Bolton Foundation Trust Wound Care Formulary. Drugs & Therapeutics Committee Date validated 9 th June 2016

Transcription

1 Bolton Foundation Trust Wound Care Formulary Document type: Wound Care Formulary Version: 2 Author (name): Angela Clough Author (designation): Lead Nurse Tissue Viability Validated by Drugs & Therapeutics Committee Date validated 9 th June 2016 Ratified by: Drugs & Therapeutics Committee Date ratified: 9 th June 2016 Name of responsible committee/individual: Angela Clough Name of Executive Lead (for policies only) Master Document Controller: Angela Clough Date uploaded to intranet: 14 th July 2016 Key words Wound Care Dressings Review date: February 2018 Version control Version Type of Change Date Revisions from previous issues 2 Update 27/4/16 Update of formulary Equality Impact Bolton NHS Foundation Trust strives to ensure equality of opportunity for all service users, local people and the workforce. As an employer and a provider of healthcare Bolton NHS FT aims to ensure that none are placed at a disadvantage as a result of its policies and procedures. This document has therefore been equality impact assessed to ensure fairness and consistency for all those covered by it regardless of their individuality. The results are shown in the Equality Impact Assessment (EIA). 1

2 Contents Page Purpose 3 Prescribing Tips 3 Dressing Formulary List 4 Tissue Viability Nurse Direction 4 Dressing Categories 5 Quick Switch Guide 13 Monitoring 14 Appendices Appendix 1 Equality Impact Assessment Tool Appendix 2 Document Development Checklist Appendix 3 Non Formulary Reporting Form for Wound Care Products Appendix 4 Bolton Nursing Homes Wound Care Prescription Request Form 15 2

3 Purpose 1. Effective wound management requires an understanding of both the healing process and knowledge of the properties of dressings available. This formulary is designed to act as a guide for professionals to aid their clinical decision making in the area of wound care. 2. This formulary is designed to act as a guide for professionals to aid their clinical decision making in the area of wound care. The aim of the formulary is to provide evidence based, cost effective choices in wound management. 3. It should be recognised that a wound will require treating differently at various stages of its healing. No dressing is suitable for all wounds. 4. Practitioners should use their own profession and clinical judgement in individual patient circumstances. 5. This document should be considered for all healthcare professionals who are providing care to patients with wounds. Prescribing Tips 1. Ensure you are familiar with the Wound Care Formulary and prescribe formulary dressings in line with this. 2. If you are a Non-Medical Prescriber (Nurse, Podiatrist, Pharmacist, etc.,) you should only prescribe / request / recommend dressings within your competence (on your P-formulary or in this formulary) in line with guidance set out by your governing body. 3. Prescribe dressings as an acute prescription (one off) and do not routinely add to repeat as dressing requirements (type, size, quantity) can change as wounds heal. 4. Silver, honey or other short term dressings should never be added to repeat. 5. Prescribe a quantity that is clinically required rather than the whole pack for ease of use. The quantity should generally be limited to a 2 week supply. Try to determine how many dressings are being used and the frequency of dressing change in order to prescribe a suitable quantity. 6. All Pharmacies in Bolton can order the exact number of dressings you prescribe always prescribe the exact number you estimate will be required until next review. 7. Prescribe the most appropriate size of dressing. Larger dressings cost more and doubling up with smaller dressings can be wasteful and affect the effectiveness of the healing. 8. Prescribe dressings by brand name 9. Incidents regarding dressings should be reported through your organisations normal processes to ensure that any lessons are learned. This includes wasteful prescribing, inappropriate dressing choice, examples of poor care or other issues that includes wound care that can be used to highlight and improve the care given to people in Bolton. 10. Items that are listed as Tissue Viability Nurse are only be to issued on recommendation of a specialist. As prescribing information will be used to review this formulary you will be required to evidence your use of non-formulary or specialist items. 3

