Wound Management Product Formulary

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Tissue Viability Service

Wound Management

Product Formulary

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INTRODUCTION TO THE FORMULARY:

The aim of this formulary is to guide the clinician in their choice of dressings so that an optimum wound healing environment can be achieved.

This formulary is to be used in conjunction with CLCH Wound Care Guidelines/policies and holistic assessment. All policies relating to Tissue Viability can be found on the HUB.

Practitioners should use their own professional judgement in individual patient circumstances. The clinician should read all product literature and manufacturers guidelines prior to use.

Dressings may be prescribed as single items and not just by pack/box.

The Tissue Viability Team are available to discuss dressing selection on: 020 8216 2329/2340 (Barnet Team) or 020 8962 4467 (Inner Boroughs Team).

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CONTENTS page

ABSORBENT DRESSINGS FOR MODERATE TO HEAVILY EXUDING WOUNDS 4-5

ADHESIVE DRESSINGS FOR LIGHTLY EXUDING WOUNDS 6

ALGINATE DRESSINGS 7

ANTIMICROBIAL DRESSINGS – HONEY 8

ANTIMICROBIAL DRESSINGS – IODINE 9

ANTIMICROBIAL DRESSINGS – SILVER 10

ANTIMICROBIAL DRESSINGS – OTHER 11

ATRAUMATIC AND LOW ADHERENCE DRESSINGS 12

BANDAGES 13-15 BARRIER CREAMS 15 FOAM DRESSINGS 16 HYDROCOLLOID DRESSINGS 17 HYDROFIBER DRESSINGS 18 HYDROGEL DRESSINGS 19

NEGATIVE PRESSURE WOUND THERAPY (NPWT) 19-21

ODOUR ABSORBENT DRESSINGS 22

RAPID CAPILLARY ACTION DRESSINGS 22

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WOUND MANAGEMENT PRODUCTS FORMULARY CLCH 2014

This formulary is to be used in conjunction with local Wound Care Guidelines/policies and holistic assessment. The clinician should read all product literature and manufacturers guidelines prior to use.

ABSORBENT DRESSINGS FOR MODERATE TO HEAVILY EXUDING WOUNDS

Change according to clinical need. Use with caution on bleeding /arterial wounds as they can exacerbate the bleeding. Creams and ointments can reduce the absorbency of some of the products. Absorbency may be reduced under compression.

Product Size Cost per dressing Max. Quantity for 2

weeks supply Comment Zetuvit E (Sterile) 10cm x 10cm 10cm x 20cm 20cm x 20cm 20cm x 40cm £0.21 £0.24 £0.38 £1.07 10 10 10 10

First Line Choice

• For use as a secondary dressing for moderate to highly exuding wounds

• Use non-sterile dressing where appropriate • For use as a secondary dressing on superficial

heavily exuding wounds Zetuvit E (Non-Sterile) 10cm x 10cm 10cm x 20cm 20cm x 20cm 20cm x 40cm £0.06 £0.09 £0.14 £0.27 10 10 10 10 Zetuvit Plus 10cm x 10cm 10cm x 20cm 15cm x 20cm 20cm x 25cm 20cm x 40cm £0.62 £0.86 £0.98 £1.34 £2.06 10 10 10 10 10 KerraMax Care 10cm x 10cm 10cm x 22cm 20cm x 22cm 30cm x 20cm £1.26 £1.65 £2.92 £3.33 10 10 10 10

Second Line Choice

• Primary or secondary dressing for moderate to highly exuding wounds

Sorbion Sachet EXTRA 7.5cm x 7.5cm 10cm x 10cm 20cm x 10cm 20cm x 20cm 30cm x 20cm £1.78 £2.25 £3.73 £7.00 £9.99 2 – 5 2 – 5 2 – 5 2 – 5 2 – 5

• Protease Modulator for moderate to highly exuding wounds

• Can be used as a primary dressing • Consult TVN if used for more than 7 days

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ABSORBENT DRESSINGS FOR MODERATE TO HEAVILY EXUDING WOUNDS Continued

weeks supply

Comment

Sorbion Sachet Multi Star 8cm x 8cm 14cm x 14cm

£2.99 £4.89

2 – 5 2 – 5

• Protease Modulator for difficult to dress anatomical sites

• For use on moderate to highly exuding wounds • To be used as a primary dressing

• Consult TVN if used for more than 7 days

Sorbion Sana Gentle 8.5cm x 8.5cm 12cm x 12cm 22cm x 12cm 22cm x 22cm £1.99 £2.49 £4.49 £7.99 2 – 5 2 – 5 2 – 5 2 – 5

• For the management of light to moderately exuding wounds and cavity wounds • Consult TVN if used for more than 7 days

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ADHESIVE DRESSINGS FOR LIGHTLY EXUDING WOUNDS

Absorbent dressings with adhesive border for lightly exuding wounds. Can be used as primary or secondary dressings and have limited absorbency.

weeks supply Comment Cosmopor E 5cm x 7.2cm 8cm x 10cm 8cm x 15cm 10cm x 20cm 10cm x 25cm 10cm x 35cm £0.08 £0.17 £0.27 £0.44 £0.55 £0.76 10 10 10 10 10 10

