WOUND MANAGEMENT PRODUCTS FORMULARY 2017 / 2018

Transcription

1 WOUND MANAGEMENT PRODUCTS FORMULARY 2017 / 2018

2 Wound Management Products Formulary CLCH Merton 2017 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 whilst using cost effective treatment options. Burden of wounds UK June Guest et al- THIN database- An average CCG with catchment area of about adults over 18 were managing about 11,200 wounds during 2012/2013 of these 40% were acute, 48% chronic and 12% lacking any specific diagnosis and the rate has been increasing every year at the rate of 9%, 12% and 13%. Estimated to cost the NHS.3 Billion in that year which equates to 4% of the total expenditure by the NHS. Current rate of wound healing must improve at least by 1% to slow down the increasing prevalence otherwise if the healing rate doesn t improve by 2019/2020 each average CCG is predicted to be managing about 23,200 wounds, therefore the treatment options chosen within this Formulary aim to improve healing rates. This formulary is to be used in conjunction with CLCH policies and holistic assessment. All policies relating to Tissue Viability can be found on the CLCH 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 Merton Tissue Viability Team is available to discuss dressing selection via single point of access on: Tel No Wandsworth CCG and Merton CCG acknowledge CLCH for developing this formulary for use locally. 1

3 CONTENTS page SUMMARY OF KEY CHANGES TO THE FORMULARY 3 KEY MESSAGES FOR ORDERING AND PRESCRIBING DRESSINGS 4 SUPERABSORBENT DRESSINGS FOR MODERATE TO HEAVILY EXUDING WOUNDS FOAM DRESSINGS FOR WOUNDS WITH LOW TO MODERATE EXUDATE 6 ADHESIVE DRESSINGS FOR LIGHTLY EXUDING WOUNDS 7 ALGINATE DRESSINGS 7 ANTIMICROBIAL DRESSINGS HONEY 8 ANTIMICROBIAL DRESSINGS IODINE 8-9 ANTIMICROBIAL DRESSINGS SILVER 9 ANTIMICROBIAL DRESSINGS OTHER 9-10 ATRAUMATIC AND LOW ADHERENCE DRESSINGS 10 BANDAGES AND COMPRESSION SYSTEMS BARRIER CREAMS 13 HYDROCOLLOID DRESSINGS 14 HYDROFIBER DRESSINGS 1 HYDROGEL DRESSINGS 1 NEGATIVE PRESSURE WOUND THERAPY (NPWT) 1-16 ODOUR ABSORBENT DRESSINGS 16 TAPES 16 STOCKINETTES 17 VAPOUR PERMEABLE FILM DRESSINGS 17 MISCELLANEOUS EXTENDED TISSUE VIABILITY NURSE FORMULARY 19 EMOLLIENTS COMPRESSION HOSIERY CROSS CHECKER 21 HOSIERY MEASUREMENT GUIDE WOUND CLASSIFICATION CHART 24 REVIEW DATE AND TVN CONTACT DETAILS 2 2

4 SUMMARY OF KEY CHANGES TO THE FORMULARY Aquacel Ag Extra has been replaced by Aquacel Ag + Extra as it s more effective than the former dressing and also costs slightly less Larger sizes of silver dressings have been removed as they are more costly, more cost effective to prescribe the smaller sizes as most wounds tend to reduce in size Juxta range of compression wraps have been added as they promote patient self-management of their treatment for lympheodema and venous disease, reduces nursing time, promotes patient con-cordance and more cost effective long-term and has been recommended by NICE Continued with UrgoK-TWO, K1, K2, K3, K4 bandaging systems which have proved to be more effective for the population of patients within Merton who are not very mobile with poor ankle flexion. Cavilon has been replaced by Cutimed Protect which is equally as effective but slightly cheaper KerraMax Care and Zetuvit Plus superabsorbent dressings replace Eclypse and Sorbion as the new ones are cheaper and equally as effective. Aderma has been replaced by KerraPro which is slightly cheaper and lasts longer Medihoney range has replaced the Advancis honey range due to the fact that there is less complains of stinging from patients and the range is cost effective KerraCel replaces Aquacel Extra as it s cheaper and equally effective Flaminal Forte and Flaminal Hydro have been added as they are antimicrobial products which are more cost effective as they can be reused for the single patient Advazorb has been removed from the Formulary due to complaints from clinicians about poor adherence and has been replaced with KerraFoam Gentle Border and FoamLite ConvaTec which are also cost effective. NA Ultra and Adaptic touch have been replaced by Atrauman and Silflex which are more cost effective KerraLite Cool and Cutimed Gel have replaced Purilon, Intrasite Conformable and Actiform Cool Avelle NPWT has been added onto the Formulary as it s more cost effective than PICO 3