4 Dressing Formulary List Dressing type Formulary position Dressing Non adherent wound contact dressings 1st choice Atrauman 2nd choice N A Ultra Silicone dressing Wound Contact Silflex Dressing Foam dressing 1 st Kliniderm Choice Foam dressing 2 nd Biatain Silicone Foam Choice Absorbent pad with Adhesive Border Formulary choice Softpore Waterproof post op dressing Formulary choice Hydrofilm Plus Absorbent dressing pads 1st choice Xupad 2nd choice Zetuvit Plus Film dressing Formulary choice Hydrofilm Hydrogel (Amorphous) Formulary choice ActivHeal Hydrogel Hydrogel (Sheet) Formulary choice Hydrosorb Hydrocolloids Formulary choice DuoDerm Extra Thin Alginate Formulary options Sorbsan Hydrofibre Formulary choice Aquacel Extra Antimicrobial Silver Atrauman Ag Aquacel Ag+ Extra Iodine Inadine Iodosorb Honey Activon Tube Activon Tulle Algivon Plus DACC Cutimed Sorbact Wound Irrigation solutions Formulary options Sal-E Pod Octenilin Odour Control Formulary choice Clinisorb Foam dressings 1st choice Advazorb Advazorb Silfix Advazorb Border 2nd choice Allevyn Adhesive Skin protection 1st choice Medi Derma-S 2nd choice Proshield Stockinette Formulary Choice Comfifast Retention bandages Formulary Choice K-Band K-Soft K-Lite Compression bandages Formulary Options K-Four K-Two K-Two Reduced Actico Coban 2 Tissue Viability Nurse Direction NPWT Larvae Acticoat Debrisoft AMD Foam Acticoat 7 Drawtex Flaminal Acticoat Flex Promogran Flaminal Forte Kerramax Care Promogran Prisma PICO Urgotul SSD 4

5 Dressing Categories 1. Low Adherent Wound Contact Dressing 1 st Choice - ATRAUMAN 5x5cm 0.27 Non adherent polyester mesh contact layer 7.5 x10cm x 20cm x 30cm 1.72 Primary wound contact layer for a wide variety of wounds, including infected wounds. Effective for up to 7 days 2 nd Choice - NA ULTRA 9.5 x 9.5cm 0.33 A primary wound contact layer consisting of a knitted viscose rayon sheet 9.5 x 19cm 0.63 with a silicone coating. 2. Silicone Dressing SILFLEX Wound Contact Layer 5 x 7cm 1.11 Soft silicone wound contact layer 8x10cm x 15cm x 30cm x 60cm Suitable for use under negative pressure wound therapy Friable/thin skin Patients with excessive pain Primary dressing for some fungating tumours Open abdominal wounds 1 st Choice - Foam Silicone - KLINIDERM FOAM SILICONE 5 x 5cm x 10cm 1.95 KLINIDERM FOAM SILICONE BORDER 7.5 x 7.5cm x10cm x12.5cm x15cm x20cm x20cm 5.00 Soft, conformable absorbent polyurethane foam dressing with a soft silicone wound contact layer and a moisture permeable film backing Can be used on fragile skin 2 nd Choice Foam Silicone BIATAIN SILICONE 7.5 x 7.5cm x 10cm x 12.5cm x 15cm x 17.5cm 5.13 Soft, absorbent polyurethane foam pad with a vapour permeable film backing and a gentle silicone adhesive border Suitable for fragile skin 5

6 3. Simple Absorbent Pad with Adhesive Border SOFTPORE 6 x 7cm x 10cm x 15cm x20cm x 25cm x 30cm x 35cm 0.58 Latex free adhesive dressing The wound pad is covered with a non-adherent layer to help prevent it sticking to the wound Suitable for low to moderate exuding wounds 4. Waterproof Post Op Dressing HYDROFILM PLUS 5 x7.2cm x10cm x15cm x 20cm x 25cm x30cm 0.68 Vapour permeable adhesive film dressing with a high moisture vapout transmission rate. For dry, non infected wounds. Can be used as a secondary dressing 5. Absorbent Dressing pad 1 st Choice - XUPAD 10x10cm x 20cm x 20cm 0.28 Latex free, ultra absorbent dressing pad 20x 40cm nd Choice ZETUVIT PLUS 10x 10cm 0.63 Superabsorbent dressing that contains a blend of cellulose fluff and fluid 10x20cm 0.87 retaining superabsorbent particles. 15x20cm 1.00 Water repellent, air permeable, non woven layer protects against 20x25cm 1.37 contamination 20x40cm 2.11 Soft consistency for a cushioning effect 6. Film Dressing HYDROFILM 6 x 7cm x 12.5cm x 15cm 0.52 Vapour permeable adhesive film dressing with a high moisture vapour transmission rate 6

