Leave top liner in place unless wound highly exuding

(11)

HYDROCOLLOID DRESSING

A Flexible adhesive sheet dressing Impermeable to Bacteria

Forms a gel in the presence of wound exudate Encourages new blood vessel formation by creating a hypoxic

Waterproof to allow for showering environment

Dressings can be left in place for up to seven days Rehydrate dead tissue and encourage autolytic debridement

Sloughy and necrotic wounds Granulating wounds Light to moderate exudate levels

Heavily exuding wounds Suspected presence of infection

Caution to be exercised for use with diabetic foot ulcers, not generally recommended

Formulary Choice Size Price Treatment Advice Comfeel Plus

Adhesive sheet dressings

4 cm x 6 cm 6 cm x 8 cm 10 cm x 10 cm 9 cm x 11 cm 15 cm x 15 cm 18 cm x 20 cm £0.88 £2.00 £2.25 £3.47 £4.82 £5.25 Granuflex 10 x10 cm 15 x15 cm £2.56 £4.87 Granuflex Bordered (Community only) 6 x 6cm 10 x 10cm 15 x 15cm £1.67 £3.06 £5.88

Dressings should cover wound with at least 2 cm overlap

Dressings can remain in place for up to seven days, depending on exudate

level

Patients can shower with dressing in place

Comfeel Plus Transparent Thin Hydrocolloid layer

5 cm x 7 cm 9 cm x 14cm 15 cm x 20 cm £0.60 £2.32 £3.05

Duoderm Extra Thin 10 x10cm

9 x15 cm 15x15cm

£1.19 £1.60 £2.56

Dressings should cover wound with at least 2 cm overlap

Dressings can remain in place for up to seven days, depending on exudate

level

Patients can shower with dressing in place

(12)

PROTEASE MODULATING MATRIX DRESSING Sodium carboxymethylcellulose spun into a fibre As the fibres absorb exudate they form a gel sheet

The fibres are absorbent and retain moderate to large amounts of exudate Gel retains its integrity on dressing removal

Requires a secondary dressing Change dressings daily if wound infected

All types of moderate to heavily exuding wounds Ribbon dressing to pack cavities

Formation of the gel encourages autolytic debridement

Dry wounds with minimal exudate

Formulary Choice Size Price Treatment Advice Aquacel

Soft sterile non woven pad with hydrocolloid fibres 5 cm x 5 cm 10 cm x 10 cm 15 cm x 15 cm £1.07 £2.54 £4.78

Dressings can remain in place for up to seven days depending on exudate

level

Aquacel Ribbon

Soft sterile non woven ribbon with hydrocolloid fibres

2 cm x 45 cm £2.59 Loosely pack into cavity, leaving a tail for ease of removal

Daily or alternate daily dressing depending on exudate level Sorbion Sachet S

Absorbant cellulose in cellulose matrix 7.5 x7.5 cm 10 x 10cm 20 x 10 cm 20 x 20 cm 30 x 20 cm £ 1.75 £ 2.22 £ 3.68 £ 6.90 £ 9.92

For use on heavily exuding wounds, Apply next to wound bed Can be used under compression

(13)

ALGINATE DRESSINGS

Dressing consists of sodium and calcium salts In contact with blood or exudate a hydrophilic gel is formed

Helps haemostasis in bleeding wounds Formation of the gel encourages autolytic debridement

Manufactured from different seaweed varieties Available in flat pad or rope

Requires a secondary dressing Change dressings daily if wound infected

All types of moderate to heavily exuding wounds Rope dressing to pack cavities

Bleeding wounds

Formulary Choice Size Price Treatment Advice Kaltostat

Calcium alginate fibre non woven pads 5 cm x 5 cm 7.5 cm x 12 cm 10 cm x 20 cm £0.87 £1.91 £3.77 Sorbsan Flat 5 x5cm 10 x10cm 10 x20cm £0.78 £1.64 £3.08

Dressing change depending on exudate level

rrigate wounds to remove dressing without discomfort

Kaltostat Wound Packing Rope 2 gms £3.54

Sorbsan (with probe) Packing Ribbon 30cm x2 gms 40 cms £3.41 £1.99

Loosely pack into cavity, leaving a tail for ease of removal

Daily or alternate daily dressing depending on exudate level Irrigate wound well to ensure all

dressings removed Sorbsan Plus

Dressing with absorbent backing

7.5cms x10cm 10 x 15cm 15 x 20cms £1.66 £2.93 £5.20

(14)