5 Key messages for ordering and prescribing dressings 1. Larger dressings are usually more expensive than the smaller sizes and most wounds should ideally reduce in size over time. Always query large size dressings on repeat to justify use. 2. Dressings should not be prescribed as long term repeat items 3. Query quantities over 10 units/month as most dressings can stay in place for 3- days except on infected/ heavily exuding wounds (Note that some patients may have multiple wound sites may require large quantities of dressings to be prescribed) 4. Write frequency of dressing change on prescriptions and / or prescription request to give an idea of how much is needed. Address underlying problems e.g. soiling from incontinence, wrong choice of dressing etc. 6. Prescribe the actual number of dressings needed rather than prescribing in packs or boxes 7. Even chronic wounds may change over time, so will the dressings required, there should be a process to refer difficult to treat wounds to a tissue viability nurse (TVN) 8. This is a standalone formulary to guide choice of products for Wound Assessment see separate Wound Management Guidelines 4

6 SUPERABSORBENT 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. Superabsorbent dressings may be used under compression provided the leg is correctly shaped to continue to achieve graduated compression. Product Size Cost per dressing Qty per pack Comment Zetuvit Plus 10cm x 10cm First Line 10cm x 20cm cm x 20cm cm x 2cm cm x 40cm Primary or secondary dressing for moderate to highly exuding wounds, if used under compression ensure that limb is shaped to an inverted cone shape in order that graduated compression will be achieved. KerraMax Care cm x cm Second Line 10cm x 10cm Primary or secondary dressing for 10cm x 22cm moderate to highly exuding wounds, 13.cm x 1.cm thinner dressing even when used under 20cm x 22cm compression. Non-adhesive dressing 20cm x30cm you can apply either side to the wound. 20cm x 0cm KerraMax Care Multisite 21cm x 23cm 3.28 KerraMax Care Border 16cm x 16cm 4.39 Second Line 16cm x 26cm 6.94 See above. 26cm x 26cm 9.98

7 FOAM DRESSINGS FOR WOUNDS WITH LOW TO MODERATE EXUDATE Change according to clinical need. Creams and ointments can reduce the adherence of some of the products. Do NOT cover with film dressings. Product Size Cost per Qty per pack Comment dressing KerraFoam Gentle Border 7.cm x 7.cm Primary or secondary dressing for low to 10cm x 10cm moderately exuding wounds 10cm x 20cm cm x 12.cm KerraFoam Gentle Border Heel 23cm x 2cm 8.14 KerraFoam Gentle Border Sacrum 17cm x 17.cm 4.7 FoamLite ConvaTec 8cm x 8cm Primary or secondary dressing for low to 10cm x 10cm moderately exuding wounds 1cm x 1cm cm x 12cm Aquacel Foam Non-adhesive cm x cm Primary or secondary dressing for moderate to high exuding wounds 10cm x 10cm Primary or secondary dressing for 1cm x 1cm 4.2 moderate to high exuding wounds 20cm x 20cm cm x 20cm.81 Aquacel Foam Adhesive 8cm x 8cm Primary or secondary dressing for 10cm x 10cm moderate to high exuding wounds 12.cm x 12.cm cm x 17.cm Aquacel Foam Heel 19.8cm x 14cm.43 Aquacel Foam Sacral 20cm x 16.9cm

8 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. Product Size Cost per Qty per pack Comment dressing Cosmopor E cmx7.2cm First Line 8cmx10cm extra careful for fragile skin 8cmx1cm cmx20cm cmx2cm cmx3cm Mepore 7cmx8cm Second Line 10cmx11cm extra careful for fragile skin 11cmx1cm cmx20cm cmx2cm cmx30cm cmx3cm Hydrofilm Plus cmx7.2cm Is waterproof and can be used as a 9cmx10cm primary or secondary dressing 9cmx1cm cmx20cm cmx2cm cmx30cm 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. Product Size Cost per Qty per pack Comment dressing Suprasorb A cm x cm Irrigate with Saline or water to remove 10cm x10cm the dressing if it has adhered to the Suprasorb A Rope 2g wound. Kaltostat cm x cm Cut sheets to size of the wound to avoid 7.cm x 12cm maceration of surrounding skin 10cm x 20cm cm x 2cm cm x 10cm