7 10X25cm 0.81 Suitable for lightly exuding wounds 12x25cm 0.86 Sterile thin, waterproof, self-adhesive film 15x20cm 0.96 Suitable as a protective primary dressing or a secondary 20x30cm 1.60 dressing/fixation Some patients may be allergic to the adhesive 7. Hydrogel Amorphous Hydrogel - ACTIVHEAL 8g 15g Clear amorphous hydrogel Suitable for wound debridement in light to medium exuding wounds Dressing allows either the release of water to rehydrate surrounding tissues or the absorption of exudate from the wound Requires a secondary dressing which will encourage occlusion (e.g. film or adhesive dressing) Hydrogel Sheet - HYDROSORB 5 x 7.5cm x10cm x20cm 6.71 Comprises of 60% water Immediately donates moisture to debride necrosis and promote granulation 8. Hydrocolloid DUODERM EXTRA THIN 5 x 10cm x7.5cm x10cm x 15cm x 25cm x 15cm 2.85 Sterile, thin hydrocolloid dressing. The adhesive layer contains elastomeric polymers which enhance the dressings ability to contain wound exudate by forming a cohesive gel. Suitable for dry to lightly exuding wounds. May be used as a secondary dressing 9. Alginate SORBSAN FLAT 5x5cm 10x10cm Absorbent dressing of calcium alginate fibres Swells and gels in contact with exudate. Has haemostatic properties 10x20cm 3.20 Management of non-infected moderately to heavily exudating wounds. Do not use for packing wounds with a narrow blind end 7

8 10. Hydrofibre AQUACEL EXTRA Size Costs Information 5x5cm x10cm x15cm x45cm ribbon 1.83 Soft,sterile non woven pad or ribbon dressing composed of Hydrofibre (sodium carboxymethylcellulose). Absorbs wound fluid and transforms to a soft gel. Suitable for medium/heavy exuding wounds. 2x45cm ribbon 2.45 When packing a narrow blind ended sinus MUST use Aquacel and ENSURE ALL DRESSING IS REMOVED. 11. Antimicrobial Silver Wound Contact Layer ATRAUMAN AG 5 x 5cm 0.51 Non adherent polyamide textile wound contact layer. 10 x10cm x 20cm 2.45 Impregnated with neutral triglycerides coated with metallic silver Effective for up to 7 days Silver Hydrofibre AQUACEL AG+ EXTRA Size Costs Information 5x5cm 1.95 Hydrofibre impregnated with 1.2% ionic silver. Forms a coherent soft 10x10cm x15cm 8.75 Ribbon 1x45cm x45cm 4.67 gel on contact with exudate. Recommended only to be used where there is infection or an increased risk of infection Not to be used on individuals who have had an allergic reaction to silver or sodium carboxymethylcellulose Iodine Wound Contact Layer - INADINE 5 x 5cm x 9.5cm 0.49 Non adherent dressing impregnated with 10% povidone-iodine. Colour change indicates when to change dressing Not to be used where known hypersensitivity to iodine, if the patient is being treated for kidney problems, is pregnant or breastfeeding 8

9 Cadexomar Iodine - IODOSORB 10g 4.51 Cadexomer powder or ointment with iodone. For treatment of chronic exuding wounds. 20g 9.03 Should not be used on dry necrotic tissue or on patiens with known sensitivity to iodine. 3g powder 1.93 Do not use on children, pregnant or lactating women, people with thyroid disorders or renal impairment. Honey ACTIVON TUBE 25g tube % Medical grade Manuka honey Used to debride / deslough wounds and eliminate odour Suitable for use on infected wounds Suitable for use in cavities, can be washed out with Normal Saline Should not be used if the patient has a bee venom allergy There may be initial discomfort on application Blood sugar levels should be monitored in patients with diabetes Honey Tulle ACTIVON TULLE 5x5cm 10x10cm Knitted viscose mesh impregnated with 100% Manuka honey Used to debride / deslough shallow wounds and eliminate odour Suitable for use on infected wounds Should not be used if the patient has a bee venom allergy There may be initial discomfort on application Blood sugar levels should be monitored in patients with diabetes Honey Alginate ALGIVON PLUS 5x5cm x10cm 3.36 Alginate dressing impregnated with 100% Manuka honey Used to debride / deslough cavity wounds and eliminate odour Suitable for use on infected wounds Should not be used if the patient has a bee venom allergy There may be initial discomfort on application Blood sugar levels should be monitored in patients with diabetes 9