FOAM DRESSINGS

Absorbent dressings that maintain a moist wound environment Can absorb light to heavy exudate

Low adherent and Comformable Can be used as a primary or secondary dressing Presented in various sizes and shapes to suit areas of the body Adhesive or non- adhesive dressings available

All types of low to heavily exuding wounds Dressings can remain in place for up to seven days

Do not adhere with film dressing as this will restrict water vapour loss

Formulary Choice Size Price Treatment Advice Biatain Dressing

Non adhesive foam dressing

5cm/8cm circle 10x10cm 15x15cm 10x20 cm 20 x20cms £1.10/ 1.56 £2.20 £4.05 £3.63 £6.01

Soft adherent layer enabling easier application

Helps to ease pain on removal

Biatain Range Adhesive

6cm diameter 12x12cm 18x18cm Sacral 23 x 23cm £1.62 £2.38 £4.77 £4.08

Adhesive border made of hydrocolloid based material

Tegaderm Foam Adhesive 10 x11cms 14 x14cms (heel)

£2.28 £3.37

Adhesive foam for moderate to highly exuding wounds

Allevyn Foam Heel (podiatry use only)

10.5 x13.5 £4.68 Podiatry specialist use only

Mepilex /Border (showerproof) Absorbent soft silicone dressing

Mepilex 10 x 11 10 x 20 Mepilex border 7 x 7.5 10 x 12.5 10 x 30 Mepilex £2.53 £4.18 Mepilex border £1.31 £2.59 £3.47 Mepilex lite/border lite

(showerproof)

Thin self adherent soft silicone absorbent dressing Mepilex lite 6 x 8.5 10 x10 15 x 15 Border-lite 4 x 5 10 x 10 15 x 15 Mepilex Lite £1.69 £2.02 £3.92 Border-Lite £0.88 £2.42 £3.95

To be considered only if use of the above dressings not appropriate. Consider the ‘lite’ version if exudate

low to moderate Only use for wounds with compromised or fragile surrounding

(15)

VACUTEX CAPILLARY DRESSING

Three layered polyester filaments and polycotton fibres Creates a pulling action of interstitial fluid from the wound bed

Encourages autolytic debridement

Highly exuding wounds Colonised wounds Fistulas or sinuses

Arterial bleeds Vascular fungating wounds

Heavily bleeding wounds

Vacutex 5 x 5 cm 10 x 10 cm 10 x 15 cm 10 x 20 cm 15 x 20 cm £0.94 £1.66 £2.23 £2.68 £3.14

Line wound with NA Ultra /atrauman prior to application

Cut dressing to size of wound bed Create layers of dressing to fill cavity Seal with a film or occlusive dressing

(16)

ANTIMICROBIAL DRESSINGS- Iodine Based

The use of topical antibiotics is not justified for the routine treatment of colonised or infected wounds An alternative to reduce wound bioburden are the antimicrobial range of iodine dressings

Iodine dressings are potent antimicrobials with broad spectrum and little resistance

The application of these antimicrobials in a slow release delivery system provides a continuous antimicrobial effect Iodine is available as povidone–iodine dressings, solutions, powders and sprays, or Cadexomer polysaccharide starch

Indications for use Contra- indications

Chronic exuding wounds Infected or heavily colonised wounds

Malodorous wounds

History of thyroid disease Known sensitivity Pregnant/ breast feeding Care with very large wounds Caution with renal impairment

Patients receiving lithium

No more than 150g of iodoflex /iodosorb per week Max duration up to three months in any single course of

treatment

Formulary Choice Size Price Treatment Advice Inadine

Knitted viscose dressing impregnated with providone- iodine

ointment 10%

5 cm x 5 cm 9.5 cm x 9.5cm

£0.32 £0.47

Wound contact layer for infected abrasions and superficial burns

Iodoflex

Cadexomer iodine 0.9% in a paste form

5 gms 10gms

£3.76 £7.51

Renew when saturated Daily if wound very wet Resembles mashed potato when

needing renewal Iodosorb Ointment

Cadexomer iodine 0.9% in ointment

10gms £4.15

Apply to work surface to depth of approx 3 mm

Resembles mashed potato when needing renewal

(17)

ANTIMICROBIAL DRESSINGS- Silver Based

The use of topical antibiotics is not justified for the routine treatment of colonised or infected wounds An alternative to reduce wound bioburden are the antimicrobial range of silver dressings Silver acts as a heavy metal by impairing the bacterial electron transport and some DNA functions