9 ANTIMICROBIAL DRESSINGS HONEY Suitable for critically colonized or locally infected wounds. Antibiotics are indicated in cases where there are clinical signs of systemic infection although in patients with diabetes these symptoms could be masked. The Tissue Viability Team should be contacted if use of antimicrobial dressings is considered for more than 14 days. Product Size Cost per Qty per pack Comment Medihoney Antibacterial Honey Apinate Medihoney Apinate Rope Medihoney HCS cm x cm 10cm x 10cm 2cm x 30cm 6cm x 6cm 11cm x 11cm dressing Effective against a broad spectrum of bacteria. Fast, effective autolytic debridement on sloughy & necrotic tissue, removes malodour, provides moist wound environment. Less complaints of stinging/ drawing effect. Contraindications- patients with known allergies to bee venom See above Medihoney HCS Surgical with Adhesive Border Medihoney HCS with Adhesive Border Square Medihoney Wound Gel 7.cm x 20cm See above 11cm x 11cm 1cm x 1cm 10g 20g order individual quantities needed. See above See above. Reusable for the same patient for up to 4 months 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. Product Size Cost per dressing Qty per pack Comment Povitulle cm x cm For lightly exuding wounds. 9.cm x 9.cm Contraindications: if patient has known sensitivity to iodine, pregnant or breastfeeding, renal impairment, before and after use of radio-iodine, in cases of Durhing s herpetiform dermatitis. Use under medical supervision in infants up to 8

10 6 months old and patients with thyroid disease. Iodoflex g 4.09 TVN/ PODIATRY ADVICE 10g g Do not use on patients with sensitivity to any of products ingredients, children, pregnant or lactating women or those with thyroid disorders or renal impairment Iodosorb Ointment 10g tube See above instructions for iodoflex 20g tube 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 14 days. Product Size Cost per Qty per pack Comment dressing Atrauman Ag cm x cm First Line 10 x 10cm x 20cm Aquacel Ag+ Extra cmxcm Review with TVN if required for more than 10cmx10cm days. 1cmx1cm 8.7 -please do not cut on the stitches line Aquacel Ag+ Ribbon 1cm x 4cm ribbon 2cm x 4cm ribbon at least 2cm overlap from the peri-wound KerraContact Ag cmxcm 10cmx12.cm 1cmx1cm Review with TVN if required for more than 14 days. Actisorb Silver cm x 9.cm TVN ADVICE/ Podiatry Use 10.cm x 10.cm cm x 19cm 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 14 days. Product Size Cost per Qty per pack Comment Cutimed Sorbact Swab 4cm x 6cm (11 x 6cm unfolded) 7cm x 9cm (17 x 27cm unfolded) dressing 1.7 Binds bacteria to the swab requires secondary dressings 9

11 Flaminal Hydro Flaminal Forte Prontosan Gel X 1g tube 0g tube 1g tube 0g tube 0g 20g tube (approximate coverage 40cm2) 1 tube (approximate coverage 130cm2) 1 tube (approximate coverage 40cm2) 1 tube (approximate coverage 130cm2) 1 1 For wounds that have mild to moderate amounts of exudate. Can be used throughout all the stages of wound healing. For wounds that have moderate to heavy amounts of exudate. Can be used throughout all the stages of wound healing. Gel containing Betaine and PHMB that removes biofilm and wound debris ATRAUMATIC AND LOW ADHERENT DRESSINGS Used to prevent trauma to granulating or friable wounds. Product Size Cost per dressing Qty per pack Comment Atrauman cm x cm First line 7.cm x 10cm Effective for up to 7 10cm x 20cm days 20cm x 30cm 1.72 Silflex cmx7cm Second line choice 8cm x 10cm cm x 1cm cm x 30cm Indications include skin tears, burns and surgical wounds Maximum wear time of 14 days so it is recommended that a 180 degree rotation is undertaken to prevent hypergranulation 10