10 Bacteria Binding Dressing CUTIMED SORBACT Ribbon 2x50cm x200cm 7.87 Swab 3cm round x6cm x9cm 2.72 Hydrophobic, antimicrobial ribbon designed to bind bacteria and fungi under moist wound conditions - coated with DACC (Dialkycarbamoyl chloride) Dressing of deep wounds such as fistulae/abscess and ulcers. Can also be used to treat fungal infections 12. Odour Absorbent CLINISORB 10x10cm x20cm x25cm 4.05 Sterile activated charcoal cloth Exudate will reduce dressing effectiveness Can be cut to size 13. Foam Dressing 1 st Choice - ADVAZORB 7.5x7.5cm x10cm x12.5cm x15cm x20cm x20cm 3.75 ADVAZORB SILFIX 7.5x7.5cm x10cm x12.5cm x15cm x20cm x20cm 4.48 ADVAZORB BORDER 7.5x7.5cm x10cm x12.5cm x15cm 3.15 Hydrophilic foam dressing with film backing Low to highly exuding wounds Non bordered dressing Hydrophilic foam dressing with soft silicone wound contact layer Low to highly exuding wounds on patients with fragile skin Non bordered dressing Hydrophilic foam dressing with soft silicone wound contact layer and border Low to highly exuding wounds on patients with fragile skin No need for secondary dressing 10

11 10x20cm x20cm x30cm nd Choice - ALLEVYN ADHESIVE 7.5x7.5cm x10cm x12.5cm x17.5cm x22.5cm x17cm (sacral) 3.96 Polyurethane Foam adhesive dressing Low to highly exuding wounds Not to be used on patients with fragile skin 14. Wound Irrigation Solutions Wound Irrigation solutions Information Sal-E Pods (25x20ml) Sodium Chloride 0.9% wound irrigation surfactant solution Irrigation/cleansing of wounds being dressed using an aseptic technique. For irrigating ulcers or wounds, tap water is often appropriate Octenilin Wound irrigation solution 350ml 4.60 Information Wound irrigation solution containing a combination of octenidine and ethylhexyglycerin. Ethylhexyglycerin reduces surface tension and moistens the skin, loosening biofilms, devitalised tissue and wound crusts Octenidine prevents bacteria and fungi growing in the solution and wound dressing 15. Skin Protectants 1 st Choice MEDI DERMA-S Information 28g tube Cream g tube Cream 5.95 Barrier Cream for protection of skin against moisture 20 x 20g sachets Cream x 1ml Film foam 3.70 applicator Non Sting Barrier Film to protect skin against moisture and 5 x 3ml Film foam adhesives applicator Can be used on broken skin 30ml Film spray

12 2 nd Choice PROSHIELD PLUS Information Foam & spray cleanser For use on moisture associated skin damage when 1 st line ml treatment has not been successful. Can be used as 1 st line if patients initially present with severe Proshield Plus 115g 9.84 moisture damage or if advised by TVN 16. Tubular Stockinette TUBITON Size 78 DT Information Surgical stockinette made from 100% unbleached cotton To be applied under wool bandage for patient comfort Not on FP10 COMFIFAST Red line 3.5cm x 1m Green line 5cm x 1m Green line 5cm x 5m Blue line 7.5cm x 1m Blue line 7.5cm x 5m Yellow line 10.75cm x 1m Yellow line 10.75cm x 5m Beige line 17.5cm x 1m Information 0.56 Suitable for infant limb 0.58 Suitable for small child limb Suitable for small limb dressing retention Suitable for large limb dressing retention Suitable for very large limb / trunk dressing retention 17. Retention Bandages K-BAND Simple Retention 5cm x 4m cm x 4m cm x 4m 0.50 Information Simple, conforming retention bandage Used to secure devices e.g. cannula K-SOFT Wadding 10cmx3.5m 0.45 Information Latex free, sub bandage wadding Used to protect bony prominences under bandaging, and to reshape the limb in compression bandaging K-LITE - Support Information 10cmx4.5m 1.00 Latex free light support bandage 18. Compression Bandages Multi layer Compression Information K-soft 10cmx3.5m 0.45 Multi-layer compression bandage system for the treatment of venous K-lite 10cmx4.5m 1.00 and mixed aetiology leg ulcers 12

