worcestershire nhs wound management formulary - south
TRANSCRIPT
Worcestershire NHS Wound
Management Formulary
September 2011
Approved by Area Prescribing Committee August 2011
Valid until May 2014
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Contents Page
Introduction 6 - 8
Members of the Worcestershire Wound Management Group
9
Members of the Worcestershire County Tissue Viability Group
10 - 12
General principles of good wound care 13
Selecting anti-microbial dressing 13 - 15
Pain Assessment 15 - 16
Documentation 16
Choice of dressings 16 - 17
Advice for working with the pharmaceutical industry and the introduction of new products to the Formulary
17
New Products 17 – 19
Exudate Management 20
Use of Absorbent pads 21 - 22
Gauze 23
Dressing packs
23
Tapes 24
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Saline 25
Silicone based adhesive remover 25 - 26
Cleansing wipes 26
Absorbent dressings 27 - 29
Protective dressings 30 - 31
Shower proof dressings 32
Film dressings 33 - 34
Non-adherent dressings 35 - 36
Alginates 37 - 40
Hydrofibre 41
Charcoal 42
Film + IV dressings 43
Foam 44 - 50
Antimicrobials 51
Honey 51 - 54
Iodine 55 - 58
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Silver 59 – 62
Bio Cellulose 63
Hydrocolloid 64 - 65
Hydrogel 66 - 68
Larvae 69
Lipidocolloid 70
Scar Management 71
Podiatry Use 72
Limited Use 73 - 74
Wound Drainage Bags 75
Hosiery and application 76 - 82
Bandage Protector 82
Footwear 83
Bandages 84 - 92
Chronic Oedema/Lymphoedema 93
Actilymph 94 - 95
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Cream 96 - 98
Over-granulation 98
Metronidazole Gel 99
Barrier Film 100
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Introduction Welcome to the Worcestershire NHS Wound Management Formulary for 2011 - 2014 which we hope you find is a helpful resource in your everyday practice. It is important that within the NHS we are able to justify our clinical decisions and expenditure on wound management products. In Worcestershire we currently spend over £2.5 million annually on dressings, bandages and tapes. This Wound Management Formulary has the explicit aims of:
• Promoting evidence based practice by providing a framework within which it is safe to practice
• Promoting continuity of care • Promoting rational prescribing • Supporting the practical application of nurse prescribing • Encouraging safe, effective and appropriate use of dressings • Promoting cost effectiveness.
Dressings in this Formulary are for general use, with the exception of those indicated for specialist prescribing. In addition, specialists may continue to recommend or use products that are not included within this formulary, based on individual clinical need. As with some other areas of clinical practice it is hard to find evidence from well controlled, randomised trials evaluating the clinical and cost effectiveness of dressings. Prescribing outside this formulary must be justified by specific patient need. Prescribing will be monitored by the Wound Management Formulary Group, the NHS Medicines Management Team, the Worcestershire Health & Care NHS Trust Medicine Management team and the Worcestershire Acute Trust.
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Evidence within the last year has raised questions regarding the use of anti-microbial dressings, in particular silver. Preventing and treating infection has become a key area in clinical practice and a significant spend for health care. Determining the difference between the infected and non-infected wound as well as the critically colonised (host reaction, but swab may be normal and therefore anti-microbials are recommended) and the colonised wound (no host reaction and anti-microbial are not needed) can be challenging. Further information may be found in the European Wound Management Association “Identifying wound Infection” 2005 document on www.ewma.org and the Best practice statement on the use of topical antiseptic/antimicrobial agents in wound management. http://www.wounds-uk.com/pdf/content_9627.pdf New evidence is reviewed annually and dressings that could be beneficial in practice are evaluated by Worcestershire Acute staff and PCT staff following clinical governance approval with the results determining the addition of new dressings to the Formulary. We plan to update the formulary every 3 years, and welcome comments and suggestions for improvement. The Formulary will be held on all Trust websites including a power-point presentation. Education and training is offered across Worcestershire in relation to all aspects of Tissue Viability including selection of wound dressings and can be booked via Jayne Allchurch: [email protected] or 01299 879453. If you wish to arrange an update in your own area please contact Jackie Stephen-Haynes: [email protected] or 07775 792775.
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Acute Trust education please contact Elaine Bethall on [email protected] or 01905 763333 ext. 33177
For education in Care Homes this can be booked via Jayne Allchurch: [email protected] or 01299 879453 or Rosie Callaghan [email protected] or 07717 543046 Alan Pollard, Chief Pharmacist, 01527 507085 Prices quoted in this booklet are NHS Price taken from NHS Logistics Authority catalogue April 2011 and Drug tariff (on prescription) May 2011 Jackie Stephen Haynes Visiting Professor and Consultant Nurse in Tissue Viability Elaine Bethell Lead Tissue Viability Nurse Drug tariff - available on prescription. NHS Price - available from NHS Logistics. This document should be referred to as: Stephen-Haynes, J. et al (2011) Worcestershire Health & Care NHS Trust Wound Management Formulary. www.hacw.nhs.uk.
This booklet may be photocopied freely. An on-
line version is available at: www.worcestershire.nhs.uk/tissueviability
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Members of the Worcestershire Wound Management Group
Jackie Stephen-Haynes, Professor, Birmingham 07775 792775 City University & Consultant Nurse Elaine Bethell, Tissue Viability Lead, Worcs. 01905 763333 Acute Hospitals NHS Trust Ext. 33177 Louise Morris, Senior Tissue Viability Nurse 01905 763333 Worcs. Acute Hospitals NHS Trust Ext. 33177 Rosie Callaghan, Tissue Viability Nurse, 07717 543046 Nursing Homes. Judith Belcher, Tissue Viability Nurse, 01905 763333 Worcs. Acute Hospitals NHS Trust Ext. 33177 Alan Pollard Chief Pharmacist for Community Care 01527 507085 Eileen Vermeulen, Lymphoedema 01386 502030 Specialist Nurse Julie Day, Leg Ulcer Specialist Nurse 01905 763333
Ext 30260 Wendy Hayes, Consultant Vascular Nurse 01905 763333 Ext 39301 Elizabeth Nutland, Staff Nurse, Witley Ward, 01562 826346 Kidderminster Hospital Carole Clive, Nurse Consultant, Infection, 01386 502552 Prevention and Control Judy Irving, Project Manager Efficiency Savings 01905 733901
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Members of the Worcestershire County
Tissue Viability Team Jackie Stephen-Haynes, Consultant Nurse & Professor, Birmingham City University 07775 792775 Rosie Callaghan, Tissue Viability Nurse Nursing Homes
07717 543046
Michelle Allen, Staff Nurse, Pershore 01386 502071
Dani Atkinson, Community Staff Nurse, Abbottswood Medical Centre, Pershore
01386 551444
Judy Belcher, Tissue Viability Nurse, Acute Trust Carol Bennett, Community Staff Nurse, Riverside Surgery, Evesham Andrea Carroll, District Nurse Team Leader Hagley
01905 763333 Ext 33177 01386 40121 01562 777269
Amanda Cassell, Community Staff Nurse, Prospect View Health Centre, Malvern Amanda Cimarosti, Manager, Bromsgrove Leg Ulcer Clinic Claire Clayton, Wound Care Nurse, Worcs. Acute NHS Trust Lyn Cox, Practice Nurse, Churchfields Surgery, Bromsgrove Dee Davies, District Nurse, Knightwick Medical Practice Sarah Degville, Practice Nurse, Riverside Surgery Lynn Dodd, Ward Sister, Wyre Forest Community Unit Trisha Futers, Staff Nurse, Evesham Hospital Alison Glover, District Nurse Team Leader, The Dow Surgery, Redditch
01684 612679 01527 488235 01527 503020 Ext. 44749 01527 872163 01886 822103 01386 444400 01562 826333 01386 502439 01527 488677
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Linda Green, Community Staff Nurse, Church Street Surgery, Kidderminster Kathryn Greenwood, Lead Nurse, Evesham Hospital Linda Harries, District Nurse/Practice Educator Albany House Surgery, Worcester Jane Hipwell, DN Team Manager, Crossgate House, Redditch Pippa Humble, Team Leader, Winyates Health Centre, Redditch Jayne Humphries, District Nurse, Team 5 POWCH, Bromsgrove Mary James, Team Leader, Elbury Moor Medical Centre, Worcester Sue Jones, Community Staff Nurse, Shrubbery Avenue
01562 822051 01386 502502 Bleep 326 01905 23949 01527 507053 01527 513886 01527 488136 01905 724061 01905 681613
Charlotte Jordon, Team Leader, Broadway Surgery Debbie Keelor, Ward Manager, Malvern Community Hospital
01386 854897 01684 612634
Ann Lofthouse, District Nurse Team Leader Catshill Clinic, Bromsgrove
01527 488337
Monique Maries, Nurse Advisor for older people Crossgates House, Redditch Claire Mason, Community Staff Nurse, Bewdley Medical Centre & Forest Glades Surgery Jola Merrick, Clinical Nurse Manager, Herons Park Nursing Home Denise Moore, District Nurse Team Leader Ombersley Medical Centre Julie Money, Community Staff Nurse Elbury Moor Medical Centre, Worcester
07857 889431 01299 402157 01562 822509 01562 825814 01905 620631 01905 724061
Deva Mooten, Clent Ward, POWCH Lorraine Newton, Community Staff Nurse Stourport Health Centre
01527 488095 01299 828486
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Rachel Nicholls, Community Staff Nurse Haresfield House Surgery Elizabeth Nutland, Staff Nurse, Witley Ward Mental Health, The Robertson Centre
08454502868 01562 826346
Claire Peacock, RGN Tenbury Community Hospital Julie Reece, District Nurse Team Leader Salters Medical Practice, Droitwich
01584 810643 01905 681031
Nicola Ross, District Nurse Team Leader Rubery Surgery Juliet Shaw, District Nurse, Stourport Health Centre
0121453 5034 01299 828486
Geraldine Stanton, District Nurse Team Leader Crossgates House, Redditch
01527 507098
Cheryl Tilt Sister, Lickey Ward, POWCH 01527 488090 Eileen Vermeulen, Lymphoedema Specialist Nurse, Pershore Gill Wills, Community Staff Nurse, Aylmer Lodge Surgery Sarah Winfield, Community Staff Nurse, Pershore Medical Centre
01386 502030 01562 822015 01386 502015
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General principles of good wound care assessment The key to successful wound management is the careful and accurate holistic assessment of the patient. The Worcestershire Wound Management guideline can be accessed at http://www.hacw.nhs.uk/default.aspx?pid=128 or via
www.hacw.nhs.uk.