12 BANDAGES AND COMPRESSION SYSTEMS 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 staffs that have completed the CLCH Leg Ulcer Management training programme and they must be signed off as competent in the application of compression bandages by the Tissue Viability Service. Order quantities needed, no more than 2 weeks supply. Product Size Cost per dressing Qty per Comment pack Actico 8cm x 6m Cohesive inelastic short stretch bandage, requires undercast padding to protect bony prominences. 10cm x 6m cm x 6m Peha-haft latex free; double 2. x 4m adhesive effect 4cm x 4m cm x 4m cm x 4m cm x 4m cm x 4m K-Soft 10cm x 3.m K-Soft Long 10cm x 4.m K-Lite 10cm x 4.m K-Lite Long 10cm x.2m K-Plus 10cm x 8.7m K-Plus Long 10cm x 10.2m KO-Flex 10cm x 6m (stretched) KO-Flex Long 10cm x 7m (stretched) K-Four (Urgo) Ankle circumference 4 layer compression bandaging kit Less than 18cm cm Comprising: 2-30cm K-Soft soft absorbent bandage for Greater than 30cm redistribution pressure over bony prominences. Applied spiral with 0% overlap. K-Lite light support type 2 bandage. Applied spiral with 0% overlap. K-Plus light compression type 3a bandage. Applied in figure of 8 with 0% stretch. 11

13 Ko-Flex Cohesive bandage. Applied spiral with 0% overlap and 0% stretch. Urgo K-Two Ankle circumference 2 layer compression bandaging kit. 18-2cm (8cm) cm (10cm) cm (12cm) cm (8cm) cm (10cm) cm (12cm) UrgoKTwo Reduced - multi-layer 18-2cm compression bandage kit 2cm - 32cm Comprising: K-Tech soft absorbent bandage for redistribution pressure over bony prominences. Applied spiral with 0% overlap for 18cm-2cm and 2/3 overlap for 2-32cm and 0% stretch. K-Press Cohesive bandage. Applied spiral with 0% overlap for 18cm- 2cm and 2/3 overlap for 2-32cm and 0% stretch. Juxta cures compression wraps Short, Standard, to last up Long to 6 months Juxta fit compression wraps Lower Legging 28cm, to last up S, M, L, XL, XXL to 12 Lower Legging 36cm months S, M, L, XL, XXL Lower Legging Extra Wide Calf 28cm M, L, XL Lower Legging Extra Wide Calf 36cm M, L, XL Ankle Foot Wrap, Interlocking S, M, L Ankle Foot Wrap, Closed Heel S, M, L Juxta lite compression wraps Available as Short to last up and Long to 6 months Small, Medium, Large, Extra Large, Extra Extra Large To ensure the correct K-Two kit is prescribed it is necessary to write the required bandage width after the size of kit as 8cm, 10cm and 12cm widths available. Guaranteed for up to 6 months for leg ulcer management Guaranteed for up to 12 months for chronic oedema/ lymphedema management. Guaranteed for up to 6 months for leg ulcer prevention or maintenance post healing. Recommended by NICE. They can be applied by the patient themselves, carers and 12

14 Available as Short Extra Wide and Long Extra Wide Medium, Large, Extra Large clinicians, better patient con-cordance with compression. Ichthopaste 7.cm x 6 m Zinc paste and Ichthammol bandage Patch test for skin sensitivity for 4 days before use -please refer to packet insert for application technique Viscopaste PB7 7.cm x 6 m Zinc paste bandage Patch test for skin sensitivity for 4 days before use -please refer to packet insert for application technique 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. Use products sparingly on the skin. Product Size Cost per dressing Qty for 2 week supply Comment Cutimed PROTECT Barrier Film 28ml Spray.1 1 First Choice Cutimed PROTECT Cream 28g tube Do not use on suspected fungal infection Provides protection up to 96hrs Proshield Plus 11g Second Choice Provides a barrier to intact and damaged skin associated with incontinence 13

