Wound Management Product Formulary

Transcription

1 Tissue Viability Service Wound Management Product Formulary Version: CLCH 204 OUR VISION: To lead out-of-hospital community healthcare 0/02/204

2 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: /2340 (Barnet Team) or (Inner Boroughs Team). 2 Tissue Viability Service

3 CONTENTS page ABSORBENT DRESSINGS FOR MODERATE TO HEAVILY EXUDING WOUNDS 4- ADHESIVE DRESSINGS FOR LIGHTLY EXUDING WOUNDS ALGINATE DRESSINGS 7 ANTIMICROBIAL DRESSINGS HONEY 8 ANTIMICROBIAL DRESSINGS IODINE 9 ANTIMICROBIAL DRESSINGS SILVER ANTIMICROBIAL DRESSINGS OTHER ATRAUMATIC AND LOW ADHERENCE DRESSINGS 2 BANDAGES 3- BARRIER CREAMS FOAM DRESSINGS HYDROCOLLOID DRESSINGS 7 HYDROFIBER DRESSINGS 8 HYDROGEL DRESSINGS 9 NEGATIVE PRESSURE WOUND THERAPY (NPWT) 9-2 ODOUR ABSORBENT DRESSINGS 22 RAPID CAPILLARY ACTION DRESSINGS 22 STOCKINETTES 23 TAPES 23 VAPOUR PERMEABLE FILM DRESSINGS 24 MISCELLANEOUS 24-2 EXTENDED TISSUE VIABILITY NURSE FORMULARY 2-27 WOUND CLASSIFICATION CHART DRESSING GUIDANCE CHART FOR PRESSURE ULCERS 30 Wound Management Product Formulary 3

4 WOUND MANAGEMENT PRODUCTS FORMULARY CLCH 204 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. (Sterile) (Non-Sterile) Zetuvit Plus KerraMax Care Sorbion Sachet EXTRA cm x cm cm x 20cm 20cm x 20cm 20cm x 40cm cm x cm cm x 20cm 20cm x 20cm 20cm x 40cm cm x cm cm x 20cm cm x 20cm 20cm x 2cm 20cm x 40cm cm x cm cm x 22cm 20cm x 22cm 30cm x 20cm 7.cm x 7.cm cm x cm 20cm x cm 20cm x 20cm 30cm x 20cm 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 Second Line Choice Primary or secondary dressing for moderate to highly exuding wounds Protease Modulator for moderate to highly exuding wounds Can be used as a primary dressing Consult TVN if used for more than 7 days 4 Tissue Viability Service

5 ABSORBENT DRESSINGS FOR MODERATE TO HEAVILY EXUDING WOUNDS Continued Sorbion Sachet Multi Star 8cm x 8cm 4cm x 4cm 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.cm x 8.cm 2cm x 2cm 22cm x 2cm 22cm x 22cm For the management of light to moderately exuding wounds and cavity wounds Consult TVN if used for more than 7 days Wound Management Product Formulary

6 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. Cosmopor E Mepore Tegaderm + Pad cm x 7.2cm 8cm x cm 8cm x cm cm x 20cm cm x 2cm cm x 3cm 7cm x 8cm cm x cm cm x cm 9cm x 20cm 9cm x 2cm 9cm x 30cm 9cm x 3cm cm x 7cm 9cm x cm 9cm x cm 9cm x 20cm 9cm x 2cm 9cm x 3cm First Line Choice Is not waterproof Second Line Choice Is not waterproof Third Line Choice Is waterproof and can be used as a primary or secondary dressing Tissue Viability Service

7 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. Kaltostat cm x cm 7.cm x 2cm cm x 20cm cm x 2cm Kaltostat Rope 2g 3.77 Sorbsan Flat cm x cm cm x cm cm x 20cm Sorbsan Packing 30cm/2g 3.47 First Line Choice Cut sheets to size of the wound to avoid maceration of surrounding skin Second Line Choice Irrigate with saline or water to remove Cut sheets to size of the wound to avoid maceration of surrounding skin Wound Management Product Formulary 7

8 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. Activon Tulle cm x cm cm x cm Knitted viscose mesh impregnated with 0% 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 2g tube Suitable for use in cavities Algivon Plus cm x cm cm x cm Reinforced alginate dressing for use on moderately exuding ulcers See allergy advice above Cut to size of wound Algivon Plus Ribbon 2.cm x 20cm 3.3 See allergy advice above 8 Tissue Viability Service