Worcestershire Acute Hospital Trust Tissue Viability
Intranet Page: Go into WHAT Intranet home page, under
the Main Links, click onto Clinical Departments and then
Click onto Essence of Care. In the middle of the screen
there will appear a list of benchmarks, Click onto Pressure
Ulcers. You will now be on the Tissue Viability home
page, where you can access relevant links.
Selecting anti-microbial dressings The identification of infection and the selection of anti-microbials is a significant challenge within practice and the Worcestershire Acute and Primary Care identification and management of infected wounds guideline can be accessed http://www.hacw.nhs.uk/default.aspx?pid=128 or via www.hacw.nhs.uk.
Worcestershire Acute Hospital Trust Tissue Viability
Intranet Page: Go into WHAT Intranet home page, under
the Main Links, click onto Clinical Departments and then
Click onto Essence of Care. In the middle of the screen
there will appear a list of benchmarks, Click onto Pressure
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Ulcers. You will now be on the Tissue Viability home
page, where you can access relevant links.
The Lead Infection Control Nurse for Worcestershire Acute Heather Gentry 01527 503030 ext 44744 and non acute NHS Infection Control Service, Evesham Community Hospital, Waterside, Evesham, Worcestershire Tel 01386 502552 or 07798 608171 has developed the following guidance:
• Prevention of wound infection is a primary management objective for all healthcare practitioners
• Management of wound infections must always include an emphasis on reducing the risk of cross infection
• It is always important to be vigilant for signs and symptoms of infection and treat accordingly e.g.
• Following surgery or if a specific risk factor for susceptibility to infection is identified etc.
• Leg Ulcers are known to be colonised with skin bacteria, infection is a clinical diagnosis based on the presence of clinical signs and symptoms
• Wound swabs should only be taken when clinical signs and symptoms of infection are present
• Antimicrobial wound management products should be considered for use in critically colonised and infected wounds as clinically appropriate
Antibiotics are only indicated when there are clinical signs and symptoms of infection
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• Antibiotics should be selected on the basis of likely organisms present and/or sensitivities : see Intranet for “skin and soft issue infection in Primary Care”
• Consultant Microbiologists are available to discuss antibiotic prescribing, they can be accessed through switchboards at either Worcestershire Royal Hospital or the Alexandra Hospital Redditch
• Patients should be assessed holistically particularly considering underlying illnesses, immune status including anaemia, diabetes, nutrition, pressure reduction, steroid usage and other contributory risk factors.
Pain assessment
Another essential area to consider is the important issue of pain assessment. A systematic and rational approach to the assessment and management of pain is essential and is a specific role of the clinician that should be documented as with other aspects of the assessment (NMC 2008). Hollinworth (2005) offers a practical template for assessment of procedural and proposes several interventions to reduce pain including:
• The use of warm cleansing solutions
• Careful removal of dressings
• The use of “time out”
• The use of atraumatic dressings including reducing dressing changes as appropriate. The correct application of bandages
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The clinician should always seek to assess and address the issue of pain as this can have a major influence on patient concordance and ultimately, healing. For further Information see www.worldwidewounds.com. Documentation Information should be documented in a reliable, valid and consistent manner to ensure continuity of care. Assessment and re-assessment should be documented as outlined in the Worcestershire Health & Care NHS Trust/ Acute Trust Wound Management guideline and can be accessed on http://www.hacw.nhs.uk/default.aspx?pid=128 or via www.hacw.nhs.uk
Choice of dressings The properties of dressings differ; there is no one product which is suitable for all wound types, or all the different stages of healing. A flexible approach to the selection of wound care is required, in order to optimise the healing process. Evaluation of the dressing and wound status should be made at every dressing change in order to guide choice of product. Remember that it is possible for any dressing to cause sensitisation of the wound. Information on individual products is given within the Formulary section of this booklet. Further information is available in the BNF www.bnf.org. Data sheets may be found on www.medicines.org.uk www.logistics.nhs.uk www.smtl.co.uk/world-wide-wounds
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Advice for Working with the Pharmaceutical industry and the introduction of new products to the Formulary
Staff are not authorised to arrange meetings with pharmaceutical company representatives unless to discuss specific issues around the use of Formulary items. Samples of dressings not on the Formulary must not be accepted. Any meetings that take place should be with groups of staff rather than individual teams. A member of the County Team should be present and the names of the staff attending recorded. Sponsorship for meetings is not allowed within individual teams. Formal education and conferences as arranged by Worcestershire Tissue Viability department may receive sponsorship and will be recorded in the Tissue Viability charity account. At any educational event the sponsors will be recorded and only Worcestershire Wound Management Formulary products will be promoted. New Products New products will be considered by the Worcestershire Acute and Health and Care NHS Trust Wound Management Formulary Group and the County Tissue Viability Team and all company representatives should be directed to the Consultant Nurse in Primary Care and the Lead Nurse for Tissue Viability in WAHNHST. A form must be completed by any manufacturer which will allow for distribution across the Wound Management Group and the process for considering new products will
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be followed. If in any doubt please contact your Directorate Lead or the Head of Medicine Management.
The County Tissue Viability Team has representation from all areas of the County. The Formulary includes dressings that are currently used successfully within the County, and prescribing outside this Formulary must be justified by specific patient need. New evidence will be reviewed frequently and dressings that might be beneficial will be evaluated in clinical practice by members of the Worcestershire County Tissue Viability Team. We believe that dressings should be chosen because of the weight of supporting evidence rather than the weight of the manufacturer’s promotional effort. We plan to update this Formulary every 3 years, and all members of the Team welcome comments and suggestions for improvement. Order and prescribe by number of dressing and NOT by box but be precise e.g. 6 x dressings NOT 6 x OP NOT 6 x original pack NOT 6 x boxes Please note when ordering the prices refer to
DT Price NHS Price Prescription/ FP10 Logistics
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New products added in 2011
Page No. Actibalm 52
Allevyn Gentle Lite 48
Appeel sterile 26
Aquacel Ag 60
Dry Max Extra 28-29
Flivasorb 29
Juxta fit 93
K Band 84
Mediven 80
Mepitac & Mepitel 24-25
Softpore
30
Sorbaderm 100 Suprasorb X 63 Suprasorb X + PHMB 63
Zetuvit E 27
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Exudate management Wound exudate poses clinicians a significant challenge. It is often perceived as detrimental but exudate assists healing (WUWHS 2007) by:
• Preventing the wound from drying out (desiccation).
• Aiding the migration of tissue repairing cells
• providing the essential nutrients for cell metabolism
• Enabling the diffusion of immune and growth factors
• Assisting the separation of dead or damaged tissue- autolysis.
It is important to consider the cause of the exudate as this is a significant indicator of how to manage it i.e. if it is caused by oedema or infection then this needs to be assessed and managed. Exudate is a problem when:
• The wound fluid strikes through necessitating frequent dressing changes
• Peri-wound changes occur such as maceration, skin stripping
• Delayed healing
• Discomfort or pain
• Fluid & electrolyte imbalance due to protein loss
The principles of effective exudate management are:
• Assess local, systemic, psycho-social & wound related factors and treat the underlying cause
• Optimise wound bed by maintaining appropriate moisture
• Prevent and treat exudates related problems
• Step up/down approach
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Use of sterile/ Non sterile absorbent pads
• Sterile pads should be used as a temporary measure and a full assessment undertaken and appropriate care commenced.
• Sterile pads may be used but not directly next to wounds. This should be over a low adherent contact dressing
• Pads should not be used under compression. Wadding specifically designed for under compression bandaging should be used
• Patients with wet legs but no wounds should be assessed for the cause and if the skin is intact then non-sterile pads may be used
• Patients with wet legs and wounds - again assess the cause but use sterile pads or use wadding over sterile dressing.
• Anybody with an infection, high risk of infection or immuno-compromised should have a sterile pad.
• Non sterile may be used over dressings that are secured with a good seal but where leakage may occur. Again if the patient is at significant risk of infection a sterile dressing should be used.
A step up step down approach should be used when using absorbent dressings Below indicates the price range for a 10 cm x 10 cm product:
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Zetuvit Non sterile
10 x 10 cm 6p
Zetuvit Sterile
10 x 10 cm
20p
Mesorb 10 x 10 cm 59p Dry Max Extra
10 x 10 cm
£1.80
Flivasorb 10 x 10 cm £2.12
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FORMULARY LISTED ITEMS
Gauze Swab Product Topper 8
Gauze swab Sizes & Prices
DT Price NHS Price 7.5 x 7.5 (packs of 5) Sterile
38p Not listed
Non- sterile 10 cm x 10 cm x 100
£1.31 Not listed
Use General purpose swabbing and cleaning. Avoid Consider cost of gauze and gloves. A
dressing pack may be cheaper overall. Application Do not apply gauze to the wound Tips Consider cost of separate gloves. Dressing packs Product Dressit & Softdrape
Dressing pack Sizes & Prices
DT
Price NHS Price
Dressit - FP10 Dressing pack with Gloves (Latex free)
60p N/A
Softdrape - Community Dressing pack with Gloves (Latex free)
N/A £7.76 for 20
Use General purpose swabbing and cleaning. Avoid Avoid using dressing pack when Topper 8
gauze could be used Application Do not apply gauze to the wound Tips Consider cost of separate gloves.