15 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. Product Size Cost per dressing Qty per pack Comment Duoderm Extra Thin 7.cm x 7.cm 0.80 For dry to lightly exuding wounds. 10cm x 10cm cm x 1cm cm x 10cm cm x 1cm Not for use in diabetic foot ulcer, otherwise seek TVN advice. Please consider using adhesive remover for fragile skin Granuflex 10cm x 10cm 1cm x 1cm For dry to lightly exuding wounds. 20cm x 20cm 1cm x 20cm Not for use in diabetic foot ulcer, otherwise seek TVN advice. Please consider using adhesive remover for fragile skin Granuflex Bordered 6cm x 6cm 10cm x 10cm For dry to lightly exuding wounds. 1cm x 1cm 10cm x 13cm Not for use in diabetic foot ulcer, otherwise seek TVN advice. Please consider using adhesive remover for fragile skin 14

16 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. Product Size Cost per dressing Qty per pack Comment KerraCel cm x cm Should overlap 1cm onto the skin 10cm x 10cm surrounding the wound 1cm x 1cm 2.71 KerraCel Ribbon 2.cm x 4cm 1.91 For cavity/sinus wounds 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 (Cutimed Gel) or hydrogel sheet (Kerralite Cool) is the most suitable. Product Size Cost per dressing Qty per pack Comment KerraLite Cool 6cm x 6cm 1.77 First Line Choice 12cm x 8.cm 2.61 Not for use on heavily exuding wounds 18cm x 12.cm 3.77 KerraLite Cool Border 8cm x 8cm cm x 11cm cm x 1cm 4.3 Cutimed Gel 8g Second Line Choice 1g Not for use on heavily exuding wounds Single Use Only NEGATIVE PRESSURE WOUND THERAPY (NPWT) Topical negative pressure applied to the wound via 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. Product Size Cost per dressing Qty per pack Comment Avelle NPWT PUMP All clinicians applying NPWT must be Avelle NPWT dressing 16cm x 16cm 1.00 Avelle NPWT dressing 16cm x 21cm Avelle NPWT dressing 12cm x 21cm 1.00 Avelle NPWT dressing 12cm x 31cm competent in the application of NPWT. Ensure TVN is aware of all referrals for NPWT. 1

17 FOR NPWT PUMP WHICH IS NOT DISPOSABLE, REFER TO TVN Contact TVN if further advice/ support is required. P.S the Avelle disposable pump lasts up to 30 days. ODOUR ABSORBENT DRESSINGS FOR PATIENTS WHO ARE NOT ABLE TO USE HONEY 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. Product Size Cost per dressing Qty for 2 week Comment supply Clinisorb 10cm x 10cm First Line Choice 10cm x 20cm Zorflex VB-K cm x cm Second Line Choice 10cm x 10cm cm x 20cm TAPES For fixation of dressings and bandages Product Size Cost per dressing Qty per pack Comment Hypafix cm x m Can be applied directly onto skin 10cm x m cm x 10m cm x 10m Micropore 1.2cm x m Do not apply directly onto skin 2.cm x m cm x m

18 STOCKINETTES Used for dressing retention. Comfifast and Tubifast are elasticated viscose stockinettes. Consider using metre packs if used regularly. Product Size Cost per dressing Qty for 2 week Comment supply Comfifast Red Line 3.cm x 1m Elasticated viscose stockinette. Comfifast Green Line cm x 1m cm x m Use for dressing retention Comfifast Blue Line 7.cm x 1m cm x m Comfifast Yellow Line 10.7cm x 1m cm x m Comfifast Beige Line 17.cm x 1m For Large Adult 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 moisture vapour transfer (MVTR). Product Size Cost per dressing Qty per pack Comment Hydrofilm 6cm x 7cm 0.22 First Line Choice 10cm x 12.cm cm x 1cm cm x 2cm 0.81 Premier Film 6cmx7cm 0.2 Second line choice 10cm x 12cm cm x 2cm 1.0 IV3000 cm x 6cm 1-hand 0.41 For use on IV/subcutaneous therapy sites 6cm x 7cm 0.6 non-winged peripheral 7cm x 9cm 0.73 ported peripheral 9cm x 12cm 1.4 PICC Line 10cm x 12cm central line