First Line Choice • Is not waterproof Mepore 7cm x 8cm 10cm x 11cm 11cm x 15cm 9cm x 20cm 9cm x 25cm 9cm x 30cm 9cm x 35cm £0.11 £0.22 £0.36 £0.44 £0.61 £0.70 £0.76 10 10 10 10 10 10 10

Second Line Choice • Is not waterproof Tegaderm + Pad 5cm x 7cm 9cm x 10cm 9cm x 15cm 9cm x 20cm 9cm x 25cm 9cm x 35cm £0.26 £0.64 £0.94 £1.37 £1.54 £2.56 10 10 10 10 10 10

Third Line Choice

• Is waterproof and can be used as a primary or secondary dressing

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ALGINATE DRESSINGS

Suitable for a wide range of wound types particularly those with moderate to heavy volumes of exudate. These dressings are NOT suitable for use on dry wounds. Cavity wounds should not be over-packed as the fibres swell and can lead to tissue ischaemia. Kaltostat has haemostatic properties. Cut sheets to the size of the wound to avoid maceration and excoriation of the surrounding skin, as any exudate will transfer laterally.

weeks supply Comment Kaltostat 5cm x 5cm 7.5cm x 12cm 10cm x 20cm 15cm x 25cm £0.94 £2.05 £4.03 £6.92 10 10 10 10

• Cut sheets to size of the wound to avoid maceration of surrounding skin

Kaltostat Rope 2g £3.77 10 Sorbsan Flat 5cm x 5cm 10cm x 10cm 10cm x 20cm £0.81 £1.71 £3.20 10 10 10

• Irrigate with saline or water to remove • Cut sheets to size of the wound to avoid

maceration of surrounding skin

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ANTIMICROBIAL DRESSINGS – HONEY

Suitable for critically colonized or locally infected wounds. Systemic antibiotics are indicated in cases of overt wound infection where the classical signs are evident. The Tissue

Viability Team should be contacted if use of antimicrobials is considered for more than 7 days.

weeks supply Comment Activon Tulle 5cm x 5cm 10cm x 10cm £1.80 £2.97 5 5

• Knitted viscose mesh impregnated with 100% Manuka honey

• For use on shallow wounds • Cut to size of wound

• Avoid use if known allergy to bee venom • Monitor blood glucose levels when using on

diabetic patients

Activon Tube 25g tube £2.05 2 • Suitable for use in cavities

Algivon Plus 5cm x 5cm 10cm x 10cm £1.96 £3.36 5 5

• Reinforced alginate dressing for use on moderately exuding ulcers

• See allergy advice above • Cut to size of wound Algivon Plus Ribbon 2.5cm x 20cm £3.36 5 • See allergy advice above

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ANTIMICROBIAL DRESSINGS – IODINE

Suitable for critically colonised or locally infected wounds. Systemic antibiotics are indicated in cases of overt wound infection where the classical signs are evident. The Tissue

Viability Team should be contacted if use of antimicrobials is considered for more than 7 days.

weeks supply Comment Iodoflex Paste 5g 10g 17g £4.01 £8.01 £12.69 10 10 10

• Not for use on dry necrotic tissue or on patients with a known sensitivity to any of its ingredients • Do not use on children, pregnant or lactating

women or people with thyroid disorders or renal impairment

• 150g of IODOFLEX can be applied per patient per week. A single application should not exceed 50g

Povitulle 5cm x 5cm 9.5cm x 9.5cm £0.28 £0.42 10 10

• For lightly exuding wounds

• Do not use if patient has known sensitivity to iodine, is pregnant or breastfeeding, has renal impairment, before and after use of radio-iodine, in cases of Durhing’s herpetiform dermatitis • Use under medical supervision in infants up to 6

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ANTIMICROBIAL DRESSINGS – SILVER

Suitable for critically colonized or locally infected wounds. Systemic antibiotics are indicated in cases of overt wound infection where the classical signs are evident. Not to be used on patients with a known sensitivity to Silver. The Tissue Viability Team should be contacted if use of antimicrobials is considered for more than 7 days.

Product Size Cost per dressing Max. Quantity for

2 weeks supply Comment Aquacel Ag Extra 5cm x 5cm 10cm x 10cm 15cm x 15cm 20cm x 30cm £1.95 £4.64 £8.75 £21.71 10 10 10 10

• Should overlap 1cm onto the skin surrounding the wound • Consult TVN for advice on combined use with antibiotics • Consult TVN if used for more than 7 days

Aquacel Ag 1cm x 45cm ribbon 2cm x 45cm ribbon £3.02 £4.62 10 10 Acticoat Flex 3 5cm x 5cm 10cm x 10cm 10cm x 20cm £3.43 £8.39 £13.11 5 5 5

• TVN Advice Only

• Consult TVN for advice on combined use with antibiotics • Dressing can stay in place for 3 days

Acticoat Flex 7 5cm x 5cm 15cm x 15cm 10cm x 12.5cm £5.97 £31.97 £17.78 2 2 2

• Consult TVN for advice on combined use with antibiotics • Dressing can stay in place for 7 days

Acticoat Absorbent 5cm x 5cm 10cm x 12.5cm 2cm x 30cm rope £5.28 £12.68 £12.76 5 5 5

• Silver coated alginate fibre

Flamazine 50g £3.85 1-2 • Contraindicated in patients sensitive to silver sulphadiazine • Can cause Kernicterus

• Not to be used at or near term pregnancy or on premature infants or newborns.