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Tapes Product Scanpor /Leukopor/Micropore
Sizes &
Prices
DT Price NHS Price
Scanpor 1.25 cm 40p
N/A 2.5 cm 65p 5 cm £1.12
Leukopor 1.25 cm 46p
N/A 2.5 cm 72p 5 cm £1.26
Micropore 1.25 cm N/A 25p
2.5 cm N/A 48p
5 cm N/A 96p Use Securing dressings. Skin closure for small
incisions. Retaining dressings. Avoid Can cause irritant and allergic reactions. Application May be applied directly on to the skin
Tips Do not apply under tension Product Mepitac/Mepitel
Sizes & Prices
DT Price NHS Price Soft silicone fixation tape 2 cm x 300 cm
£6.56p 7.13 (each)
4 cm x 1.5 cm £6.56 Not listed
Wound contact layer 5 cm x 7cm
£1.57 £1.57
8 cm x 10 cm £3.13 £3.13
12 cm x 15 cm 6.34 £6.34
Use ONLY For use on neonates and patients with Epidermolysis Bullosa
Avoid Not on arterial catheters and cannulae
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Application Mepitac can be under or to fix devices such as probes, electrodes, IV cannulae and dressings Mepitel may be used as a wound contact layer
Tips Do not apply under tension Saline Product Irripod
Sizes & Prices
DT Price NHS Price
20 ml Sterile saline (Order box of 25)
£5.50 for 25
£5.12 for 25
Use General wound cleansing. Avoid Splash-back when irrigating wound Application Warm before applying to wound Tips Consider use of tap water for chronic and
traumatic wounds Silicone based adhesive remover Product Appeel non sterile Sizes & prices
DT Price NHS Price 50 ml aerosol £8.69 £9.71 Wipes (packs of 30)
£14.41 £15.73
Use Silicone based no-sting medical adhesive remover for removal of dressings
Application Test Appeel on a small area of skin before using on damaged skin. No need to wash off. Will not affect adhesion of dressings. Suitable for sensitive or fragile skin.
Avoid If sensitisation occurs (very rarely) or known sensitivity to silicone
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Product Appeel Sterile Sizes & prices
DT Price NHS Price Sterile single sachet for specific patient circumstances. Consider using non-sterile
£11.00 Box of 10
£23.39 for 20
Use Silicone based no-sting medical adhesive remover. To remove dressings without trauma or stinging
Application Test Appeel on a small area of skin before using on damaged skin Apply at any angle. No need to wash off. Will not affect adhesion of dressings. Suitable for sensitive or fragile skin
Avoid If sensitisation occurs (very rarely) or known silicone allergy
Cleansing Wipes Product Cinco Wipes
Sizes & Prices
DT Price NHS Price 330 x 220 mm pack of 25
N/A Not listed
Use Continence cleansing wipes, deodorise, moisturise and barrier protection
Avoid Only for use following faecal incontinence Application Use as cleansing wipe
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Absorbent dressings Product Zetuvit E
Absorbent cellulose pad with fluid repellent Backing
Sizes & Prices
DT Price NHS Price
Sterile 10 cm x 10 cm
20p £3.03 (25)
10 cm x 20 cm 23p £3.64 (25)
20 cm x 20 cm 37p £3.46 (15) 20 cm x 40 cm £1.02 £6.89 (10) Non Sterile 10 cm x 10 cm
6p
£3.04 (50)
10 cm x 20 cm 8p £4.06 (50) 20 cm x 20 cm 13p £6.15 (50) 20 cm x 40 cm 26p £7.21 (30)
Use Low to Moderate exuding wounds. Can be used as a primary or secondary dressing
Avoid Should not be used under compression Application Apply to wound area with at least 1 cm
overlap Tips Apply white side of dressing direct to wound
If dressing does not last at least 24 hours then step up to next level
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Product Mesorb (sterile) Absorbent dressing with strike through barrier
Sizes & Prices
DT Price NHS Price
10 cm x 10 cm 59p £5.86 (10) 10 cm x 15 cm 77p £7.59 (10) 10 cm x 20 cm 95p £9.57 (10)
15 cm x 20 cm £1.36 £14.16 (10) 20 cm x 25 cm £2.14 £21.04 (10) 20 cm x 30 cm £2.43 £25.34 (10)
Use May be used as a primary or secondary dressing on moderate to heavily exuding wounds
Avoid Mesorb should not be used on infected wounds or under compression
Application Apply to wound area with at least 1 cm overlap
Tips Depending on levels of exudate, Mesorb may be left in place for several days
Product DryMax Extra
Absorbent dressing with strike through barrier
Sizes & Prices
DT Price NHS Price
10 cm x 10 cm £1.80 £22.10 (10) 10 cm x 20 cm £2.38 £27.62 (10) 20 cm x 20 cm £4.20 £51.50 (10)
20 cm x 30 cm £4.80 359.47 (10) Use Highly exuding wounds. Can be used as a
primary or secondary dressing where high absorbency is required
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Avoid Not for dry or low exuding wounds or eyes, mucous membranes or wound cavities where swelling could be an issue
Application Apply to wound area with at least 1 cm overlap
Tips Either side of the dressing may be appliedMay be applied in stack. May be left in place for several days
Product Flivasorb
Absorbent dressing with strike through barrier for Lymphorroea
Sizes & Prices
DT Price NHS Price
10 cm x 10 cm £2.12 £24.71 (10) 10 cm x 20 cm £3.55 £41.38 (10) 20 cm x 20 cm £6.68 £77.82 (10) 20 cm x 30 cm £9.45 £127.11 (10)
Use Highly exuding wounds. Can be used as a primary dressing (directly on the wound) or as a secondary dressing where high absorbency is required
Avoid Not for dry or low exuding wounds or eyes, mucous membranes or wound cavities where swelling could be an issue. Not to be used under compression
Application Apply to wound area with at least 1 cm overlap
Tips Either side of the dressing may be applied. May be applied in stack. May be left in place for several days
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Protective dressings Product Softpore
Self-adhesive absorbent dressing
Sizes & Prices
DT Price NHS Price
6 cm x 7 cm 6p £2.22 (60) 10 cm x 10 cm 13p £3.24 (50)
10 cm x 15 cm 20p £5.42 (50) 10 cm x 20 cm 35p £4.11 (30) 10 cm x 25 cm 40p £4.76 (30) 10 cm x 30 cm 49p £6.78 (30) 10 cm x 35 cm 58p £7.15 (30)
Use Can be used on a variety of wounds low to moderately exuding most commonly used on post-op and surgical wounds Shower proof
Avoid Heavily exuding wounds, avoid use on fragile skin
Application Apply directly to the wound. Do not stretch the dressing when applying
Tips May be left in place up to one week
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Product Mepore Self-adhesive absorbent dressing
Sizes & Prices
DT Price NHS Price
7 cm x 8 cm 10p N/A 9 cm x 10 cm N/A £7.77 (50) 10 cm x 11 cm 21p N/A
9 cm x 15 cm N/A £9.68 (50) 11 cm x 15 cm 34p N/A 9 cm x 20 cm 42p £8.79 (30) 9 cm x 25 cm 58p £9.30 (30) 9 cm x 30 cm 67p £13.79 (30) 9 cm x 35 cm 73p £16.74 (30)
Use Can be used on a variety of wounds low to moderately exuding most commonly used on post-op and surgical wounds
Avoid Heavily exuding wounds, avoid use on fragile skin and beneath compression
Application Apply directly to the wound. Do not stretch the dressing when applying
Tips May be left in place up to one week
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Shower proof
Product Mepore Ultra Shower proof self-adhesive dressing
Sizes & Prices
DT Price NHS Price
6 cm x 7 cm 28p N/A 7 cm x 8 cm 39p £21.69 (60) 9 cm x 10 cm 61p N/A 10 cm x 11 cm 75p N/A 9 cm x 15 cm 92p N/A
11 cm x 15 cm £1.12 £30.87 (36) 9 cm x 20 cm £1.43 £33.80 (24) 9 cm x 25 cm £1.58 £35.74 (24) 9 cm x 30 cm £2.61 £60.65 (24)
Use Absorbent dressing for post op and surgical wounds. Wounds healing by primary intention
Avoid Heavily exuding wounds and beneath compression
Application Apply directly to the wound. Do not stretch dressing when applying
Tips Shower proof. May be left in place for up to one week
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FILM DRESSINGS
Vapour permeable films allow the passage of water vapour and oxygen but not of water and micro organisms. They are highly conformable, convenient to use and provide a moist healing environment.