Silver sulphadiazine is a safe, broad spectrum agent for topical use Effective against common pathogenic organisms

Malodorous wounds

Do Not Use with patient undergoing radiotherapy Care for patients with renal, hepatic insufficiency Care in pregnancy, lactation, children and neonates

Prolonged use or use over a large surface area will warrant review of systemic response to silver

Appropriate use of silver dressings to be reviewed after maximum duration of one month

Known sensitivity to silver

Formulary Choice Size Price Treatment Advice Atrauman Ag Urgotul SSD 5 x 5cm 10 x 10 cm 10 x 20 cm 11 x11 cm 16 x21 cm £0.47 £1.14 £2.23 £2.95 £8.35

Useful as a non adherent silver application Cover with secondary dressing Atrauman Ag, cheapest option, aimed at

first line dressing for infected or heavily colonised superficial areas

Aquacel Ag

Protease Modulating Matrix containing 1.2% ionic silver

5 x5 cm 10 x 10 cm 15 x15 cm 2g ribbon £1.81 £4.32 £8.13 £4.34

Not suitable for dry wounds or those covered with hard black necrosis For deeper cavities or sinuses ribbon

packing is generally preferred For

Biatain Ag Foam Non Adhesive Range

Silver Foam dressing

5 cm round 10x 10 cm 15 x 15 cm £3.13 £7.47 £15.00

Used in wounds with moderate to high exudates levels

(18)

wound bed ANTIMICROBIAL DRESSINGS- Honey

The use of topical antibiotics is not justified for the routine treatment of colonised or infected wounds An alternative to reduce wound bioburden are the antimicrobial range of honey dressings

Honey products from Leptospermum sp. use their antibacterial action to protect wounds from infection Honey will help to debride wounds and reduce odour

Indications for use Contra- indications/Cautions

Malodorous wounds

Do Not Use with patients who have had an allergic reaction to honey Some patients may experience pain from honey dressing, which will

subside with time

Formulary Choice Size Price Treatment Advice Activon honey tube

Medical grade Manuka honey

25gms £1.99 Apply to wound on simple dressing, with

secondary padding depending on exudate level

Medi honey – Manuka Honey Gel sheet

5 x5cms 10 x10cms

£1.75 £4.20

For use on mild to moderate exuding infected wounds.

May need to protect the surrounding wound edges with a barrier preparation

Dressings can be cut to fit wound size, they can also be layered if necessary

(19)

SUB-COMPRESSION WADDING BANDAGE Soft Absorbent bandage

To protect vulnerable areas such as tissues and tendons Essential to apply prior to compression bandaging To provide padding to shape the leg prior to bandage

application

Absorbs exudate from highly exuding wounds

Some patients may have sensitivity to the bandage and will need a cotton liner prior to application

Formulary Choice Size Price Treatment Advice Lantor (hospital use)

K-Soft 5 cm All x 3 .5metres 10 cm 15 cm (Hospital only) £0.42 (Community only)

Acts as the First layer in the 4 layer bandage system

Useful under crepe bandage to protect frail limbs Eg the elderly

(20)

TYPE 1: LIGHTWEIGHT CONFORMING STRETCH BANDAGES These bandages have a simple dressing retention function

High degree of elasticity but with little power

To retain a dressing close to the wound Does not inhibit movement Does not restrict blood flow

Formulary Choice Size Price Treatment Advice K- Band

Knitted polyamide and cellulose contour bandage 5 cm 7 cm All x 4 metres 10 cm 15 cm £0.10 £0.15 £0.26 £0.46

10 cm size should be minimal size used for the lower limb

For fragile skin consider wool padding layer first

Easy Fix

Polyamide and cellulose contour bandage

5 cms £0.33 To use for bandaging toes in

conjunction with lymphoedema bandaging

(21)

TYPE 2: LIGHT SUPPORT BANDAGES Used to prevent oedema

Gives support to mild sprains and strains Limited extensibility

(22)

For support without exerting undue pressure To prevent formation of oedema

Formulary Choice Size Price Treatment Advice K- Lite

Knitted elastomer and Viscose bandage 5 cm 7 cm All x 4 .5metres 10 cm 15 cm £0.51 £0.71 £0.93 £1.34

Acts as the second layer in the 4 layer bandage system

(23)

TYPE 3: COMPRESSION BANDAGES

Provides high compression used in the management of venous insufficiency and ulcerations Inappropriate application can lead to hazardous levels of pressure

Full assessment of the patient including doppler studies essential prior to the application of the bandages Different classes of type 3 bandages (3a, 3b, 3c, )are designed to provide differing levels of pressure to the limb