• Tubes of Flamazine should be discarded 7 days after opening 250g £10.32 7-14 • Flamazine pots should be discarded 24 hours after opening

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ANTIMICROBIAL DRESSINGS – OTHER

Suitable for critically colonized or locally infected wounds. Systemic antibiotics are indicated in cases of overt wound infection where the classical signs are evident. The Tissue

Viability Team should be contacted if use of antimicrobials is considered for more than 7 days.

weeks supply

Comment

Cutimed Sorbact Swab 4cm x 6cm (11 x 6cm unfolded) 7cm x 9cm (17 x 27cm unfolded) £1.60 £2.67 5 5

• Hydrophobic antimicrobial wound layer designed to bind bacteria under moist wound conditions • Do not use in combination with ointments/creams

as the binding effect is impaired Cutimed Sorbact Dressing Pad 7cm x 9cm

10cm x 10cm 10cm x 20cm £3.42 £5.34 £8.33 5 5 5

• Absorbs exudate and binds bacteria

• Do not use in combination with ointments/creams as the binding effect is impaired

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ATRAUMATIC AND LOW ADHERENT DRESSINGS

Used to prevent trauma to granulating or friable wounds. Atrauman can be left in situ for 7 days. Silflex has a maximum wear time of 14 days so it is recommended that a 180 degree rotation is undertaken to prevent hypergranulation. Jelonet if left on too long can dry out and cause trauma as granulation tissue may grow into the weave of the dressing.

weeks supply Comment Atrauman 5cm x 5cm 7.5cm x 10cm 10 cm x 20cm 20cm x 30cm £0.26 £0.27 £0.61 £1.69 5 5 5 5

• Effective for up to 7 days

• Primary wound contact layer for a wide variety of wounds N-A Dressing 9.5cm x 9.5cm 9.5cm x 19cm £0.35 £0.67 5 5

• For lightly exuding wounds, superficial wounds

N-A Ultra 9.5cm x 9.5cm 9.5cm x 19cm £0.33 £0.63 5 5

Profore WCL 14cm x 20cm £0.31 5 First Line Choice

• For use under leg ulcer bandages

Silflex 5cm x 7cm 8cm x 10cm 12cm x 15cm 20cm x 30cm £1.11 £2.27 £4.58 £11.79 5 5 5 5

• Indications include skin tears, burns and surgical wounds

Jelonet 10cm x 10cm £0.40 5 • When initiated in secondary care

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BANDAGES

Can be divided into simple retention bandages or compression bandages. Compression bandages should onlybe applied following a holistic leg ulcer assessment inclusive of Doppler ultrasound. Compression bandages should be selected carefully according to ankle circumference and limb length. Compression bandages are contraindicated in arterial leg ulcers.

Compression bandages should only be applied by staff who have completed the CLCH Leg Ulcer Management training programme.

They must be signed off as competent in the application of compression bandages by the Tissue Viability Service.

weeks supply Comment Actico 4cm x 6m 6cm x 6m 8cm x 6m 10cm x 6m 12cm x 6m £2.36 £2.76 £3.18 £3.30 £4.21 10 10 10 10 10

• Cohesive inelastic short stretch bandage

Flexiban 10cm x 3.5m £0.49 12 • Undercast padding

Hospicrepe 239 5cm x 4.5m 7.5cm x 4.5m 10xcm x 4.5m 15cm x 4.5m £0.44 £0.62 £0.80 £1.17 5 5 5 5

• Cotton Crepe light support bandage

Ichthopaste 7.5cm x 6m £3.64 5 • Zinc paste and Ichthammol bandage

• Patch test for skin sensitivity for 4 days before use

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BANDAGES Continued

weeks supply

Comment

K-FOUR SYSTEMS - Refer to CLCH Wound Management Guidelines / Leg Ulcer Policy (available from 2014)

K-Soft 10cm x 3.5m £0.45 5 • Sub-compression bandage wadding

K-Soft Long 10cm x 4.5m £0.56 5

K-Lite 10cm x 4.5m £0.98 5 • Second layer of four layer bandage system

K-Lite Long 10cm x 5.25m £1.13 5

K-Plus 10cm x 8.7m £2.24 5 • Type 3a light compression bandage

• Third layer in K-Four multilayer system

K-Plus Long 10cm x 10.25m £2.59 5

Ko-Flex 10cm x 6m £2.97 5 • Type 3a cohesive compression bandage

Ko-Flex Long 10cm x 7m £3.40 5

K-ThreeC 10cm x 3m £2.75 5 • Type 3C high compression

• For use on ankle size circumference above 25cm

Knit-band 5cm x 4m 7cm x 4m 10cm x 4m 15cm x 4m £0.12 £0.15 £0.17 £0.30 5 5 5 5 • Synthetic Retention