9 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. Iodoflex Paste Povitulle g g 7g cm x cm 9.cm x 9.cm 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 g of IODOFLEX can be applied per patient per week. A single application should not exceed 0g 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 months old and patients with thyroid disease Wound Management Product Formulary 9

10 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 Aquacel Ag Extra Aquacel Ag Acticoat Flex 3 cm x cm cm x cm cm x cm 20cm x 30cm cm x 4cm ribbon 2cm x 4cm ribbon cm x cm cm x cm cm x 20cm First Line Choice Should overlap cm onto the skin surrounding the wound Consult TVN for advice on combined use with antibiotics Consult TVN if used for more than 7 days Second Line Choice TVN Advice Only Consult TVN for advice on combined use with antibiotics Dressing can stay in place for 3 days Acticoat Flex 7 cm x cm cm x cm cm x 2.cm Second Line Choice TVN Advice Only Consult TVN for advice on combined use with antibiotics Dressing can stay in place for 7 days Acticoat Absorbent cm x cm cm x 2.cm 2cm x 30cm rope Second Line Choice TVN Advice Only Silver coated alginate fibre Flamazine 0g 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 20g Flamazine pots should be discarded 24 hours after opening See above for contraindications Tissue Viability Service

11 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. Cutimed Sorbact Swab 4cm x cm ( x cm unfolded) 7cm x 9cm (7 x 27cm unfolded) 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 cm x cm cm x 20cm Absorbs exudate and binds bacteria Do not use in combination with ointments/creams as the binding effect is impaired Wound Management Product Formulary

12 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 4 days so it is recommended that a 80 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. Atrauman N-A Dressing N-A Ultra cm x cm 7.cm x cm cm x 20cm 20cm x 30cm 9.cm x 9.cm 9.cm x 9cm 9.cm x 9.cm 9.cm x 9cm First Line Choice Effective for up to 7 days Primary wound contact layer for a wide variety of wounds First Line Choice For lightly exuding wounds, superficial wounds Profore WCL 4cm x 20cm 0.3 First Line Choice For use under leg ulcer bandages Silflex cm x 7cm 8cm x cm 2cm x cm 20cm x 30cm Second Line Choice Indications include skin tears, burns and surgical wounds Jelonet cm x cm 0.40 When initiated in secondary care Consider Atrauman as an alternative 2 Tissue Viability Service

13 BANDAGES Can be divided into simple retention bandages or compression bandages. Compression bandages should only be 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. Actico 4cm x m cm x m 8cm x m cm x m 2cm x m Flexiban cm x 3.m Undercast padding Hospicrepe 239 cm x 4.m 7.cm x 4.m xcm x 4.m cm x 4.m Cohesive inelastic short stretch bandage Cotton Crepe light support bandage Ichthopaste 7.cm x m 3.4 Zinc paste and Ichthammol bandage Patch test for skin sensitivity for 4 days before use Wound Management Product Formulary 3

14 BANDAGES Continued K-FOUR SYSTEMS - Refer to CLCH Wound Management Guidelines / Leg Ulcer Policy (available from 204) K-Soft cm x 3.m 0.4 Sub-compression bandage wadding K-Soft Long cm x 4.m 0. K-Lite cm x 4.m 0.98 Second layer of four layer bandage system K-Lite Long cm x.2m.3 K-Plus cm x 8.7m 2.24 Type 3a light compression bandage K-Plus Long cm x.2m 2.9 Third layer in K-Four multilayer system Ko-Flex cm x m 2.97 Type 3a cohesive compression bandage Ko-Flex Long cm x 7m 3.40 K-ThreeC cm x 3m 2.7 Type 3C high compression For use on ankle size circumference above 2cm Knit-band cm x 4m 7cm x 4m cm x 4m cm x 4m Profore Latex Free # cm x 3.m #2 cm x 4.m #3 cm x 8.7m #4 cm x 2.m Plus(+) cm x 3m Synthetic Retention Only for use on patients with LATEX ALLERGY 4 Tissue Viability Service

15 BANDAGES Continued Rosidal K cm x m 8cm x m cm x m 2cm x m Short Stretch Compression Bandage Requires undercast padding to protect bony prominent areas Steripaste 7.cm x m 3.24 Zinc oxide paste cotton bandage Patch test for skin sensitivity for 4 days before use Viscopaste PB7 7.cm x m 3.0 Zinc paste bandage Patch test for skin sensitivity for 4 days before use 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. Cutimed PROTECT Barrier Film 28ml Spray.0 Do not use on infected skin Primary barrier against body fluids. Provides up to 9 hours protection Cutimed PROTECT Cream 28g tube 90g tube Do not use on infected skin Prevents skin from drying out whilst keeping it permeable to water vapour and oxygen Proshield Plus g 9. Provides a barrier to intact and damaged skin associated with incontinence Wound Management Product Formulary