Product Tegaderm Film
Sizes and prices
4.4 cm x 4.4 cm N/A £22.49 (100)
6 cm x 7 cm 38p £21.46 (100) 10 cm x 12 cm N/A £28.72 (50) 10 cm x 25 cm N/A £28.31 (20) 12 cm x 12 cm £1.08 N/A 15 cm x 20 cm £2.34 £17.34 (10) 20 cm x 30 cm N/A £23.41 (10)
Uses A sterile transparent vapour permeable film dressing with ‘frame delivery’ system
Application May be applied directly to intact skin or wounds with superficial exudate. May be cut into strips to form a ‘picture frame’ to secure dressings. May protect against friction
Tips Not for deep cavity. Avoid wrinkles or applying under tension. Pull towards you with close proximity of the dressing to the site
Avoid Applying under tension. Remove by pulling dressing downwards to prevent trauma. Not for heavily exuding wounds, full thickness wounds, tendon, bone, third degree burns or fragile skin
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Product Tegaderm plus pad
Sizes and prices
5 cm x 7 cm 25p £12.10 (50)
9 cm x 10 cm 62p £14.39 (25) 9 cm x 15 cm 92p £19.17 (25) 9 cm x 20 cm £1.34 £25.60 (25)
9 cm x 25 cm £1.51 £26.09 (25) 9 cm x 35 cm £2.50 £44.63 (25)
Uses A sterile transparent vapour permeable film dressing with ‘frame delivery’ system. Post operative dressing
Application Waterproof, hypoallergenic, impermeable to micro-organisms
Tips Do not apply under tension Avoid Deep cavity wounds, exuding wounds and
infected wounds
Product OpSite Flexifix
Film adhesive fixation
Sizes & prices
DT Price NHS Price
OpSite Flexifix (non sterile) 5 cm roll
£3.69 (1m roll)
23.73 (10m roll)
OpSite Flexifix (non sterile) 10 cm roll
£6.22 (1m roll)
39.57 (10m roll)
Use A non-sterile film for fixation of dressings or protection from friction
Application Apply to edges of dressings to secure Tips Crack the backing before application Avoid Covering over dressings with a breathable
backing e.g. Allevyn. This reduces their ability to manage exudate
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Non- adherent dressings Intended for use in contact with the wound i.e. primary wound dressing – instead of gauze. Will require a secondary dressing. Low adherent dressings – most are low adherent rather than non-adherent. Product Atrauman
Sizes & Prices
DT Price
NHS Price
5 cm x 5 cm 24p £7.98 (50) 7.5 cm x 10 cm 26p £9.31 (50)
10 cm x 20 cm 58p £11.25 (30) 20 cm x 30 cm £1.58 £10.61 (10)
Use May be applied to a variety of wounds in all healing phases and is useful for patients with sensitive skin
Avoid N/A Application Remove the dressing from the sterile peel
pack with both the cover papers in place. The dressing can be cut to the size of the wound if necessary. After removal of one of the papers, place this side of the dressing onto the wound and remove the second cover. Place a sterile absorbent dressing pad over the dressing to absorb exudates. May be used under compression
Tips Store flat. Dressing can be left in place for up to 7 days. Loosen dressing with warm water
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Product N-A Ultra
Sizes &
Prices
DT Price NHS Price
9.5 cm x 9.5 cm 33p 16.06 (40)
9.5 cm x 19 cm 63p 19.93 (25)
19 cm x 19 cm N/A 12.90 (5)
Use Use beneath compression, burns, traumatic epithelialising and granulating wounds A low adherence wound contact layer easily removed without causing pain or trauma Allows for the free passage of exudate from the wound surface through dressing
Application Apply directly to wound bed Maximum wear time of 7 days Will require secondary dressing and/or padding
Tips If adherent, may be loosened with warmed saline Contains silicone
Avoid
If silicone allergy. Avoid bulky padding beneath compression
Product Tricotex Size &
price
Size DT Price DT Price 9.5 cm x 9.5cm 32p 19.58 (50)
Use Apply directly to wound. Intended for use as an interface layer between ulcers/granulating wounds and absorptive dressings May be used beneath compression Low risk of sensitisation
Application May be left in place for up to 7 days Will require secondary dressing and/or padding
Tips If adherence occurs, may be loosened with warmed saline
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Alginates
Alginates are highly absorbent and are used in medium to heavily exuding wounds forming a gel in contact with wound exudate. They are inappropriate for dry wounds or wounds with minimal exudate and for eschars. Product Sorbsan
Sizes & Prices
Flat DT Price
NHS price
5 cm x 5cm 79p £7.55 (10) 10 cm x 10cm £1.66 £15.68 (10)
10 cm x 20cm £3.10 £16.10 (5)
Ribbon with probe 40 cm
£2.01 £10.44 (5)
Surgical packing 30 cm (2g)
£3.41 £15.62 (5)
Use Highly absorbent used in medium to heavily exuding wounds. Haemostatic properties
Application Apply dry next to the wound, or above a low adherent dressing to make removal easier in instances such as fungating wounds Change every 2-3 days; maximum 7 days Highly exuding wounds may need daily change. Needs a secondary dressing Surgical packing for large wounds – probe not included Ribbon – for smaller wounds – probe included
- 38 -
Tips Do not wet before applying to the wound Needs changing when there is “strikethrough” on secondary dressing Needs to be in place for at least 24 hours to form a gel in contact with wound exudate Remove gel by irrigation with warmed saline solution. Probe may be used to assess a cavity wound
Avoid Not suitable for dry wounds or if minimal exudate, or for wounds with necrotic tissue or eschar
- 39 -
Product Sorbsan Plus non adhesive
Sizes & Prices
Flat DT Price NHS Price
7. 5 cm x 10 cm £1.67p £8.46 (5) 10 cm x 15 cm £2.96 £14.95 (5)
10 cm x 20 cm £3.77 £19.08 (5)
15 cm x 20 cm £5.24 £25.90 (5)
Use 2 in 1 dressing. Flat - shallow wet wounds and ulcers Surgical packing - for large deep open wet wounds Ribbon- for smaller, deep, open wet wounds
Avoid Not suitable for wounds which are dry or contain necrotic tissue as this will further allow the wound to dry out
Application Apply dry next to the wound or above a low adherent dressing to make removal easier in instances such as fungating wounds Change every 2-3 days & maximum 7 days may a secondary dressing
Tips Do not wet before applying to the wound May be used on infected wounds. Needs changing when there is “strikethrough” on secondary dressing. Forms a runny gel which can be rinsed off with warmed saline solution. Need to be in place for at least 24 hours as it takes this long to form the gel
- 40 -
Product Sorbsan Plus SA (Self adhesive)
Sizes & Prices
Flat DT Price NHS Price
11.5 cm x 14 cm £2.92 £29.23 (10) 14 cm x 19 cm £4.25 £42.73 (10)
14 cm x 24 cm £5.14 £25.74 (5)
19 cm x 24 cm £6.45 £32.33 (5)
Use Skin Friendly adhesive Moderate to heavy exuding wounds Shower proof Flat or shallow wounds
Application Lasts up to 7 days Ensure 5 mm overlap Apply dry next to the wound Care with delicate skin due to adhesive
Tips On removal if required saline will loosen the adhesive
NB. NEED TO SPECIFY SELF ADHESIVE
- 41 -
Hydrofibre
Soft sterile, non woven pad or ribbon composed of Hydrofiber. Sodium carboxymethylcellulose. Absorbs wound fluid and transforms into a gel.
Product Aquacel
Sizes & Prices
DT Price NHS Price 5 cm x 5 cm £1.10 £1.78 10 cm x 10 cm £2.61 £2.57 15 cm x 15 cm £4.91 £4.84 4 cm x 10 cm £1.39 £1.84 4 cm x 20 cm £2.05 £2.21 4 cm x 30 cm £3.08 £3.32
Ribbon: 2 cm x 45 cm
£2.61 £2.61
1 cm x 45 cm £1.76 £1.88 Use Moderate to heavy exuding wounds Application Apply directly onto wound
A 2 cm overlap around the wound is advisable and requires a secondary dressing For cavity wounds, only pack deep wounds up to 80% as Aquacel will expand to fill the wound space on contact with wound fluid
Tips There is some cellulose stitching in the ribbon to provide additional strength Change when fully saturated, usually 2 – 3 days. May last up to 7 days
Avoid Do not force the dressing into narrow or tracking sinuses where there is no room for dressing expansion and retrieval would be difficult
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Charcoal dressing
Most odour-producing organisms in wounds are anaerobes, which thrive in deep cavities. Ideally they should be eliminated, particularly in fungating carcinomas. The preferred approach is administration of oral metronidazole, 200mg - 400mg three times a day for as long as necessary. Topical metronidazole gel can be applied (these are only licensed for use in fungating carcinomas but are widely used to control malodorous pressure ulcers and leg ulcers). The main objective for these patients is to control odour as rapidly as possible.