Profore Latex Free #1 10cm x 3.5m #2 10cm x 4.5m #3 10cm x 8.7m #4 10cm x 2.5m Plus(+) 10cm x 3m £0.75 £1.41 £4.21 £3.48 £3.87 5 5 5 5 5

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BARRIER CREAMS

Protect peri-wound and vulnerable skin from excoriation by wound exudate, urine and faecal matter. Cutimed film is used as a barrier against body fluids and the cream is used to moisturise and protect. Proshield Plus is for use on both intact skin and skin that is damaged as a result of incontinence. Use products sparingly on the skin.

weeks supply

Comment

Cutimed PROTECT Barrier Film

28ml Spray £5.05 1 • Do not use on infected skin

• Primary barrier against body fluids. Provides up to 96 hours protection Cutimed PROTECT 28g tube £3.14 1 • Do not use on infected skin

BANDAGES Continued

weeks supply Comment Rosidal K 6cm x 5m 8cm x 5m 10cm x 5m 12cm x 5m £2.58 £3.08 £3.36 £4.08 6 6 6 6

• Short Stretch Compression Bandage • Requires undercast padding to protect bony

prominent areas

Steripaste 7.5cm x 6m £3.24 5 • Zinc oxide paste cotton bandage

• Patch test for skin sensitivity for 4 days before use

Viscopaste PB7 7.5cm x 6m £3.60 5 • Zinc paste bandage

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FOAM DRESSINGS

Foams are made up of a combination of hydrophilic, absorbent polyurethane or silicone foam. The outer surface is hydrophobic. They are gas permeable and help to maintain a moist wound environment. May be used as a primary or secondary dressing. Do NOT cover with film dressings.

weeks supply

Comment

Allevyn Gentle Border 7.5cm x 7.5cm 10cm x 10cm 10cm x 20cm 12.5cm x 12.5cm 15cm x 15cm 17.5cm x 17.5cm Multisite 17.1cm x 17.9cm Sacral 16.8cm x 17.1cm Sacral 21.6cm x 23cm £1.47 £2.16 £3.48 £2.65 £3.93 £5.22 £4.22 £3.91 £5.53 5-10 5-10 5-10 5-10 5-10 5-10 5 -10 5-10 5-10

• Suitable for use on patients with fragile skin

Allevyn Non-Adhesive 5cm x 5cm 10cm x 10cm 10cm x 20cm 20cm x 20cm £1.24 £2.46 £3.96 £6.61 5-10 5-10 5-10 5-10

• Do not cover with film dressings

Kerraheel 12cm x 20cm £4.56 5 -10 First Line Choice For Heels

• Do not use as a pressure relieving device Mepilex Transfer 7.5cm x 8.5cm 10cm x 12cm 15cm x 20cm 20cm x 50cm £2.23 £3.51 £10.64 £27.20 5-10 5-10 5-10 5-10

• Useful for management of fungating wounds • Requires absorbent secondary dressing

• Can be left in place whilst outer dressing is changed

Tegaderm Foam Adhesive Mini Oval 6.9cm x 7.6cm Oval 10cm x 11cm Oval 14.3cm x 15.6cm Oval 19cm x 22.2cm Oval Heel 13.9cm x 13.9cm £1.44 £2.36 £4.18 £6.85 £4.15 5 5 5 5 5

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HYDROCOLLOID DRESSINGS

Self adhesive and waterproof dressings for the management of light to moderately exuding wounds. Facilitate rehydration and autolytic debridement of dry, sloughy or necrotic wounds. Also suitable for promoting granulation tissue. Hydrocolloid wafer dressings are not recommended for heavily exuding or infected wounds. Hydrocolloid wafer dressings should extend at least 2cm beyond the edge of the wound. Not for use on diabetic foot ulcers.

weeks supply

Comment

DuoDERM Extra Thin 7.5cm x 7.5cm 10cm x 10cm 15cm x 15cm 5cm x 10cm 9cm x 15cm 9cm x 25cm 9cm x 35cm £0.79 £1.30 £2.81 £0.74 £1.74 £2.78 £3.85 5 5 5 5 5 5 5

• For dry to lightly exuding wounds • Can be used as a protectant for peri-ulcer

tissue on NPWT therapy • Not for use on diabetics

Granuflex 10cm x 10cm 15cm x 15cm 20cm x 20cm 15cm x 20cm £2.76 £5.24 £7.88 £5.67 5 5 5 5

• For dry to lightly exuding wounds • Not for use on diabetics

Granuflex Bordered 6cm x 6cm 10cm x 10cm 15cm x 15cm 10cm x 13cm 15cm x 18cm £1.74 £3.29 £6.28 £3.88 £6.05 5 5 5 5 5