13 K plus 10cmx8.7m 2.27 Can be ordered as individual components Ko-flex 10cmx6m 3.01 K-TWO 18-25cm (10cm) cm (12cm) cm (10cm) cm (12cm) Information 2-layer compression system composite wadding & short-stretch bandage provides an average compression of 40mmHg K-TWO REDUCED Information 18-25cm layer compression system composite wadding & short-stretch 25-32cm 8.84 bandage provides an average compression of 20mmHg ACTICO 4cm x 6m cm x 6m cm x 6m cm x 6m cm x 6m 4.26 Information Two-layer compression bandage system, padding & cohesive, inelastic (short-stretch) bandage Quick Switch Guide See table below for guidance on changes from previous formulary Dressing type Formulary position Dressing to choose from formulary Products you might be using at the moment Non adherent wound First choice Atrauman contact dressings Second choice N A Ultra Silicone dressing Wound contact Silflex Mepitel dressing Foam dressing Kliniderm Foam Mepilex Foam dressing Biatain Silicone Absorbent post-op dressing Formulary choice Softpore Mepore Waterproof post-op Tegaderm Formulary choice Hydrofilm Plus dressing pad film&pad Absorbent dressing pads First choice Xupad Zetuvit Second choice Zetuvit Plus Mesorb/Ecypse Film dressing Formulary choice Hydrofilm Tegaderm film Hydrogel Amorphous ActivHeal Hydrogel Intrasite gel Sheet Hydrosorb Actiform Cool Hydrocolloids Formulary options DuoDerm Extra Thin Granuflex/Comfeel Alginate Formulary options Sorbsan Kaltostat Hydrofibre Formulary choice Aquacel Extra Acticoat Antimicrobial Silver Atrauman Ag flex3/urgotul silver/ssd Aquacel Ag + Extra Silvercel Iodine Inadine 13

14 Foam dressings Honey DACC 1 st choice Iodosorb Activon Tube Activon Tulle Algivon Plus Cutimed Sorbact Advazorb Advazorb Silfix Advazorb Border 2 nd choice Allevyn Adhesive Medihoney Wound Gel Medihoney Tulle Allevyn Allevyn Gentle Odour control Formulary choice Clinisorb Carboflex Cavilon durable Skin protection 1 st Choice Medi Derm-S barrier cream/cavilon no sting barrier film 2 nd choice Proshield Wound Irrigation Solution Formulary Options Sal-E Pods Irriclens Octenilin Tubular Stockinette Formulary Choice Comfifast K-Band Retention Bandages Compression bandages Formulary Choice Formulary options K-Soft K-Lite K-Four System K-Two K-Two Reduced Actico Profore Monitoring Compliance 19. This should be a short section on how compliance with the document will be monitored. A table like the one below or narrative can be used. Area to be monitored Methodology Who Reported to Frequency Formulary compliance Review of epact data monthly to determine compliance Divisions Medicines Management Tissue Viability Divisions Monthly 14

15 Appendices Appendix 1 Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Yes/No Comments 1. Does the document/guidance affect one group less or more favourably than another on the basis of: Race No Ethnic origins (including gypsies and travellers) No Nationality No Gender (including gender reassignment) No Culture No Religion or belief No Sexual orientation No Age No Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are there any valid exceptions, legal and/or justifiable? 4. Is the impact of the document/guidance likely to be negative? No No N/A No 5. If so, can the impact be avoided? N/A 6. What alternative is there to achieving the document/guidance without the impact? 7. Can we reduce the impact by taking different action? N/A N/A If you have identified a potential discriminatory impact of this procedural document, please refer it to the Equality and Diversity Co-ordinator together with any suggestions as to the action required to avoid/reduce this impact. 15

16 Appendix 2 Document Development Checklist Type of document Lead author: Is this new or does it replace an existing document? What is the rationale/ Primary purpose for the document What evidence/standard is the document based on? Is this document being used anywhere else, locally or nationally? Who will use the document? Wound Formulary Angela Clough Replacement To guide community nursing staff on cost effective dressing choices Case studies, knowledge of products, table top review of products No Community Nursing and Podiatry services Is a pilot run of the document required? (optional) Has an evaluation taken place? What are the results? (optional) What is the implementation and dissemination plan? (How will this be shared?) How will the document be reviewed? (When, how and who will be responsible?) Are there any service implications? (How will any change to services be met? Resource implications?) Keywords (Include keywords for the document controller to include to assist searching for the policy on the Intranet) Staff/stakeholders consulted Any document that gives an instruction to prescribe or administer a medicine should have that instruction reviewed by the senior divisional pharmacist before it goes for ratification. EIA No No Uploaded to intranet. Cascaded via management structure in community Ongoing review No Wound Care Dressings Community Nurses, TVNs Signature of pharmacist: Signed and dated By validator... 16