19 MISCELLANEOUS Product Size Cost per dressing Qty per pack Adhesive Remover: Hollister Adapt Spray 0ml Cleansing Solutions: Clinipods Prontosan Solution Dressing Packs: Polyfield Nitrile patient pack Nurse it 20ml ampoules 30ml bottle S/M/L Small/medium gloves; medium/large gloves ampoules Footwear: KerraPed S, M, L, XL max Hosiery types, strength Please see p.1, p.16 & p.17 Hosiery applicator: Actiglide Soak Aid KerraPro Pressure Reducing Pads (silicone gel pads) LimbO Waterproof Protector Adult ½ leg Non-woven Fabric Swab (sterile) Sacrum/ankle One size Heel One size Sheet 10cm x 10cm x 0.3cm Sheet 10cm x 10cm x 1.2cm Strips 0cm x 2.cm x 0.3cm Strips 30cm x cm x 0.3cm Slim build MP76 Slim build short leg MP76S Normal build MP80 Normal build,short leg MP80S Large build MP180 Large build,short leg MP180S 7.cm x 7.cm ( pads per pack) bot Comment Removes adhesive dressing residue No sting formula Cleansing solutions / Saline X2pcs in a box Wound irrigation solution which aids the removal of biofilm and wound debris Only for use if patient has no other suitable footwear Please see attachment hosiery applicators for close toe & open toe Polymer gel-shaped pad that redistributes pressure while protecting and padding bony prominences Do not use on broken skin -washable / reusable Use to protect dressing from getting wet Sterile gauze not required for chronic wounds UCS Debridement Cloth Physical Debridement Pad, should not be left on the wound bed as it s not a dressing. Non-woven Fabric Swab (non-sterile) 10cm x 10cm Use non-sterile gauze for chronic wounds Potassium Permanganate PermiTabs 400mgs tablets (30 tablets) tablets max TVN advice only 18

20 Steri-strip 6mm x 7mm Dissolve to 1:10 to provide 0.01% solution. Dissolve one (400mg) tablet in 4 litres water EXTENDED TVN FORMULARY For use by TVN or as advised by TVN only Product Size Cost per dressing Qty for 2 week supply Acticoat Flex 3 cm x cm 10cm x 10cm 10cm x 20cm Comment Dressing can stay in place for 3 days Acticoat Flex 7 cm x cm.97 2 Dressing can stay in place for 7 days 1cm x 1cm cm x 12.cm Anabact 1g Clear gel containing 0.7% 30g metronidazole for topical application only Biobag (Larval Therapy) 2.cm x 4cm Not for use on bleeding wounds or if 4cm x cm close to major blood vessel cm x 6cm Not for use on patients on 6cm x 12cm anticoagulants 10cm x 10xm Use with caution on wounds over exposed organs Mollelast 4cm x 4m For the management of toe oedema. Emollients* - Consider patient sensitivities to constituents when prescribing. Prescribe smaller quantities as required to reduce waste. Ointments Product Main constituents Price per pack Emulsifying Ointment* (00g) Emulsifying wax 30%, white soft paraffin 0%, liquid paraffin 20% 2.92 White soft paraffin (00g) White petroleum jelly 3.23 Zeroderm Ointment* (00g) Liquid paraffin 40%, white soft paraffin 30% :0 Liquid paraffin: White Soft Paraffin (00g) Liquid paraffin 0%, white soft paraffin 0% 4.7 Hydromol Ointment* (00g) Yellow soft paraffin 30%, emulsifying wax 30%, liquid paraffin 40% 4.89 Hydrous Ointment (00g) (Oily cream), dried magnesium sulfate 0.%, phenoxyethanol 1%, wool alcohols ointment 0%, in freshly boiled and cooled purified water

21 Creams / gels Name of product Main constituents Price per pack Epimax Cream (00g)* White soft paraffin 1% w/w and liquid paraffin 6% w/w 2.49 Isomol Gel (00g) Liquid paraffin 1%, isopropyl myristate 1% 2.92 ZeroAQS Emollient cream (00g)* Liquid paraffin 6%, white soft paraffin 1% 3.29 Aquamax Cream* (00g)* White soft paraffin 20%, liquid paraffin 8% 3.99 Zerocream (pump dispenser) (00g) Liquid paraffin 12.6%, white soft paraffin 14.% 4.08 AproDerm Emollient Cream (40g) Liquid paraffin 6% 4.74 Zerobase Emollient Cream (pump dispenser) (00g) Liquid paraffin, white soft paraffin,.26 Oilatum Cream / Junior Cream (pump dispenser) (00g) Light liquid paraffin 6%, white soft paraffin 1%.28 E4 Cream (00g) White soft paraffin 14 %, hypoallergenic anhydrous lanolin 1%, light liquid paraffin 12 6% Ultrabase Cream (pump dispenser) (00g) White soft paraffin 10%.96 Zeroguent Emollient Cream (00g) Light liquid paraffin 8%, white soft paraffin 4%, soya oil % 6.99 *Note: Each cream/ointment/gel is available in smaller quantities. See Factsheet 17 - The use of Emollients in Dry skin conditions (Merton CCG Factsheet) for further guidance on emollients