• For dry to lightly exuding wounds • Not for use on diabetics

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HYDROFIBER DRESSINGS

Hydrofiber is a fibrous hydrocolloid. It has the ability to absorb and lock away large amounts of exudate; it prevents lateral wicking of exudate and forms a soft gel. Not suitable for use on dry wounds. Do not use in combination with hydrogels. Requires a secondary dressing.

weeks supply Comment Aquacel Extra 5cm x 5cm 10cm x 10cm 15cm x 15cm 4cm x 10cm 4cm x 20cm 4cm x 30cm £0.99 £2.36 £4.44 £1.29 £1.89 £2.85 14 14 14 14 14 14

• Should overlap 1cm onto the skin surrounding the wound Aquacel Ribbon 1cm x 45cm 2cm x 45cm £1.79 £2.42 14 14

• For cavity wounds

HYDROFIBER FOAM DRESSING Aquacel Foam Non-adhesive 5cm x 5cm

10cm x 10cm 15cm x 15cm 20cm x 20cm 15cm x 20cm £1.33 £2.51 £4.22 £6.88 £5.77 5-7 5-7 5-7 5-7 5-7

• Absorbent foam dressing with integral Aquacel wound contact layer

• Can be used as a primary dressing for wounds which have light to moderate exudate

• Can be used as a secondary dressing, especially when covering Aquacel Extra or Aquacel Ag Extra Aquacel Foam Adhesive 8cm x 8cm

10cm x 10cm 12.5cm x 12.5cm 17.5cm x 17.5cm 21cm x 21cm 25cm x 30cm £1.37 £2.12 £2.63 £5.26 £7.70 £9.96 5-7 5-7 5-7 5-7 5-7 5-7

Aquacel Foam Heel 19.8cm x 14cm £5.38 5-7 Aquacel Foam Sacral 20cm x 16.9cm £4.82 5-7

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HYDROGEL DRESSINGS

A primary wound dressing product consisting of insoluble polymers which are hydrophilic and contain large amounts of water. Used primarily to promote autolytic debridement of sloughy/necrotic wounds. Can donate liquid to produce a moist environment at the surface of the wound. Not suitable for heavily exuding wounds as can lead to skin

maceration/excoriation. Consider the site of the wound whether an amorphous gel (Intrasite) or hydrogel sheet (ActiFormCool) is the most suitable.

weeks supply Comment ActiFormCool 5cm x 6.5cm 10cm x 10cm 10cm x 15cm 20cm x 20cm £1.78 £2.61 £3.75 £7.86 5-7 5-7 5-7 5-7

• Not for use on heavily exuding wounds

Intrasite Gel 8g 15g 25g £1.78 £2.39 £3.54 5 5 5

• Not for use on heavily exuding wounds • Single Use Only

• 15g/25g tubes to be used on larger wounds only

NEGATIVE PRESSURE WOUND THERAPY (NPWT)

Topical negative pressure applied to the wound via a foam or gauze dressing, sealed with an airtight adhesive drape which creates a vacuum via a suction device. Suitable for wounds that have large soft tissue defects, e.g. post operative wounds, pressure ulcers, diabetic foot ulcers, leg ulcers, and fixation of skin grafts. Contraindications: Acute bleeding or risk of bleeding; exposed vessels and vascular prostheses; fistulas of unknown origin; untreated osteomyelitis; malignant wounds (except under medical guidance for palliative management of exudate); necrotic wound beds; patients with cognitive problems – review each patient individually as not suitable for all patients.

weeks supply

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NEGATIVE PRESSURE WOUND THERAPY (NPWT) Continued

weeks supply

Comment

Foam dressing kit with transfer pad Small Medium Large £19.61 £22.71 £26.84 5-10 5-10 5-10

• For use by teams in Hammersmith and Fulham Only

• All clinicians must complete the CLCH NPWT training programme. They must be signed off as competent in the application of NPWT by the Tissue Viability Service.

Gauze Dressing kit with Flat Drain Small Medium Large £16.00 £20.13 £25.81 5-10 5-10 5-10 Gauze Dressing kit with Avance

Film with SafeTac Technology and flat drain Small Medium Large £16.99 £22.48 £27.48 5-10 5-10 5-10

Avance Transfer pad £9.69 5-10

Avance Canister & Tubing 300ml 800ml

£19.61 £25.81

5-10

Avance Transparent Film 20cm x 28cm £6.14 5-10 Avance Film with Safetec 20cm x 27cm £7.44 5-10

Avance Y-connector £2.74 5-10

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NEGATIVE PRESSURE WOUND THERAPY (NPWT) Continued

weeks supply

Comment

V.A.C. Drape 30.5cm x 26cm £9.26 6 • For use by teams in Barnet, Kensington & Chelsea and Westminster only

• All clinicians must complete the CLCH NPWT training programme. They must be signed off as competent in the application of NPWT by the Tissue Viability Service.