Product Clinisorb
Sizes & Prices
Flat DT Price NHS Price
10 cm x 10 cm £1.78 £18.33 (10) 10 cm x 20 cm £2.37 £24.51 (10)
15 cm x 25 cm £3.81 £39.37 (10)
Use Activated charcoal has the ability to absorb volatile molecules from the air such as those which are liberated by a wound that are responsible for odour production
Application It is not intended to be placed in direct contact with the wound, but should be applied over a suitable primary dressing, and held in place with tape or a bandage as appropriate Once the charcoal cloth comes into contact with exudate, its odour adsorbing properties are reduced and a change is recommended. May be cut to fit
Tips Both sides of the dressing are identical
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Product IV 3000 Intravenous site dressing
Sizes & prices
DT Price NHS Price
5 cm x 6 cm 40p £36.46 (100)
6 cm x 7 cm (non winged)
52p £35.43 (100)
6 cm x 8 cm (ported)
N/A £36.29 (100)
6 cm x 8.5 cm N/A £36.16 (100)
7 cm x 9 cm (ported peripheral catheter)
69p £37.23 (100)
9 cm x12 cm (PICC line)
£1.37 N/A
10 cm x 12 cm (central venous catheter)
£1.32 £76.47 (50)
10 cm x 14 cm N/A £16.77 (10)
10 cm x 20 cm epidural
N/A £80.19 (50)
Use A sterile film for fixation over intravenous catheter sites
Application Do not apply under tension. Apply directly to site
Tips Not for deep cavity Avoid wrinkles or applying under tension. Pull towards you with close proximity of the dressing to the site
Avoid Not suitable for heavily exuding IV site
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FOAMS Foam and foam/film dressings vary in their structure and properties. An important feature is their ability to prevent ‘strike-through’ of wound exudate to the surface of the dressing. This ‘strike-through’ frequently occurs with conventional dressings and provides a pathway for infection. Foam dressings can usually remain in place for longer than 24 hours, unless the wound is exudating heavily. Infected or sloughy wounds should be re-dressed daily, but for non-infected wounds most products can be left in place for up to one week. FOAM DRESSINGS SHOULD NOT BE APPLIED BENEATH COMPRESSION
Product Allevyn Adhesive (including sacral) Sizes & prices
DT Price
NHS Price
7.5 cm x 7.5 cm £1.43 £15.59 (10)
10 cm x 10 cm £2.10 £22.85 (10)
12.5 cm x 12.5 cm £2.57 £27.86 (10)
17.5 cm x 17.5 cm £5.07 £54.97 (10)
22.5 cm x 22.5 cm £7.38 £80.07 (10)
12.5 cm x 22.5 cm £4.00 £43.00 (10)
Sacral 17 cm x 17cm £3.80 £41.17 (10)
Sacral 22 cm x 22cm £5.47 £59.38 (10)
Use Moderate to heavily exuding wounds May be used as a secondary dressing
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Application Apply directly to the wound surface Can be left in place for up to 7 days if not infected Infected or sloughy wounds should be re-dressed more frequently
Tips A 2 cm overlap around the wound is advisable. Saline may be applied to the edge of the dressing to aid removal
Avoid Dry wounds or eschar
Product Allevyn Non-adhesive (including heel) Sizes & prices
DT Price
NHS Price
5 cm x 5 cm £1.21 £13.20 (10) 10 cm x 10 cm £2.40 £26.05 (10) 10 cm x 20 cm £3.86 £41.86 (10) 20 cm x 20 cm £6.44 £69.85 (10) Heel 10.5 cm x13.5 cm – THIS IS NOT A PRESSURE RELIEF DRESSING
£4.81
£26.11 (5)
Use Moderate to heavily exuding wounds May be used as a secondary dressing
Application Apply directly to the wound surface Needs retention bandage, stockinette or tape Can be left in place for up to 7 days if not infected Infected or sloughy wounds should be re-dressed more frequently
Tips A 2 cm overlap around the wound is advisable
Avoid Dry wounds or eschar
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Product Allevyn Plus Adhesive Sizes & prices
DT Price
NHS Price
12.5 cm x 12.5 cm £3.16 £34.23 (10) 17.5 cm x 17.5 cm £6.10 £67.49 (10)
12.5 cm x 22.5 cm £5.60 £60.63 (10) 17 cm x 17cm £4.61 £49.31 (10) 2 cm x 22 cm £6.67 £71.36 (10) Use Moderate to heavily exuding wounds
May be used as a secondary dressing Tips A 2 cm overlap around the wound is
advisable Application Apply directly to the wound surface
Can be left in place for up to 7 days for non-infected wounds. Infected or sloughy wounds should be Re-dressed more frequently
Avoid Dry wounds or eschar
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Product Allevyn Gentle Non Bordered Sizes & prices
Size DT Price
NHS Price
5 cm x 5 cm £1.21 £1.40 (10) 10 cm x 10 cm £2.40 £27.62 (10) 15 cm x 15 cm £4.03 £49.97 (10)
10 cm x 20 cm £3.86 £44.38 (10) 20 cm x 20 cm £6.44 £74.05 (10) Use Secondary dressing for moderately exuding
wounds. Allevyn Gentle is suitable for use on fragile, sensitive skin
Tips A 2 cm overlap around the wound is advisable
Application Apply direct to the wound surface. Can be left in place for up to 7 days dependant on level of exudate. Secondary fixation is required e.g. tape or bandage
Avoid Dry wounds or eschar. Do not use Allevyn Gentle with oxidising agents such as hypochlorite solutions
Product Allevyn Gentle Border Sizes & prices
Size DT Price
NHS Price
7.5 cm x 7.5 cm £1.43 £16.52 (10) 10 cm x 10 cm £2.10 £24.24 (10) 12.5 cm x 12.5 cm £2.57 £29.56 (10) 10 cm x 20 cm £3.38 £33.37(10) 17.5 cm x 17.5 cm £5.07 £58.25 (10)
23 cm x 23.2 cm (heel)
£9.24 £55.36 (5)
Sacrum 16.8 cm x 17 cm
3.80 43.90 (10)
- 48 -
Use Secondary dressing for moderately exuding wounds. This is the dressing choice for skin tears. Allevyn Gentle Border is suitable for use on fragile, sensitive skin
Tips A 2 cm overlap around the wound is advisable
Application Apply direct to the wound surface. Can be left in place for up to 7 days dependant on level of exudate
Avoid Dry wounds or eschar. Do not use Allevyn Gentle Border with oxidising agents such as hypochlorite solutions
Product Allevyn Gentle Border Lite Sizes & prices
Size DT Price
NHS Price
5 cm x 5 cm 86p £10.37 (10)
7.5 cm x 7.5 cm £1.33 £15.98 (10) 10 cm x 10 cm £2.07 £24.90 (10) 5.5 cm x 12 cm £1.77 £21.28 (10) 15 cm x 15 cm £3.65 £43.74 (10)
8 cm x 15 cm £3.29 £39.42 (10) Use Suitable for use on fragile, sensitive skin
with low to moderate exuding wounds Tips A 2 cm overlap around the wound is
advisable
Application Apply direct to the wound surface. Can be left in place for up to 7 days dependant on level of exudate
Avoid Dry wounds or eschar. Do not use Allevyn Gentle Border Lite with oxidising agents such as hypochlorite solutions
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Product Tegaderm Foam ( Non adhesive) Sizes & Prices
DT Price NHS Price 5 cm x 5 cm Not listed £1.75 10 cm x 10 cm £2.09 £2.04 10 cm x 20 cm £3.54 £3.74
20 cm x 20 cm £5.65 £5.98 10 cm x 60 cm £11.96 £12.66 8.8 cm x 8.8 cm fenestrated
£2.13 £2.14
Use All tissue types, Arterial ulcers, burns, neuropathic ulcers, pressure ulcers
Avoid Do not occlude back of dressing as this will prevent the evaporation of exudates
Application Use the “picture frame” technique to secure. May be secured with retention bandage May be left in place for up to 7 days.
Tips Use the “picture frame” technique to secure May be secured with retention bandage May be left in place for up to 7 days
- 50 -
Product Tegaderm Foam adhesive Sizes and Prices
DT price
NHS price
8.8 cm x 8.8 cm N/A
£20.23 (10)
10 cm x 11 cm oval £2.09 £20.25
(10) 14.3 cm x 14.3 cm square
£3.37 £35.82
(10) 14.3 cm x 15.6 cm oval
£4.05 £22.72
(5)
6.9 cm x 7.6 cm mini oval
£1.42 £61.57
(40)
6.9 cm x 6.9 cm mini wrap
£1.66 £71.83
(40)
19 cm x 22.2 cm oval £6.61 £33.11
(5) 13.9 cm x 13.9 cm heel
£4.06 £21.64
(5) Use All tissue types
Arterial ulcers, burns, naturopathic ulcers, Pressure ulcers, skin tears abrasions
Avoid Do not occlude back of dressing as this will prevent the evaporation of exudates
Application Remove liner, position over wound. Apply directly to the wound surface, and then peel tabs from the centre. One-handed application Secondary dressing not required May be left in place for up to 7 days
Tips No need to cut, shape or dart, with oval and heel shaped dressing. To remove pull dressing flat against the peri-wound area
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Anti-microbial dressings In Acute trust all anti-microbials are on the Specialist Formulary Include, honey, Iodine silver & PHMB. Their use should be time limited and used to achieve a specific patient outcome. The Best practice statement on the use of topical antiseptic/antimicrobial agents in wound management. http://www.wounds-uk.com/pdf/content_9627.pdf Honey has a high Osmotic Action which aids de-sloughing and de-briding of wounds. It offers anti-bacterial protection, malodour reduction, maintains a moist wound environment and is non-adherent. May increase exudate so take precautions to prevent maceration. Product Activon tulle (Honey)
Sizes DT price NHS price
5 cm x 5cm £1.78 £8.93 (5) 10 cm x 10cm £3.01 £15.15 (5)
Use Use on partial and full thickness necrotic sloughy and malodorous wounds including all wounds, leg ulcers, pressure ulcers.
Avoid DO NOT USE IF ALLERGIC TO BEE VENOM Patients may report increase in pain levels If unabated with simple analgesia remove dressing and irrigate wound with saline
- 52 -
Application The dressing is designed to be applied as a triple layer as packaged, it may be unfolded but this will reduce the efficacy of the honey, do not introduce any creases that may cause pressure areas. Osmotic action may increase the exudate levels to begin with so cover with a secondary absorbent dressing
Tips Change dressing when honey is diluted by exudate, change in colour is a useful indicator of when to change a dressing. Protect peri-wound area
Product Actibalm topical ointment (Honey)
Sizes DT price NHS price
Pharmaceutical grade petroleum jelly and Activon honey. Single Patient use 10G
£2.48 Available via pharmacy
Use Dry chapped lips, cold-sores, insect bites Avoid DO NOT USE IF ALLERGIC TO BEE
VENOM. Blood sugar levels should be monitored in patients with diabetes Stinging sensation may be experienced when applying honey, if unacceptable remove and discontinue use
Application Apply directly to affected area Tips Monitor blood sugar levels
Protect peri-wound area
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Product Algivon (Honey)
Sizes DT price NHS price
Calcium alginate impregnated with Manuka honey
5 cm x 5 cm £2.09 £14.21 (5)
10 cm x 10 cm £3.53 £17.80 (5) Use Sloughy, necrotic and malodorous wounds
where increased exudates management is required
Avoid DO NOT USE IF ALLERGIC TO BEE VENOM. Blood sugar levels should be monitored in patients with diabetes Stinging sensation may be experienced when applying honey, if unacceptable remove and discontinue use
Application Apply directly to affected area Tips Monitor blood sugar levels Product Mesitran (Honey)
Semi-
permeable
with honey
DT
Price NHS Price
10 cm x 10 cm £2.51 £36.89 (10) 20 cm x 15 cm £5.22 £54.98 (10) 10 cm x 17.5 cm £4.52 £47.64 (10)
Adhesive 10 cm x 10 cm £2.61 £27.49 (10) 15 cm x 13 cm
(sacral) £4.42 N/A
15 cm x 15 cm £4.62 £48.64 (10) Mesh 10 cm x 10 cm £2.41 £25.38 (10) Ointment 15g £3.47 £3.64 50g £9.55 £10.04 Ointment
Soft 15g £3.46 £4.19
- 54 -
Use Partial and full thickness wounds. Use on sloughy wounds, malodorous wounds, leg ulcers and pressure ulcers Mesh may be used on skin tears
Avoid Monitor blood levels of those with diabetes. Patients may report increase in pain levels. If unabated remove dressing and irrigate wound with saline. DO NOT USE IF ALLERGIC TO BEE VENOM
Application Apply directly to wound, cover ointment/ mesh with appropriate wound dressing Apply adhesive border directly to wound
Tips As osmotic action and fluid will be drawn from the wound and can increase pain Change dressing when honey is diluted by exudate, change in colour is a useful indicator of when to change a dressing Protect peri-wound area
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Iodine Antimicrobial and antifungal dressing.