16 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. Allevyn Gentle Border Allevyn Non-Adhesive 7.cm x 7.cm cm x cm cm x 20cm 2.cm x 2.cm cm x cm 7.cm x 7.cm Multisite 7.cm x 7.9cm Sacral.8cm x 7.cm Sacral 2.cm x 23cm cm x cm cm x cm cm x 20cm 20cm x 20cm First Line Choice Suitable for use on patients with fragile skin First Line Choice Do not cover with film dressings Kerraheel 2cm x 20cm 4. - First Line Choice For Heels Do not use as a pressure relieving device Mepilex Transfer 7.cm x 8.cm cm x 2cm cm x 20cm 20cm x 0cm 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.9cm x 7.cm Oval cm x cm Oval 4.3cm x.cm Oval 9cm x 22.2cm Oval Heel 3.9cm x 3.9cm Second Line Choice Useful for areas that are awkward to dress Tissue Viability Service

17 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. DuoDERM Extra Thin Granuflex Granuflex Bordered Tegaderm Hydrocolloid 7.cm x 7.cm cm x cm cm x cm cm x cm 9cm x cm 9cm x 2cm 9cm x 3cm cm x cm cm x cm 20cm x 20cm cm x 20cm cm x cm cm x cm cm x cm cm x 3cm cm x 8cm Oval cm x 2cm Oval 3cm x cm Sacral.cm x 7.cm First Line Choice For dry to lightly exuding wounds Can be used as a protectant for peri-ulcer tissue on NPWT therapy Not for use on diabetics First Line Choice For dry to lightly exuding wounds Not for use on diabetics First Line Choice For dry to lightly exuding wounds Not for use on diabetics Second Line Choice For dry to lightly exuding wounds Not for use on diabetics Wound Management Product Formulary 7

18 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. Aquacel Extra Aquacel Ribbon HYDROFIBER FOAM DRESSING Aquacel Foam Non-adhesive Aquacel Foam Adhesive cm x cm cm x cm cm x cm 4cm x cm 4cm x 20cm 4cm x 30cm cm x 4cm 2cm x 4cm cm x cm cm x cm cm x cm 20cm x 20cm cm x 20cm 8cm x 8cm cm x cm 2.cm x 2.cm 7.cm x 7.cm 2cm x 2cm 2cm x 30cm Aquacel Foam Heel 9.8cm x 4cm Aquacel Foam Sacral 20cm x.9cm Should overlap cm onto the skin surrounding the wound For cavity wounds 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 8 Tissue Viability Service

19 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. ActiFormCool Intrasite Gel cm x.cm cm x cm cm x cm 20cm x 20cm 8g g 2g First Line Choice Not for use on heavily exuding wounds Second Line Choice Not for use on heavily exuding wounds Single Use Only g/2g 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. Foam Dressing Kit with Avance Film Safetac Technology and Transfer Pad Small Medium Large 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. Wound Management Product Formulary 9

20 NEGATIVE PRESSURE WOUND THERAPY (NPWT) Continued Foam dressing kit with transfer pad Gauze Dressing kit with Flat Drain Gauze Dressing kit with Avance Film with SafeTac Technology and flat drain Small Medium Large Small Medium Large Small Medium Large Avance Transfer pad Avance Canister & Tubing 300ml ml 2.8 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. Avance Transparent Film 20cm x 28cm.4 - Avance Film with Safetec 20cm x 27cm Avance Y-connector Avance Round Drain Tissue Viability Service

21 NEGATIVE PRESSURE WOUND THERAPY (NPWT) Continued V.A.C. Drape V.A.C. Gel Strip V.A.C. Granufoam Bridge Dressing Kit 30.cm x 2cm 4cm x 3cm One size only 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 V.A.C. Granufoam Dressing Kits with Small competent in the application of NPWT by the SensaT.R.A.C. Medium Tissue Viability Service. Large 3.07 V.A.C. Simplace Dressing Kit V.A.C. White Foam Small Medium Small Large Ensure all assessment forms are completed before ordering Contact TVN if further advice is required V.A.C. White Foam Dressing Kits Small Large Acti-V.A.C. 300ml Canister with gel 300ml canister with gel, tubing clamp and connector T.R.A.C. Y Connector One size only 3.09 Wound Management Product Formulary 2