• Ensure all assessment forms are completed before ordering

• Contact TVN if further advice is required

V.A.C. Gel Strip 14cm x 3cm £3.71 6

V.A.C. Granufoam Bridge Dressing Kit One size only £31.61 6 V.A.C. Granufoam Dressing Kits with

SensaT.R.A.C. Small Medium Large £32.79 £38.04 £31.07 6 6 6 V.A.C. Simplace Dressing Kit Small

Medium

£26.25 £30.18

6 6 V.A.C. White Foam Small

Large

£10.50 £16.82

6 6 V.A.C. White Foam Dressing Kits Small

Large

£25.56 £33.10

6 6 Acti-V.A.C. 300ml Canister with gel 300ml canister with gel,

tubing clamp and connector

£28.18 4

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ODOUR ABSORBENT DRESSINGS

Dressings containing activated charcoal that is effective in absorbing chemicals released from malodorous wounds. These can be used as primary or secondary dressings in the management of exuding, purulent and contaminated wounds (e.g. fungating) complicated by bacterial infection and offensive odour. May adhere to wounds that have dried out in which case a non-adhesive contact layer will be required. Can be used as a secondary dressing over a primary dressing to suppress odour. Moisture inactivates charcoal.

weeks supply Comment Clinisorb 10cm x 10cm 10cm x 20cm 15cm x 25cm £1.86 £2.45 £3.95 14 14 14

• Apply as primary or secondary dressing

Carboflex 10cm x 10cm 8cm x 15cm oval 15cm x 20cm £3.12 £3.74 £7.09 14 14 14

• For use as a primary dressing

RAPID CAPILLARY ACTION DRESSINGS

Absorbent non-adherent dressings with a rapid wicking effect. Can be used in sloughy, necrotic or exuding wounds. Advadraw spiral can be used for cavity wound, narrow wounds or wounds with a small opening to a larger cavity. Advadraw can be cut to wound shape and layered within the wound. Not recommended for wounds with a high risk of bleeding. Requires a secondary retention dressing.

weeks supply Comment Advadraw 5cm x 7.5cm 10cm x 10cm 10cm x 15cm 15cm x 20cm £0.57 £0.88 £1.19 £1.57 5-10 5-10 5-10 5-10

• Contraindicated on arterial bleeds, heavily bleeding wounds, vascular fungating tumours

Advadraw Spiral 0.5cm x 40cm £0.82 5 -10 • Rapid capillary action ribbon for cavities, sinuses, narrow wounds • See above for contraindications

• Not for use on post operative dehisced wounds, or suspected fungating tumours or fistulas of unknown origin

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STOCKINETTES

Used for dressing retention. Comfifast and Tubifast are elasticated viscose stockinettes. Consider using 5 metre packs if used regularly.

weeks supply

Comment

Comfifast Red Line 3.5cm x 1m £0.56 2 • Elasticated viscose stockinette

• Use for dressing retention Comfifast Green Line 5cm x 1m

5cm x 5m

£0.58 £2.81

2 2 Comfifast Blue Line 7.5cm x 1m

7.5cm x 5m

£0.77 £3.74

2 2 Comfifast Yellow Line 10.75cm x 1m

10.75cm x 5m

£1.20 £6.04

2 2 Tubifast Purple Line 20cm x 1m

20cm x 5m

£3.42 £16.76

2 2

• For Large Adult

TAPES

For fixation of dressings and bandages

weeks supply Comment Hypafix 5cm x 5m 10cm x 5m 5cm x 10m £1.40 £2.36 £2.60 1 1 1

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VAPOUR PERMEABLE FILM DRESSINGS

Comfortable, waterproof film dressings that are vapour permeable allowing the passage of water vapour and oxygen. For use as a secondary dressing over hydrogels or as a primary dressing to protect fragile skin. Do not use to cover foam dressings as it reduces MVTR.

weeks supply Comment C-View 6cm x 7cm 10cm x 12cm 12cm x 12cm 15cm x 20cm £0.38 £1.02 £1.09 £2.36 5 5 5 5

IV3000 1-hand 5cm x 6cm Non-winged peripheral 6cm x 7cm Ported peripheral 7cm x 9cm PICC Line 9cm x 12cm Central line 10cm x 12cm £0.42 £0.55 £0.72 £1.43 £1.38 5 5 5 5 5

• For use on IV/subcutaneous therapy sites

Tegaderm Film 6cm x 7cm 12cm x 12cm 15cm x 20cm £0.38 £1.09 £2.37 5 5 5

MISCELLANEOUS

weeks supply

Comment

Acti-glide N-A £14.28 1

Appeel Sterile Spray

Single use wipes (pack of 30) £9.10 £15.09

1 5 wipes

• Removes adhesive dressing residue • No sting formula

Woundcare Dressing Pack S/M/L £0.44 10 First Line Choice Dressing Pack Dressit Small/medium gloves;

medium/large gloves

£0.60 10 Second Line Choice Dressing Pack

Easy-Slide for Open Toe Stockings

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MISCELLANEOUS Continued

Product Size Cost per dressing Max. Quantity for

2 weeks supply

Comment

Irripods 25 x 20ml ampoules £5.76 1 • Can use tap water instead for cleansing of leg ulcers Kerraped Shoe S, M, L, XL £17.55 2 • Only for use if patient has no other suitable footwear Kerrapro Pressure Reducing Pads Sacrum/ankle One size