Product Inadine (Non adherent dressing with 10% Povidone Iodine)
Sizes & Prices
Sizes DT Price
NHS Price
5 cm x 5 cm 32p £8.55 (25)
9.5 cm x 9.5 cm 48p £13.80 (25)
Use Used for the prevention and treatment of infection in minor burns, minor traumatic injuries, pressure ulcers, leg ulcers with low exudate. Provides sustained activity against gram-positive and gram-negative organisms, anaerobes, fungi and viruses. suitable for use in adults and children
Application Apply directly onto wound Secondary dressing required Unless used in palliative care settings these products must be reviewed on a regular basis, at least every month
Tips Exudate removes iodine from the dressing and changes from orange to white Not to be used on those with iodine sensitivity Not indicated for moderate to high exudate
- 56 -
Product Iodoflex Sterile cadexomer iodine Sizes & prices
DT Price NHS Price 5 gram sachet
£3.82 £22.56 (5)
10g sachet £7.62 £27.10 (3) 17g sachet £12.08 £25.58 (2)
Use Sloughy, infected wounds Chronic leg ulcers
Application Provides sustained activity against gram-positive and gram-negative organisms, anaerobes, fungi and viruses Apply to wound surface, removing backing, renew when saturated, changes from orange to white, usually 2 - 3 times weekly Once infection is under control, discontinue. Unless used in palliative care settings these products must be reviewed on a regular basis, at least every month
Tips Replace before adherent crust forms May be left in place for up to 7 days
Avoid IODINE SENSITIVITY Absorption of iodine can occur Not to be used in pregnant, lactating women, and patients with severely impaired renal function Caution with patients with thyroid disorder as more susceptible to alterations in thyroid metabolism. Monitor thyroid function test Potential interaction with lithium Maximum single application is 50g. Do not exceed 150g weekly or treatment course of 3 months. Do not use with hydrogels.
- 57 -
Product Iodosorb ointment and powder Sizes & prices
DT Price NHS Price
3 gram sachet £1.80 £14.93 (7) 10g ointment £4.21 £19.96 (4) 20g ointment £8.43 £19.96 (2)
Use Chronic leg ulcers Light to medium exuding ulcers
Application Provides sustained activity against gram-positive and gram-negative organisms, anaerobes, fungi and viruses Apply to wound surface, removing backing, renew when saturated, changes from orange to white, usually 2 - 3 times weekly Once infection is under control, discontinue Unless used in palliative care settings these products must be reviewed on a regular basis, at least every month
Tips Apply to wound surface 3 mm in depth
- 58 -
Avoid IODINE SENSITIVITY Not to be used in pregnant, lactating women, and patients with severely impaired renal function as absorption of iodine can occur Caution with patients with thyroid disorder as more susceptible to alterations in thyroid metabolism. Monitor thyroid function test Potential interaction with lithium Maximum single application is 50g. Do not exceed 150g weekly or treatment course of 3 months. Do not use with hydrogels
- 59 -
Silver Note regarding ordering Ag as this appears first in pick list. BE CAREFUL
Sorbsan Ag - Silver
Sizes &
Prices
Flat DT Price NHS price
5 cm x 5 cm £1.50 £14.51 (10) 10 cm x 10 cm £3.80 £36.03 (10) 10 cm x 20cm £6.94 £33.49 (5)
Ribbon with probe 40 cm
£3.97 £19.20 (5)
Surgical packing 30 cm (2g)
£5.55 £26.76 (5)
Use Calcium alginate containing 1.5% silver used in medium to heavily exuding critically colonised or infected wounds
Application Apply dry next to the wound, or above a low adherent dressing to make removal easier in instances such as fungating wounds Change every 2-3 days; maximum wear time is 7 days. Highly exuding wounds may require daily change. Needs a secondary dressing. A probe is available to assess the extent of a cavity wound and to assist with packing
Tips Do not wet before applying to the wound Needs changing when “strikethrough” on secondary dressing. Needs to be in place for at least 24 hours to form a gel in contact with wound exudates. Remove gel by irrigation with warmed saline solution
Avoid Not suitable for dry wounds or if minimal exudate, or for wounds with necrotic tissue or eschar
- 60 -
Aquacel Ag
Product Aquacel Ag Sizes & prices Sizes DT Price NHS Price
5 cm x 5 cm £1.86 £1.91 10 cm x 10 cm £4.44 £4.57
15 cm x 15 cm £8.36 £8.59 4 cm x 10 cm £2.67 £3.12
4 cm x 20 cm £3.48 £3.77 4 cm x 30 cm £5.21 £5.67
RIBBON 2 cm x 45 cm £4.46 £4.57
1 cm x 45 cm £2.97 £3.17 Use Infected and critically colonised wounds
Moderate to heavily exuding wounds Application Apply directly onto wound. A 2 cm overlap
around the wound is advisable and requires secondary dressing. For cavity wounds, only pack deep wounds up to 80% as Aquacel will expand to fill the wound space on contact with wound fluid
Tips There is some cellulose stitching in the ribbon to provide additional strength Change when fully saturated, usually 2 – 3 days. May last up to 7 days
Avoid Do not force the dressing into narrow or tracking sinuses where there is no room for dressing expansion and retrieval would be difficult
- 61 -
Product Acticoat Absorbent Sizes & prices
DT Price NHS Price
5 cm x 5 cm £5.01 £26.73 (5)
10 cm x 12.5 cm £12.02 £64.56 (5)
2 cm x 30 cm rope £12.09 £64.97 (5) Use Burns, traumatic wounds, donor sites
Leg ulcers, pressure ulcers, epithelialising and granulating wounds, cavity wounds May be used beneath multi-layer compression Acticoat absorbent may be used on critically colonised or infected wounds. Where the product is used on infected wounds the infection should be inspected and treated as per local clinical protocol
Application Apply directly to wound bed Will require secondary dressing May be left in place for up to 7 days Secondary dressing changed as necessary
Tips On handling the silver is readily given up and gloves may appear to be stained Arygia (staining of the wound) may be seen
Avoid Acticoat absorbent is not compatible with oil based products such as petrolatum Avoid contact with electrodes or conductive gels Do not use on patients with known sensitivity to silver or alginates Do not use on patients undergoing MRI examination Do not use on non-exuding wounds
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Product Urgotul SSD Sizes & prices
Sizes DT Price
NHS Price
10 cm x 12 cm £3.34 £84.97 (25)
15 cm x 20 cm £9.09 £161.52 (16) Use Burns, traumatic wounds, donor sites
leg ulcers, pressure ulcers, epithelialising and granulating wounds May be used beneath compression
Application Apply directly to wound bed May be left in place for up to 7 days Will require secondary dressing Do not fold
Tips Easier to apply with moistened gloved hands
Avoid On highly exuding wounds
- 63 -
Bio cellulose dressing Suprasorb X and Suprasorb X + PHMB Product Suprasorb X Sizes & prices
DT Price NHS Price 5 cm x 5 cm £1.90 £14.95 (5)
9 cm x 9 cm £3.95 £30.37 (5)
14 cm x 20 cm £7.83 £67.74 (5)
2 cm x 21 cm £6.08 £46.89 (5)
Use Bio-cellulose dressing designed to regulate moisture levels. Can remain in place for up to 7 days. Use on light to moderate non- infected exuding wounds in all phases of wound healing
Application May be cut or folded into shape of wound Apply directly to the wound
Tips Secondary dressing required Avoid Heavily exuding wounds Product Suprasorb X+ PHMB Sizes & prices
DT Price NHS Price 5 cm x 5 cm £2.38 £18.56 (5)
9 cm x 9 cm £4.73 £36.32 (5)
14 cm x 20 cm £10.76 N/A
2 cm x 21 cm £6.70 £51.45(5)
Use Bio-cellulose dressing with PHMB 0.3% designed to regulate moisture levels for critically colonised and infected wounds Can remain in place for up to 7 days. Use on light to moderate exuding wounds
Application May be cut or folded into shape of wound. Apply directly to the wound
Tips Secondary dressing required Avoid Heavily exuding wounds
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Hydrocolloids The dressing sheets are self-adhesive and are useful for removal of sloughy tissue by promoting autolysis. Do not require daily dressing change. Product Duoderm (Extra Thin)
Sizes & prices
DT Price NHS Price
5 cm x 10 cm 72p 70p 7.5 cm x 7.5 cm 75p 74p
10 cm x 10 cm £1.24 £1.21 15 cm x 15 cm £2.68 £2.62 9 cm x 15 cm 79p £1.65 9 cm x 25 cm £1.64 £2.42 9 cm x 35 cm £2.63 £3.40
Spots 4.4 cm x 3.8 cm Spots
£8.20 (10)
Use For lightly exuding wounds e.g. superficial pressure ulcers and acute wounds Useful for removal of sloughy tissue by promoting autolysis and softening eschar Protect peri-wound area
Application Usually left in place for 3 - 7 days as clinically indicated The dressing sheets are self-adhesive If adherent, may be loosened with warmed saline solution
Tips If over-granulation occurs replace with a non-adhesive foam dressing Warm before applying to make dressing more pliable. A 2 cm overlap around the wound is advisable
Avoid Heavily exuding wounds, infected wounds
- 65 -
Product Tegaderm Hydrocolloid
Sizes & Prices
Non-bordered DT Price NHS Price
10 cm x 10 cm £2.30 £2.30 15 cm x 15 cm £4.46 £4.46 Bordered 16.1 cm x 17.1 cm £4.71 £4.71 10 cm x 12 cm £2.26 £2.26 13 cm x 15 cm £4.22 £4.22
Thin bordered 10 cm x 12 cm £1.50 £1.50 13 cm x 15 cm £2.81 £2.81 10 cm x 10 cm £1.51 £1.51
Use
For light to medium exuding wounds e.g. leg ulcers, pressure ulcers and acute wounds
Avoid Dry or heavily exuding wounds
Application Secondary dressing/tape may be required Usually left in place for 3 - 7 days
Tips Leave a 2 cm overlap around the wound May be used with larvae therapy Protect peri-wound area
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Hydrogels
They will debride a wound by hydration and promotion of autolysis. Product Intrasite Gel Sizes & prices
DT Price NHS Price 8g £1.69 £22.77 (10)
15g £2.26 £25.99(10)
25g £3.36 £35.89 (10)
Use First choice should be 8g. Superficial, deep, dry, sloughy & necrotic wounds as releases moisture into wound May be used in the presence of aerobic or anaerobic infection, but systemic antibiotics should also be given Hard black eschar may be scored gently to allow better penetration of gel with care taken of underlying structures such as tendons, nerves etc Also indicated for excoriated tissue and radiotherapy reactions