ALL COMPRESSION BANDAGES SHOULD HAVE WADDING LAYER APPLIED FIRST (See sub-compression wadding advice page)AND CAREFUL OBSERVATION OF EXTREMITIES AFTER APPLICATION OF BANDAGES

Gross oedema Venous ulceration

Post -thrombotic venous insufficiency

Arterial insufficiency

Inadequate training of bandaging technique Caution with diabetic patients

(24)

3a Light compression bandage (14-17 mmHg at ankle) K- Plus 10 cm x 8.7 cm stretched 15 cm £2.08 (Hospital only)

Always apply toe to knee 50 % overlap

Used as 3rd layer of 4 layer bandage system, but applied in a figure of eight

3b Moderate compression bandage (18-24 mmHg at ankle)

Coban cohesive bandage (Hospital)

Ko-Flex Cohesive Bandage (community)

10 cm x 6m stretched

£2.74 £2.76

Adheres to themselves but not the skin

Fourth layer of 4 layer bandage system

Used for sports injuries Do not apply with excessive tension

Apply in spiral with 50 % overlap

Activa 40mmhg hosiery kit S, M, L, XL, XXL £20.79 Choose size based on individual patient measurements

SURGICAL TAPES

Adhesive tapes are useful to retain dressings Permeable and non- woven

To secure non adhesive dressings Can cause irritation and allergic reactions Are occlusive and may cause maceration Creates a tourniquet if applied under tension

(25)

Formulary Choice Size Price Treatment Advice Scanpor

Surgical synthetic adhesive tape

1.25 cm 2.5 cm All x 5metres 5 cm £0.40 £0.65 £1.12 Mefix

Permeable apertured non- woven surgical synthetic adhesive tape

2.5 cm 5 cm All x 5metres 10 cm 15 cm 20 cm 30 cm £0.95 £1.68 £2.69 £3.66 £4.69 £6.72

Used when a wider tape coverage is required

SHORT STRETCH BANDAGES

Indications for use Contra- indications

Oedema in limbs Venous Leg Ulceration Lymphoedema management

Inappropriate application can lead to uneven application, or hazardous levels of pressure

(26)

Comprilan 6 cm 8 cm 10 cm 12 cm £2.52 £2.96 £3.18 £3.87

To be applied over a wool padding layer

Can be applied using various techniques eg putter, or in a spiral toe

to knee at full stretch Actico

Cohesive short Stretch

10cm 12 cm

(Various other sizes available for use by Lymphodema specialist)

£3.07 £3.91

To be applied over a wool padding layer

Can be applied using various techniques eg putter, or in a spiral toe

(27)

TUBULAR BANDAGES Available in different forms

Some are elasticated, whilst others are gauze and stockinette Sizes vary to suit body area

To support muscle sprains, strains and joints

To provide a skin coverage after dressings or creams applied To retain dressings in awkward parts of the body eg digits or

trunks

Caution with elasticated versions with arterial incompetence Always apply elasticated versions from toe to knee on the lower

limb

Formulary Choice Size Price Treatment Advice Cotton stockinette

Comfi gauz

Sizes vary for different body areas, digits –

limbs 20 m lengths

Hospital Only

Ideal for retention of dressings on digits

Elastic tubular bandage Comfi grip

Sizes B-G depending on body area

Vary from £1.10 - £1.47 per 1m length

To provide support to sprains and strains

Ensure arterial sufficiency before application

Tubular viscose stockinette Comfi fast

Colour coded red – beige depending on

body area

Vary from £0.56 - £1.20 Per 1m length

Useful in the wet wrapping treatment of atopic eczema

(28)

Larval Therapy

Sterile larvae from the greenbottle Lucilia Sericata

Secrete proteolytic enzymes which soften necrotic tissue enabling the larvae to ingest the dead tissue Reduce the bacterial load in the wound

Available in a “tea-bag” for superficial areas, although not as effective as the free range applications

All soft necrotic /sloughy wounds Osteomyelitis

Abscesses Necrotising fasciitis

Hard Dry necrotic tissue

Fistula or wounds connecting to vital organs Wounds with exposed blood vessels

Formulary Choice Size Price Treatment Advice LarvE

Contact TVN’s to order Made to fit wound size

Minimum cost £177 per single pot

Enclosed bags min. £250

On FP10 for community use

Always remove hydrogels prior to application

Protect surrounding skin from enzymes

Use a foot bag for toes/ foot wounds Therapy less effective if patient is

(29)

Topical Negative Pressure (TNP)Therapy

Application of localised negative pressure to the wound to encourage granulation Removal of interstitial fluid allows tissue decompression and enhanced blood flow

Removes infectious materials

Creates a negative environment and blood pulled into area along with beneficial white blood cells and growth factors.