Heel One size

Sheet 10cm x 10cm x 0.3cm Sheet 10cm x 10cm x 1.2cm Strips 50cm x 2.5cm x 0.3cm Strips 30cm x 5cm x 0.3cm £16.50 £14.66 £4.15 £12.50 £5.20 £6.25 1 2 1 1 1 1

• Polymer gel-shaped pad that redistributes pressure while protecting and padding bony prominences • Do not use on broken skin

Limbo Waterproof Protector £10.56 2 • For use in the bath or shower • Waterproof leg protector

• Enables the user to have a bath or shower while protecting stockings, or bandages

Non-woven Fabric Swab (sterile) 7.5cm x 7.5cm (5 pads per pk) £0.26 15 Non-woven Fabric Swab

(non-sterile) 10cm x 10cm (100 per pack) £0.82 15 Potassium Permanganate PermiTabs 400mgs tablets (30 tablets) £14.59 10 tablets max • TVN advice only

• Dissolve to 1:10 to provide 0.01% solution • Dissolve one (400mg) tablet in 4 litres water

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EXTENDED TVN FORMULARY For use by TVNS only

weeks supply Comment Anabact 15g 30g £4.47 £7.89 1 1

• Clear gel containing 0.75% metronidazole for topical application only

Askina Calgitrol Ag 10cm x 10cm 15cm x 15cm 20cm x 20cm £3.18 £6.15 £14.36 4 4 4

• Contraindicated in those with sensitivities to alginates or silver

• For third degree burns Biatain Non-Adhesive 10cm x 10cm 10cm x 20cm 15cm x 15cm 20cm x 20cm £2.35 £3.87 £4.32 £6.42 10 10 10 10 Biobag (Larval Therapy) 2.5cm x 4cm

4cm x 5cm 5cm x 6cm 6cm x 12cm 10cm x 10xm £195.00 £220.00 £245.00 £270.00 £295.00 6 6 6 6 6

• Not for use on bleeding wounds or if close to major blood vessel

• Not for use on patients on anticoagulants • Use with caution on wounds over exposed

organs Debrisoft 10cm x 10cm £6.27 5 Haelan Tape 7.5cm x 50cm 7.5cm x 200cm £9.27 £24.95 1 1

• Contraindications: Chicken pox, vaccinia, tuberculosis of the skin, facial rosacea, acne vulgaris Hyiodine 22g 50g £19.95 £35.00 1 1

• Contraindicated in patients with sensitivity to iodine

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EXTENDED TVN FORMULARY Continued

weeks supply Comment Iodozyme 6.5cm x 5cm 10cm x 10cm £7.50 £12.50 5 5

• For use on infected superficial wounds with low-moderate levels of exudate

• Not for use on patients with allergy to iodide or iodine, or patients with thyroid disorders

• Use with caution on children or lactating mothers Microfine Toecaps XS, S, M, L £26.30 2 • For the management of forefoot oedema

(Gives 20 – 36mmHg) Oxyzyme 6.5cm x 5cm 10cm x 10cm £6.00 £10.00 5 5

• For use on non-infected superficial wounds with low-moderate levels of exudate.

• Not for use on patients with allergy to iodide or iodine, or patients with thyroid disorders

• Use with caution on children or lactating mothers

Urgotul 5cm x 5cm 10cm x 10cm 10cm x 40cm 15cm x 15cm 15cm x 20cm £1.52 £3.03 £10.20 £6.45 £8.59 4 4 4 4 4

• Effective for up to 7 days

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WOUND CLASSIFICATION CHART

This guide is to be used in conjunction with CLCH Wound Care Guidelines and holistic assessment. Refer to the Wound Management Products Formulary if you are unable to find a suitable dressing on this table.

*Refer to Wound Care Guidelines and/or contact TVN. Podiatry and Walk-In / Urgent Care Centres may use different dressings according to specific need. ** Not for use on diabetic feet. ***Contra-indicated on arterial bleeds, heavily bleeding wounds and vascular fungating tumours.

Consider using Cutimed PROTECT for peri-ulcer skin on heavily exuding wounds. For further advice on skin care please refer to Wound Care Guidelines.

NECROTIC SLOUGHY GRANULATING

Please refer to CLCH Wound Care Guidelines or contact TVN before

commencing debridement of necrotic tissue

Primary Dressing Secondary Dressing Primary Dressing Secondary Dressing Primary Dressing Treatment Choice

without a Cavity

Dry Keep dry and contact TVN for advice

ActiFormCool or Activon Tulle or Granuflex**

Allevyn or Kerraheel or Zetuvit E

Low Exudate ActiFormCool or Granuflex** Allevyn or Kerraheel or Zetuvit E ActiFormCool or Activon Tulle or Granuflex** Allevyn or Kerraheel or Zetuvit E