22 Compression Hosiery Cross Checker 1. It is important to check for the signs and symptoms of venous disease, please see chart below. 2. The chart should be used as a prompt to check for skin and lower limb changes as part of the holistic assessment. 3. Vascular status i.e. ABPI must be determined before applying the compression. If in doubt. DO NOT use and refer the patient to TV Nurses. 4. In the early/medium intervention and intensive management phases, before managing with hosiery, a period of treatment with appropriate compression system such as bandaging or compression wraps may be required. If in doubt seek TVN advice. Prevention 1. Tick the box if the sign /symptom is reported, or present on the limb of the patient ( )Tired, aching, heavy legs ( )Spider veins ( )Ankle Flare ( )Mild/moderate varicose veins ( )Mild/moderate varicose veins ( )Mild /mod. hyperkeratosis ( )Hyperpigmentation ( )Venous dermatitis ( )Mild/moderate varicose veins 2. Is oedema also present? Tick YES or NO (in the colour band of the lowest tick in step 1.) NO YES Consider application of the compression below, depending on disease severity (mild, moderate or severe) as part of management. Activa / Credelast / Duomed Soft Mild: Liner or Class 1 Moderate: Class 1 or 2 Activa / Credelast / Duomed Soft Mild: Class 1 Moderate: Class 2 Early / Medium Intervention Intensive Credit to: L&R Company: ***The COMPRESSION BANDAGE may be required at this phase *** ( )Varisoce Eczema ( )Atrophie Blanche ( )Induration ( )Moderate /severe varicose veins ( )Moderate /severe hyperkeratosis ( )Healed Ulcer ( )Recurring ulcer /open ulcer ( )Cellulitis ( )Lipodermatosclerosis (acute or chronic) ( )Chronic edema/lymphoedema ( )Severe hyperkeratosis ( )Skin Folds ( )Papillomatosis ( )Lymphangiomata NO YES Activa / Credelast / Duomed Soft / Actilymph / Mediven / Activa Hosiery Kit Class 1 or 2 Actilymph / Mediven or Ready Wrap Moderate: Class 2 Severe: Class 3 NO Activa / Credelast / Duomed Soft / Actilymph / Mediven / Activa Hosiery Kit /Ready Wrap Severe: Class 3 Actilymph / Mediven / Ready Wrap YES Moderate: Class 2 Severe: Class 3 21

23 Hosiery Measurement Guide British Standard Hosiery (lower compression) Duomed Small Medium Large Extra Large Ankle 19cm 21cm 22cm 24cm 2cm 27cm 28cm - 30cm Calf 28cm 34cm 32cm 38cm 36cm 42cm 40cm - 46cm Thigh 42cm 6cm 48cm 62cm 4cm 68cm 60cm 74cm Credelast (sand & open Small Medium Large Extra Large toe only) Ankle 18cm 22cm 20cm 24cm 24cm 28cm 28cm - 32cm Calf 28cm 34cm 32cm 38cm 36cm 42cm 40cm - 46cm Thigh 40cm 4 cm 46cm 60cm 4cm 68cm 60cm 74cm Foot length (closed toe only) under 23cm under 2cm under 29cm up to 32cm Standard Length: below knee = up to 38cm Long Length: below knee = up to 4cm Activa (b/s colour) Small Medium Large Extra Large Ankle cm cm cm cm Calf cm 33 40cm cm 38-4cm Thigh 40. 3cm 43 cm cm 3 66cm Foot cm 23-26cm cm cm Activa Small Medium Large Extra Large Extra Extra Large Hosiery Kit Liner and Stocking) Ankle cm cm cm cm cm Calf cm 33 40cm cm 38-4cm 40 49cm Foot cm 23-26cm cm cm cm 22