Acute and traumatic wounds Arterial insufficiency ulcers

Flaps

Dehisced incisions Meshed grafts

Fistulas to organs or body cavities Necrotic tissue

Untreated osteomyelitus Malignancy in the wound Exposed arteries or veins

N.B. Care with bleeding and anticoagulated patients

Refer to TVN’s and TNP Policy to order

Hire and dressing unit depending on machine

and dressing size Minimum hire cost £20

per day

Dressings range from £16 - £29 per dressing

(30)

CAVILON BARRIER FILM

No Sting transparent protective barrier film Forms a waterproof barrier

Non alcohol base

Non petroleum based so ensures incontinence aids do not clog

Skin exposed to bodily wastes, fluids, adhesive dressings and tapes

Superficial skin break, stoma and peg sites Incontinence dermatitis

Formulary Choice Size Price Treatment Advice Cavilon

No sting Barrier film

Foam applicator 1&3 mls

Spray bottle 28ml

£4.98 £7.99 £6.67

Treats skin breakdown Clean skin prior to application

Apply uniform coating Reapply 48-72 hrs or more often if

needed

No need to remove film in between use

(31)

METRONIDAZOLE GEL- Odour Absorbing Products Contains antibiotic metronidazole

Effective against anaerobic bacteria

Malodorous fungating tumours Malodorous wounds

Those with a hypersensitivity to metronidazole Pregnant or lactating mothers

Overuse will induce resistance Formulary Choice Size Price Treatment Advice

Anabact 0.75% 15g £4.47 Apply one or twice daily to the wound

Consider oral metronidazole if odour is not controlled

(32)

PARAFFIN TULLE DRESSING

Yellow or soft white paraffin impregnated into open weave cotton Requires a secondary dressing

Clean superficial wounds

Not recommended as first line treatment only under specialist area prescription eg burns and plastic referral

Change daily to prevent drying out and wound adhesion Granulation tissue can be incorporated into open weave and

removed with dressing Heavily exuding wounds

Jelonet 10 x 10cm £0.37 Use several layers to prevent

dressing drying out and adhering to wound bed

(33)

Sterile Dressing Packs

Formulary Choice Size Price Treatment Advice Poly-field

Soft Vinyl Patient Pack Sterile Pack containing: 1 Pair Powder Free sterile soft

vinyl gloves 1 Polythene Sheet 7 Non Woven Swabs

1 Towel

1 White Polythene Disposable Bag

1 Apron

Available in Small, Medium and Large…

50x45cm 10x10cm 43x38cm

£0.52 Please specify on Prescription what size is required (size is in reference to

(34)

MEDICATED BANDAGES

Open wove cloth impregnated with zinc oxide paste

To manage leg ulcers under compression For chronic skin condition

Do not use on individuals with known sensitivity. If used under compression a full Doppler ABPI is needed Formulary Choice Size Price Treatment Advice

Steripaste Viscopaste PB7

7.5cm x 6m £3.24

£ 3.35

Beginning at the base of the toes, the bandage should be loosely wrapped around the foot and the heel and then, whilst wrapping from the ankle, with every turn, the bandage should be folded back on itself in a pleat, at the front of the leg. This should be repeated up the leg until just below the knee.

Can be left on up to a week. Ichthopaste

(zinc paste and ichthammol bandage)

7.5cm x 6m

(35)

ACTIVATED CHARCOAL DRESSING

Sterile, non adhesive dressing with an absorbent wound contact layer, an active charcoal central pad, water resistant top layer. Effective against malodorous.

To manage of malodorous acute and chronic wounds. Can be used on exuding wounds.

Do not use on individuals with know sensitivity.

Formulary Choice Size Price Treatment Advice Carboflex

Activated charcoal absorbent dressing. 10 x 10 cm 8 x 15 cm 15 x 20 cm £2.95 £3.55 £6.72

Place fibrous (non-shiny) surface on wound. Secure in place over the wound with tape or other

appropriate material.

Change dressing when needed or if there is strike through. Do not cut

Clinisorb

Odour controlling dressing

10 x10cms £1.75

Not to be used as stand alone dressing but in conjunction with other dressings to help reduce odour