Atraumen or N-A Dressing or Duoderm Extra Thin** or Granuflex** or Activon Tulle

Moderate Exudate Algivon or Aquacel Extra Allevyn or Kerraheel or Zetuvit E

Aquacel Extra or Algivon or Kaltostat

Aquacel Extra or Kaltostat or Algivon

High Exudate Aquacel Extra Sorbion or Kerramax or Zetuvit E

Aquacel Extra or Kaltostat or Advadraw Sorbion or Kerramax or Zetuvit E Aquacel Extra or Advadraw or NPWT* Treatment Choice with a Cavity

Dry Keep dry and contact TVN for advice ActiFormCool or Activon Tulle or Granuflex**

Low Exudate ActiformCool or Activon Tube Allevyn or Kerraheel ActiFormCool or Activon Tube or Granuflex**

Atraumen or DuoDerm Extra Thin**

Moderate Exudate Aquacel Ribbon or Algivon Plus Ribbon

Aquacel Ribbon or Kaltostat Rope or Algivon Plus Ribbon

Aquacel Ribbon or Kaltostat Rope or Algivon Rope

High Exudate Aquacel Ribbon or Advadraw Spiral***

Allevyn or Kerraheel or Zetuvit E or Kerramax

Aquacel Ribbon or Kaltostat Rope or Advadraw Spiral***

Allevyn or Kerraheel or Zetuvit E or Kerramax

Aquacel Ribbon or Kaltostat Rope or Advadraw Spiral*** or NWPT*

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EPITHELIALISING INFECTED FUNGATING/MALODOROUS

Please check formulary for application and duration of silver dressings

Secondary Dressing Primary Dressing Secondary Dressing Primary Dressing Secondary Dressing Primary Dressing Secondary Dressing

Zetuvit E for Atraumen. No secondary dressing required for Hydrocolloids

Atrauman or Duoderm Extra Thin** or N-A Dressing

Cosmopor E or Allevyn or Kerraheel

Activon Tulle or Povitulle Cosmopor E Allevyn or Kerraheel or Zetuvit E

Activon Tulle or Atrauman Zetuvit E or Allevyn (for Activon Tulle only) Allevyn or Kerraheelor

Zetuvit E or Aquacel foam

Atrauman or Activon Tulle Allevyn or Kerraheel or Zetuvit E

Aquacel Ag Extra or Iodoflex Allevyn or Kerraheel or Zetuvit E

Aquacel Extra or Kalotstat or Clinisorb or Atrauman or Mepilex Transfer

Clinisorb (for odour control), Zetuvit or Allevyn. Consider Cutimed PROTECT Sorbion or Kerramax or

Zetuvit E

High exudate should not occur in an epithelialising wound Aquacel Ag Extra or Iodoflex Sorbion or Kerramax or Zetuvit E

Aquacel Extra or Kalotstat or Clinisorb or Atrauman or Mepilex Transfer

Clinisorb (for odour control) Zetuvit E or Kerramax or Sorbion

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DRESSING GUIDANCE CHART FOR PRESSURE ULCERS

When treating patients with pressure ulcers consider pressure reducing/relieving equipment and repositioning regimes in addition to dressing choices. Refer to the CLCH Pressure Ulcer Policy or contact the TVN for additional guidance on the management of pressure ulcers.

CATEGORY/GRADE 1

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its colour may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons.

Ensure a pressure relieving/reducing mattress, cushion or heal protectors are in place. KerraPro pressure reducing pads for pressure relief.

Implement a repositioning regime

Use of skin barriers such as Cutimed PROTECT Barrier Film or Cream. Use Proshield Plus to protect intact and damaged skin associated with incontinence

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanginous filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising*. This category should not be used to describe skin tears, tape burns, incontinence associateddermatitis, maceration or excoriation. *Bruising indicates deep tissue injury.

Allevyn Gentle Border or Aquacel Foam Adhesive or Granuflex or Duoderm Extra Thin**

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a Category/Grade III pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus

NB: do not have (adipose) subcutaneous tissue and Category/Grade 3 ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep Category/Grade 3 pressure ulcers. Bone/tendon is not visible or directly palpable.

Dry Necrosis

Keep Dry and Consult TVN Wet Necrosis.

Apply absorbent dressings such as Aquacel with Allevyn Gentle Border and consult TVN Slough or Granulation Aquacel (consider ribbon if cavity present) or Algivon Plus Top with a secondary dressing of Allevyn Gentle Border or Topical Negative Wound Therapy* Infected Aquacel Ag (consider ribbon if cavity present) or Iodoflex with a secondary dressing of Allevyn Gentle Border CATEGORY/GRADE 4

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling. The depth of a Category/Grade 4 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Category/Grade 4 ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis or osteitis likely to occur. Exposed bone/muscle is visible or directly palpable.

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If further information is needed, the Tissue Viability Service can be contacted at:

TISSUE VIABILITY SERVICE (BARNET)

TISSUE VIABILITY SERVICE (INNER BOROUGHS)

East Barnet Health Centre

St. Charles Centre for Health and Wellbeing

149 East Barnet Road

Exmoor Street

New Barnet

London

EN4 8QZ

W10 6DZ

Tel: 020 8216 2329/2340

Tel: 020 8962 4467

Fax: 020 8364 8762

Fax: 020 8962 4145

Review date: 2016