17 By ratifying officer... Appendix 3 Non-Formulary Reporting Form for Wound Care Products PATIENT INITIALS DATE OF PRESCRIPTION PATIENT PRACTICE NAME OF PRESCRIBER SIGNATURE OF PRESCRIBER BASE Type of wound bed (%) Type of wound Exudate levels Epithelialising Primary intention Mild Granulating Secondary intention Sloughy Leg ulcer Moderate Necrotic Foot ulcer Pressure ulcer Heavy Fungating Critically colonised Infected Formulary Dressing Choice Non-formulary Dressing Choice Date Commenced (if applicable) Date Commenced Please state your reasons for not prescribing from the Woundcare Formulary WOULD LIKE THE PRODUCT TO BE CONSIDERED FOR THE NEXT FORMULARY REVIEW? YES/NO (Please Comment) Please use this form when initiating all non-formulary wound care products and then forward by to: tissueviabilityservice@boltonft.nhs.uk 17

18 Appendix 4 Bolton Nursing Homes Wound care prescription request Dear Dr (enter GP name here) please can we have a prescription for the following patient: Name DoB Nursing Home: Requested by Date: Contact phone number Site being dressed Please note none of these dressings should be put on regular repeats all will be ordered as acute items Dressing type Dressing Sizes Non adherent wound Atrauman 5x5, 7.5x10, 10x20, 20x30 contact dressings N A Ultra 9.5 x 9.5, 9.5 x19 Silflex 5 x7, 8x10, 12x15, 20x30, 35x60 Kliniderm Foam 5 x 5, 10 x 10 Silicone dressing Kliniderm Foam Silicone Border 7.5x7.5, 10x10, 12.5x12.5, 15x15, 10x23, 15x20 Biatain Silicone 7.5x7.5, 10x10, 12.5x12.5, 15x15, 17.5x17.5 Absorbent post-op dressing Softpore 6x7, 10x10, 10x15, 10x20, 10x25, 10x30, 10x35 Waterproof post-op 5 x7.2, 9 x10, 9 x15, Hydrofilm Plus dressing pad 10 x20, 10x25, 10x30 Absorbent dressing pads Xupad 10x10, 10x20, 20x20, 20x40 Zetuvit Plus 10x10, 10x20, 15x20, 20x25, 20x40 Film dressing Hydrofilm 6x7, 10x12.5, 10x15, 10x25, 12x25, 15x20, 20x30 Hydrogel Activheal hydrogel 8grams, 15grams Hydrosorb 5x7.5, 10x10, 20x20 Hydrocolloids DuoDerm Extra Thin 7.5x7.5, 10x10, 15x15, 5x10, 9x15, 9x25, 9x35 Alginate Sorbsan 5x5, 10x10, 10x20 Hydrofibre Aquacel Extra 5x5cm, 10x10cm, 15x15cm, 1x45, 2x45 Atrauman Ag 5x5, 10x10, 10x20 Inadine 5x5, 9.5x9.5 4x6, 7x9, Cutimed Sorbact Antimicrobial ribbon- 2x50, ribbon -5x200 Iodosorb 3grams, 10 grams Aquacel Ag + Extra 5x5, 10x10, 15x15, 4x10, 4x20, 4x30, 20x30, ribbon -1x45 or 2x45 Activon Tube 25grams Antibacterial Activon Tulle 5x5, 10x10 Algivon Plus 5x5, 10x10 Advazorb 7.5x7.5, 10x10, 12.5x12.5, 15x15, 10x20, 20x20 Foam dressings Advazorb Silfix 7.5x7.5, 10x10, 12.5x12.5, 15x15, 10x20, 20x20 Advazorb Border 7.5x7.5, 10x10, 12.5x12.5, 15x15, 10x20, 20x20 Allevyn Adhesive 7.5x7.5, 10x10, 12.5x12.5, 17.5x17.5, 22.5x22.5, 17x17(sacral) Odour control Clinisorb 10x10, 19x20, 19x25 Skin protection Medi Derma S 1ml, 3ml, 30ml, 28g 90g Proshield 235ml, 115g Wound Irrigation Solutions Octenilin Sal-E Pods Quantity 18