Application Gel must be applied to a minimum depth of 5 mm to prevent drying out at the edges Secondary dressing required
Tips Hydrogels are strictly single use items
Avoid Heavily exuding wounds. Protect peri-wound area to prevent maceration Patients sensitive to propylene glycol
- 67 -
Product Intrasite Conformable Sizes & prices
DT Price NHS Price 10 cm x 10 cm £1.69 £19.55 (10)
10 cm x 20 cm £2.28 £26.45 (10)
10 cm x 40 cm £4.07 £47.33 (10)
Use Management of shallow and deep wounds healing by secondary intent, including leg ulcers, pressure ulcers, diabetic foot ulcers and surgical wounds. Can also be used for excoriated tissue and radiotherapy reactions
Application Apply the dressing to loosely fill or cover the wound as required. Cover with a secondary dressing
Tips Hydrogels are strictly single use items Avoid Heavily exuding wounds. Protect peri-
wound area to prevent maceration Patients sensitive to propylene glycol
- 68 -
Product Actiform Cool Sizes & prices
Ionic Sheet Hydrogel
DT Price NHS Price
5 cm x 6.5 cm £1.70 £8.45 (5)
10 cm x 10 cm £2.49 £12.44 (10)
10 cm x 15 cm £3.58 £10.71(3)
20 cm x 20 cm £7.51 N/A
Use For use on painful wounds ,superficial, deep, dry, wet, sloughy and necrotic wounds May be used in the presence of aerobic or anaerobic infection, but systemic antibiotics should also be given. Hard black eschar may be scored gently to allow better penetration of gel with care taken of underlying structures such as tendons, nerves etc
Application Absorbs or donates moisture depending upon wound type so cut to fit wound. Lightly/moderately exuding wounds – leave film top liner in place For heavily exuding wounds – remove top liner
Tips Dressing will expand upon absorption of exudate and will take on the colour of the wound breaking down into granules as it works
Avoid Narrow cavities or sinuses and highly vascular wounds
- 69 -
Larvae
Product LarvE Sterile maggots. These should be prescribed by the GP
Sizes Community £98 + VAT +carriage per standard pot Hospital £86 + VAT + carriage per standard pot Larvae in bags also available
Use Sloughy wounds. Measure wound to ensure appropriate larvae applied. See www.biomonde.com for calculator and range available
Avoid • Hard necrotic tissue
• Education and training required prior to application
• Do not allow to dry out
• If patient declines treatment Application Apply to wound using net secure with
sleek and hydrocolloid or zinc paste. Leave 48 - 72 hours Caution with patients taking Warfarin
Tips No deliveries of larvae on Sundays and Bank holidays Consider cost effectiveness of treatment Order from Biomonde 0845 2301810 or GP prescription Orders for the next day need to be received by 12 midday for larvae in pots and larvae in bags
- 70 -
Lipidocolloid
Product Urgotul Sizes & prices
DT Price
NHS Price
5 cm x 10 cm Urgotul Duo
£2.37 £72.71
(26) 10 cm x 12 cm (Duo)
£3.67 £69.18
(16) 15 cm x 20 cm (duo)
£8.53 £104.07 (10)
8 cm x 8 cm Duo with border
£2.29 £64.96 ( 26)
10 cm x 12 cm Duo with border
£3.54 £61.97 (16)
11 cm x 11 cm £3.02 £67.03 (16) 16 cm x 21 cm £8.55
10 cm x 40 cm £10.08 £130.67(10)
Use Burns, traumatic wounds, donor sites, leg ulcers, pressure ulcers, epithelialising and granulating wounds
Application Apply directly to wound bed May be left in place for up to 14 days Secondary dressing required. Outer dressing may be changed, leaving Urgotul in direct contact. Do not fold
Tips Easier to apply with moistened gloved hands
Avoid Do not use when other appropriate non-adherents could be used or when applying other topical agents
- 71 -
Scar management NB Consider seeking professional advice Product Mepiform
Soft silicone adherent dressing for scar care
Sizes & Prices
DT Price NHS Price 4 cm x 31 cm £10.19 £55.07 (5) 5 cm x 7 m £3.23 £17.43 (5)
9 cm x 18 cm £12.62 £64.37 (5) Use Old and new hypertrophic scars and
keloids. Has SPF of 7 May be cut to shape with 1 cm border and avoid stretching over joints
Avoid Flat white scars Application Apply directly to the wound, dressing to be
removed once a day e.g. when bathing for inspection and washing of the skin and re-applied
Tips Dressing can be used for several days
- 72 -
Podiatry use: These products may be used by Podiatry or when sharing care Product Biatain Adhesive Sizes & Prices
DT
Price NHS Price
10 cm x 10 cm Circular
£1.63 £16.11 (10)
19 cm x 20 cm (heel) £4.80 £23.63 (5) Use Partial and full thickness wounds with
low to heavy exudate Patients who have a history of poor healing
Avoid Exposure to temperatures above 50°C Application Apply directly to the wound
Leave on until indicated when to change or on 7th day
Tips Dressing indicated to stay on for up to 7 days
Product Flexitol Sizes & prices
DT Price
NHS Price
75g £4.35 200g £9.90
Use Contains 25% Urea. For the treatment of dry, cracked skin and hyperkeratosis on the soles of the feet and heels. Suitable for those with diabetes
Application Apply twice daily after bathing/washing Avoid Irritated or inflamed skin. Use on those
aged over 12 years Tips Some foot wear should be used to avoid
staining carpets
- 73 -
Limited Use Protease modulating Product Promogran Sizes & Prices
DT Price NHS Price 28 cm2 £5.19 £58.24 (10) 123 cm2 £15.62 £175.34 (10)
Use Prior to use ensure holistic assessment undertaken, exclude anaemia, diabetes and monitor for adequate diet and address factors that delay wound healing
Avoid Wounds that have dry necrotic tissue This must be removed by surgical, enzymatic or autolytic debridement Wounds with visible signs of infection
Application Degree of exudate Re-application Heavy 1 - 2 days Low/None 2 - 3 days Product is bio-absorbed into the wound Improvement in the wound should be apparent within 2 weeks and a maximum of 4 weeks and if no improvement discontinue treatment and re-evaluate
Tips Exudate may increase initially To optimise clinical outcomes, a residual of Promogran should be visible in the wound bed upon dressing change
- 74 -
Product Promogran Prisma Sizes & Prices
DT Price NHS Price 28 cm2 £6.31 £68.59 (10) 123 cm2 £17.98 £190.50 (10)
Use It contains 1.6 mg of Silver per 100 cm2 As product gels, silver ions are released Ensure holistic assessment undertaken, exclude anaemia, diabetes and monitor for adequate diet and address factors that may delay healing
Avoid Wounds that have dry necrotic tissue This must be removed by surgical, enzymatic or autolytic debridement Wounds with visible signs of infection
Application Degree of exudate Re-application Heavy 1 - 2 days Low/None 2 - 3 days Product is bio-absorbed into the wound, and is not removed at dressing change Improvement in the wound should be apparent within 2 weeks and a maximum of 4 weeks. If no improvement discontinue treatment and re-evaluated
Tips Exudate may increase as Promogran activates the delayed wound healing process To optimise clinical outcomes, a residual of Promogran should be visible in the wound bed upon dressing change. A lack of residual product upon dressing change may indicate the need to either layer the product into the wound or increase the frequency of dressing change
- 75 -
Oakmed Wound Drainage Bags
Product Oakmed Sizes & Prices
DT
Price NHS Price
For sizes and full range see www.oakmed.co.uk (Go to order a sample to see full range ) Nb X large not available on DT. Or 07775 511712
Subject to size
Subject to size
Use For highly exuding wounds. Consider use when changing dressing more than once daily
Avoid Non-exuding wounds Application Keep hydrocolloid flange warm to aid
adhesion Use template to ensure accurate fit (Remember to reverse image when cutting) Ensure spout faces downwards-may be fitted to drainage collection bag Encourage patient to restrict movement for approx 20 minutes post application to increase wear time
Tips Available as sterile and non-sterile
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Hosiery and Bandaging Education is available across the Acute and Primary Care Trust for the use of bandages and hosiery. Product Hosiery - Activa (British standard)
Prices
DT Price NHS price Class 1 14 -17 mmHg Below Knee
£6.95
£8.23
Class 1 14 -17 mmHg Thigh
£7.61
£8.23
Class 2 18 - 24 mmHg Below Knee
£10.16
£11.58
Class 2 18 - 24 mmHg Thigh
£11.31
£12.89
Class 3 25 - 35 mmHg Below Knee
£11.52
Class 3 25 - 35 mmHg Thigh
£13.40
Sizes Class 1 - 3 requires circumference measurements of 2 cm above ankle, widest part of calf and for thigh length measure 5 cm below groin. Available in open and closed toe, measure foot length (closed toe n/a in class 3) S,M,L,XL,XXL
Use Prevention of recurrence of venous leg ulceration
- 77 -
Application Use Acti-glide to assist with application. Sock aids should not used with hosiery Patient may select colour Doppler assessment required prior to the application of Class 2 compression therapy
Tips Apply as manufacturer’s instructions Remember to measure each leg on each application
Avoid Extreme caution should be taken with arterial disease, arterial ulcers, diabetes and those with small vessel disease
Product Activa Hosiery Treatment kit
Prices Sizes
DT Price NHS Price 1 class 3 stocking and 2 liners
£21.74
Not listed
Small, medium, large, extra large, extra, extra large
Use To apply 40 mmHg as compression therapy MUST HAVE A FULL ASSESSMENT AND DOPPLER ULTRASOUND. MEASURE PATIENT FOR ACCURATE FIT Use after bandaging or as an alternative way of achieving 40 mmHg
Application Consider application and removal Tips Apply as manufacturer’s instructions
Remember to measure each patient individually
Avoid Those unsuitable for compression Circumferential leg ulceration due to high exudate levels
- 78 -
Product Activa Liners
Prices Sizes
DT Price NHS Price
3 liners £15.59 Not listed Small, medium, large, extra large, extra, extra large
Use Each liner gives 10 mmHg and can be used to layer compression and for palliative care Available in White and Sand colour
Application Consider application and removal Tips Apply as manufacturer’s instructions
Remember to measure each patient individually
Avoid Those not suitable for compression Hosiery applicator This is for single patient use. It may be washed and should last several years. It makes it significantly easier to apply hosiery.