22 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. Clinisorb Carboflex cm x cm cm x 20cm cm x 2cm cm x cm 8cm x cm oval cm x 20cm First Line Choice Apply as primary or secondary dressing Second Line Choice 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. Advadraw cm x 7.cm cm x cm cm x cm cm x 20cm Contraindicated on arterial bleeds, heavily bleeding wounds, vascular fungating tumours Advadraw Spiral 0.cm x 40cm 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 22 Tissue Viability Service

23 STOCKINETTES Used for dressing retention. Comfifast and Tubifast are elasticated viscose stockinettes. Consider using metre packs if used regularly. Comfifast Red Line 3.cm x m 0. 2 Elasticated viscose stockinette Comfifast Green Line Comfifast Blue Line Comfifast Yellow Line Tubifast Purple Line cm x m cm x m 7.cm x m 7.cm x m.7cm x m.7cm x m 20cm x m 20cm x m Use for dressing retention For Large Adult TAPES For fixation of dressings and bandages Hypafix Micropore cm x m cm x m cm x m cm x m cm x m 20cm x m.2cm x m 2.cm x m cm x m Can be applied directly onto skin Do not apply directly onto skin Wound Management Product Formulary 23

24 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. C-View cm x 7cm cm x 2cm 2cm x 2cm cm x 20cm First Line Choice IV3000 -hand cm x cm Non-winged peripheral cm x 7cm Ported peripheral 7cm x 9cm PICC Line 9cm x 2cm Central line cm x 2cm For use on IV/subcutaneous therapy sites Tegaderm Film cm x 7cm 2cm x 2cm cm x 20cm Second Line Choice MISCELLANEOUS Acti-glide N-A 4.28 Appeel Sterile Spray Single use wipes (pack of 30) wipes Removes adhesive dressing residue No sting formula Woundcare Dressing Pack S/M/L 0.44 First Line Choice Dressing Pack Dressit Small/medium gloves; medium/large gloves 0.0 Second Line Choice Dressing Pack Easy-Slide for Open Toe Stockings S, M, L, XL Tissue Viability Service

25 MISCELLANEOUS Continued Product Size Cost per dressing Max. Quantity for 2 Irripods 2 x 20ml ampoules.7 Can use tap water instead for cleansing of leg ulcers Kerraped Shoe S, M, L, XL 7. 2 Only for use if patient has no other suitable footwear Kerrapro Pressure Reducing Pads Sacrum/ankle One size Heel One size Sheet cm x cm x 0.3cm Sheet cm x cm x.2cm Strips 0cm x 2.cm x 0.3cm Strips 30cm x cm x 0.3cm Polymer gel-shaped pad that redistributes pressure while protecting and padding bony prominences Do not use on broken skin Limbo Waterproof Protector. 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.cm x 7.cm ( pads per pk) 0.2 Non-woven Fabric Swab (non-sterile) cm x cm (0 per pack) 0.82 Potassium Permanganate PermiTabs 400mgs tablets (30 tablets) 4.9 tablets max TVN advice only Dissolve to : to provide 0.0% solution Dissolve one (400mg) tablet in 4 litres water Prontosan Solution 30ml bottle 4.7 TVN Advice Only Wound irrigation solution which aids the removal of biofilm and wound debris Prontosan Wound Gel 30ml.30 TVN Advice Only Gel containing Betaine and PHMB that removes biofilm and wound debris Stericlens 240ml 3.09 Can use tap water instead for cleansing of leg ulcers Steri-strip mm x 7mm 8.3 Wound Management Product Formulary 2

26 EXTENDED TVN FORMULARY For use by TVNS only Anabact g g 7.89 Askina Calgitrol Ag cm x cm cm x cm. 4 20cm x 20cm Biatain Non-Adhesive cm x cm 2.3 cm x 20cm 3.87 cm x cm cm x 20cm.42 Biobag (Larval Therapy) 2.cm x 4cm 4cm x cm cm x cm cm x 2cm cm x xm Clear gel containing 0.7% metronidazole for topical application only Contraindicated in those with sensitivities to alginates or silver For third degree burns 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 cm x cm.27 Haelan Tape 7.cm x 0cm 7.cm x 200cm Contraindications: Chicken pox, vaccinia, tuberculosis of the skin, facial rosacea, acne vulgaris Hyiodine 22g 0g Contraindicated in patients with sensitivity to iodine 2 Tissue Viability Service