24 RAL Compression System (European System - higher compression) Actilmyph Small Medium Large Extra Large XXL (b/s colour) Ankle 19 21cm cm 23 27cm 27 32cm 32 37cm Calf 31 39cm 34 31cm 3-44cm 39 48cm 44 2cm Mediven Size 1 Size 2 Size 3 Size 4 Size Size 6 Size 7 (b/s colour) Ankle 18 20cm 20 22cm 22 24cm 24-26cm 26-28cm 28 30cm 30 32cm C- standard 28 34cm 32 38cm 36 42cm 40-46cm 37 46cm 39-49cm 41-1cm C-extra wide 34 38cm 37 41cm 40 44cm 42 46cm 44 48cm 46 0cm 48 2cm Other Compression Garments Ready Wrap Small Medium Large Extra Large (black / beige) Ankle 18 23cm 20 28cm 2 33cm 30 38cm Calf 28 38cm 33 43cm 38-48cm 43 8cm Length (above the ankle below knee): 1.) up to 30cm; 2.) up to 3cm 23

25 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). EPITHELIZING GRANULATING SLOUGHY NECROTIC INFECTED FUNGATING DESCRIPTION: DESCRIPTION: DESCRIPTION: DESCRIPTION: DESCRIPTION: DESCRIPTION: Wound bed is pink and Wound bed is red with Devitalised tissue; yellow, Devitalised tissue, Erythema, increased Necrotic, cauliflower shallow. Minimum exudate granular appearance white or grey Black/Brown, dry, leathery exudate, pain, heat, appearance, non-healing, malodour malodour, pain and bleeding AIMS: Protect and maintain moisture balance 24 AIMS: Protect and maintain moisture balance AIMS: Debride and prevent infection AIMS: Debride and prevent infection AIMS: Treat local infection and manage exudate AIMS: Manage exudate, pain, odour and bleeding DRESSING TYPES: DRESSING TYPES: DRESSING TYPES: DRESSING TYPES: DRESSING TYPES: DRESSING TYPES: PRIMARY: PRIMARY: PRIMARY: PRIMARY: PRIMARY: PRIMARY: Atrauman, Atrauman, Aquacel Ag+ extra Atrauman ; Odour Control KerraCel Cutimed Gel ; Iodoflex Cutimed Gel, Flaminal Cutimed Sorbact Swab CliniSorb, Medihoney Apinate, Medihoney wound gel, Duoderm extra thin, KerraLite Cool ; Sorbsan, hydro KerraContact Ag, Sorbsan ; Suprasorb, Silflex, Medihoney HCS Suprasorb A Medihoney HCS Flaminal Forte, Kerracel, KerraLite Cool, Medihoney Apinate, Medihoney wound gel Medihoney Apinate, Medihoney wound gel, Flaminal Forte if wet, Flaminal Hydro if dry. Suprasorb, Medihoney Apinate, Medihoney HCS, Medidoney wound gel. Atrauman Ag Povitulle SECONDARY: SECONDARY: SECONDARY: SECONDARY: SECONDARY: SECONDARY: KerraFoam Gentle Border, Aquacel Foam Adhesive Aquacel Foam Adhesive Aquacel Foam Adhesive Aquacel Foam Adhesive, Aquacel Foam Adhesive Duoderm Extra Thin, KerraMax Care, KerraFoam KerraMax Care, KerraFoam Zetuvit plus, KerraMax Care, KerraFoam KerraMax Care, KerraFoam Foam Lite ConvaTec Gentle Border, Zetuvit Plus Gentle Border KerraMax Care - only if very Gentle Border, Gentle Border, Zetuvit plus Foam Lite ConvaTec Zetuvit Plus wet, Duoderm extra thin, CliniSorb Odour Control, Aquacel Adhesive KerraFoam Gentle Border Zetuvit plus

26 Review Date: July 2019 If further information is needed, the Tissue Viability Service can be contacted via single point of access at: TISSUE VIABILITY SERVICE (WANDSWORTH) Battersea studios 80 Silvertorn road Battersea, London SW8 3HE Tel No: TISSUE VIABILITY SERVICE (MERTON BOROUGH) Central London Community Healthcare NHS Trust (CLCH) 13 th Floor, Merton Civic Centre, London Road Morden SM4 DX Tel No:

27 Acknowledgments With special thanks to: ConvaTec Print and production kindly supported by

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