27 EXTENDED TVN FORMULARY Continued Iodozyme.cm x cm cm x cm 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 For the management of forefoot oedema (Gives 20 3mmHg) Oxyzyme Urgotul Suprasorb X+PHMB.cm x cm cm x cm cm x cm cm x cm cm x 40cm cm x cm cm x 20cm cm x cm 9cm x 9cm 4cm x 20cm 2cm x 2cm For use on non-infected superficial wounds with lowmoderate 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 Effective for up to 7 days Bio cellulose dressing impregnated with PHMB Can remain in-situ for 7 days Wound Management Product Formulary 27

28 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. NECROTIC SLOUGHY GRANULATING Treatment Choice without a Cavity Dry Low Exudate 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 Keep dry and contact TVN for advice ActiFormCool or Granuflex** Allevyn or Kerraheel or Moderate Exudate Algivon or Aquacel Extra Allevyn or Kerraheel or ActiFormCool or Activon Tulle or Granuflex** ActiFormCool or Activon Tulle or Granuflex** Aquacel Extra or Algivon or Kaltostat Allevyn or Kerraheel or Allevyn or Kerraheel or Allevyn or Kerraheel or Atraumen or N-A Dressing or Duoderm Extra Thin** or Granuflex** or Activon Tulle Aquacel Extra or Kaltostat or Algivon Treatment Choice with a Cavity High Exudate Aquacel Extra Sorbion or Kerramax or Aquacel Extra or Kaltostat or Advadraw 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** Moderate Exudate High Exudate Aquacel Ribbon or Algivon Plus Ribbon Aquacel Ribbon or Advadraw Spiral*** Allevyn or Kerraheel or Allevyn or Kerraheel or or Kerramax Aquacel Ribbon or Kaltostat Rope or Algivon Plus Ribbon Aquacel Ribbon or Kaltostat Rope or Advadraw Spiral*** Sorbion or Kerramax or Allevyn or Kerraheel or Allevyn or Kerraheel or Allevyn or Kerraheel or Allevyn or Kerraheel or or Kerramax Aquacel Extra or Advadraw or NPWT* Atraumen or DuoDerm Extra Thin** Aquacel Ribbon or Kaltostat Rope or Algivon Rope Aquacel Ribbon or Kaltostat Rope or Advadraw Spiral*** or NWPT* *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. 28 Tissue Viability Service

29 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 for Atraumen. No secondary dressing required for Hydrocolloids Allevyn or Kerraheelor or Aquacel foam Sorbion or Kerramax or Atrauman or Duoderm Extra Thin** or N-A Dressing Atrauman or Activon Tulle Cosmopor E or Allevyn or Kerraheel Allevyn or Kerraheel or Activon Tulle or Povitulle Aquacel Ag Extra or Iodoflex Cosmopor E Allevyn or Kerraheel or Allevyn or Kerraheel or High exudate should not occur in an epithelialising wound Aquacel Ag Extra or Iodoflex Sorbion or Kerramax or Activon Tulle or Atrauman Aquacel Extra or Kalotstat or Clinisorb or Atrauman or Mepilex Transfer Aquacel Extra or Kalotstat or Clinisorb or Atrauman or Mepilex Transfer or Allevyn (for Activon Tulle only) Clinisorb (for odour control), Zetuvit or Allevyn. Consider Cutimed PROTECT Clinisorb (for odour control) or Kerramax or Sorbion Allevyn (for Atraumen only) Not Applicable Povitulle or Activon Tube Allevyn or Kerraheel or Allevyn or Kerraheel or or Aquacel Foam Allevyn or Kerraheel or or Kerramax Not Applicable Not Applicable Aquacel Ag Ribbon or Activon Tube or Iodoflex Allevyn or Kerraheel or Aquacel Ag Ribbon or Allevyn or Kerraheel or Advadraw Spiral*** or NWPT* or Kerramax Activon Tube or Atrauman Aquacel Extra Ribbon or Kaltostat Rope or Atrauman Aquacel Extra Ribbon or Kalotstat or Atrauman or Allevyn (for Activon Tulle only) Clinisorb (for odour control), Zetuvit or Allevyn. Clinisorb (for odour control) or Kerramax Wound Management Product Formulary 29

30 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 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. CATEGORY/GRADE 2 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. 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 Allevyn Gentle Border or Aquacel Foam Adhesive or Granuflex or Duoderm Extra Thin** CATEGORY/GRADE 3 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. 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. 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 30 Tissue Viability Service

31 Wound Management Product Formulary 3

32 Review date: 20 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 49 East Barnet Road Exmoor Street New Barnet London EN4 8QZ W DZ Tel: /2340 Tel: Fax: Fax: If you need to prescribe a dressing that is not on the formulary, please contact the Tissue Viability Serice.