Product Hosiery applicator
Prices Drug Tariff NHS Price Acti-Glide £13.64 Not listed
- 79 -
Product Jobst - UlcerCARE
Prices DT Price
NHS Price
Ready to Wear 1 Medical stocking + 1 liner
£29.95 Not listed
Ready to wear Compression Liner Pack of 3 (White)
£18.09
Not
listed Custom Made
1 Medical Stocking £60.69 Not
listed Custom Made
Compression Liner Pack of 2. Black or beige
£30.35
Not
listed Sizes S, M.L. XL
+ Custom Made to fit any size or shape leg Use For the management of venous leg ulcers and
prevention of further recurrence Application Cover any below knee wounds with appropriate
non-bulky dressings before applying the liner compression layer. Hold the top edges of the stocking together just below the knee and gently pull up the zip from the ankle to the knee. The zip loop may be unclipped for later use
Tips For easier application use rubber gloves to aid grip. While the compression liner may be worn 24 hours a day the patient should remove the medical stocking with zipper during bed rest
Avoid Application with long fingernails and jewellery may damage the stockings when putting them on Avoid greasy ointments, body lotions or similar substances unless recommended for use with compression hosiery
- 80 -
Product Mediven Plus
Sizes & Prices Open prices are for Class 1 and Class 2 . Prices in brackets are for Class 3
1 (I) to 7 (VII) Standard and Petite length
DT Price NHS Price
Below Knee £27.06 (£29.72)
£29.03 (£31.93)
Below Knee Extra Wide
£30.88 (£33.75)
£32.26 (£35.26)
Thigh Length N/A £42.80 (£46.90)
Thigh Petite
N/A £38.86 (£42.13)
Thigh Petite with top band
£48.50
(£54.13)
£50.67
(£53.78) Thigh Petite with extra wide top band
£48.32 (£53.93)
£50.67 (£53.78)
Thigh with top band
£52.00
(£54.13)
£55.11
(£58.76)
Thigh extra wide with top band
£51.81
(£53.93)
£55.11
(£58.76)
Panty-Hose
N/A
£59.13
(£62.64)
- 81 -
Maternity Panty-Hose
N/A
£60.31
(£66.41)
Mens Leotard
N/A £62.64 (£66.41)
Thigh right waist attach
£27.17 (£29.91)
£29.89 (£32.99)
Thigh left waist attach
£27.17 (£29.91)
£29.89 (£32.99)
Use RAL standard Compression garments for Vascular conditions and Lymphoedema treatment Class 1 (18-21mmHg) –Mild lymphoedema or varicosis . Class 2 (23-32mmHg) – Mild/moderate lymphoedema, pronounced varicosis with oedema or after healing minor ulcers Class 3 (34-46mmHg) – Moderate lymphoedema, significant varicosis or after healing severe ulcers
Avoid Arterial disease, arterial ulcers, diabetes and those with small vessel disease THOSE UNSUITABLE FOR COMPRESSION Circumferential leg ulceration due to high exudate level.
- 82 -
Application Select Compression class based on dosage of mmHg required and for which condition being treated Decide if below knee or thigh length required. Measure leg points as per size guide and measurement chart to determine size required .
Bandage Protector Seal Tight
Product Seal Tight
Prices & Sizes
DT Price
NHS Price
Adult ankle 11cm - 28 cm
£10.50 Not listed
Adult long leg 42 cm -107 cm
£10.50 Not listed
Adult wide short leg 23 cm – 59 cm
£10.50 Not listed
Paediatric sizes for arms and legs are also available, but not on drug tariff
Use To maintain bandage or dressing in place when bathing. Not available in WAHNHST
Application Always measure to ensure good fit. Consider safety of patient if bathing
Tips Apply as manufacturer’s instructions Remember to measure each patient individually
Avoid Wearing when not bathing
- 83 -
Footwear Limited use to maintain mobility and independence. Please consider using the patient’s own foot wear. Product Kerraped
Prices &Sizes
DT Price NHS Price Shoe size S (2 - 5.5) M (6 - 7.5) L (8 - 10) XL (10.5 – 13)
£16.95 per shoe
£18.87 (per shoe)
Use Is suitable as foot wear. Designed to last 12 weeks. Comes as a single item. Not separate right and left foot Not available in WAHNHST
Application Ensure ankle strap cut to fit. Consider size when bandage on foot
Tips Can be hand washed. NOT in washing machine. Is suitable for wearing outdoors Consider in reducing risk of falls Consider when using compression bandage, lymphoedema, diabetic foot
Avoid Always encourage to wear their own footwear and consider reducing the risk of falls
- 84 -
Bandages Product Light weight conforming bandage
K Band Sizes & Prices
DT Price NHS Price 5 cm x 4 m 19p £2.18 (20) 7 cm x 4 m 24p £2.62 (20) 10 cm x 4 m 26p £2.43 (20) 15 cm x 4 m 46p £4.80 (20)
Use Conforming retention bandage Avoid Do not apply with full tension Application Spiral bandage method Tips Change as directed by primary dressing
Product Sub compression wadding bandage K-Soft
Sizes & Prices
DT Price NHS Price 10 cm x 3.5 m 41p Not listed
10 cm x 4.5 m 51p £14.65 (24)
Use Latex free, conformable absorbent sub- compression wadding. Use for absorbency and beneath compression
Avoid Uneven application Application Spiral bandage method Tips Change as directed by primary dressing
- 85 -
Product Light weight conforming bandage Cellona
Sizes &
Prices
DT Price NHS Price 5 cm x 2.75 m 29p Not listed 7.5 cm x 2.75 m 35p Not listed 10 cm x 2.75 m 43p Not listed
15 c 15 cm x 2.75 m 56p Not listed Use Padding for use under compression,
particularly Lymphoedema Avoid Do not use to apply compression Application Spiral bandage method Tips Cha Change as directed by primary dressing
Product Type 2 light support bandage K-Lite
Sizes &
Prices
DT Price NHS Price
5 cm x 4.5 m 52p £6.90 (16) 7 cm x 4.5 m 73p £9.65 (16) 10 cm x 4.5 m 95p £11.53 (16) 15 cm x 4.5 m £1.38p £18.27 (16)
10 cm X 5.25 m £1.11 £18.78 (16) Use Type 2 Light support
Layer number 2 in multi- component bandaging
Application Spiral bandage method
Tips Change as directed by primary dressing
Avoid Do not use to apply compression
- 86 -
Product Knitted elastomer & viscose bandage K-Plus
Sizes & Prices DT Price NHS Price
10 cm x 8.7 m £2.14 £44.30 (24)
10 cm x 10.25 cm long
£2.47 £67.10 (24)
Use Type £A Light compression. 3rd layer in multi-component bandaging
Application Education required in the correct application Apply at mid-stretch 50% in a figure of 8 with 50% overlap from toe to knee Applies 17mm at the ankle on an ankle 18-25 cm Apply as manufacturer’s instructions
Tips May be left in place for 7 days Avoid Multi- component compression is contra-indicated
in patients with arterial disease/ulcers May be used on patients with mixed aetiology under the advice of vascular clinic
- 87 -
Product Cohesive extensible bandage
Sizes & Prices DT Price
NHS Price
Coban 10 cm x 6 m £2.79 £3.06 (1)
Profore #4
£3.32
£50.77 (12)
Ko-Flex 10 cm x 6 m £2.76 £59.40 (18)
Ko- Flex 10 cm x 7 m £3.25 £62.96 (18)
Use Outer layer of multi-layer compression Application Education required in the correct
application. Apply at mid-stretch 50% in a spiral with 50% overlap from toe to knee Delivers 23 mm at ankle of 18 - 25 cm Apply as manufacturer’s instructions
Tips May be left in place for 7 days
Avoid Multi layer compression is contra-indicated in patients with arterial disease and/ulcers
Product Multi-layer compression bandaging Kits
Multi-Layer Kits
DT Price
NHS Price
K-Four 18 - 25 cm £6.73 £7.42 (each
Profore up to 18 cm £9.58 £12.24
Profore 18 - 25 cm £8.92 £11.14
Profore 25 - 30 cm £7.41 £9.51
Profore > 30 cm £11.09 £13.84
- 88 -
Profore Lite £5.15 £6.74
Sizes K- Four - for ankle circumference 18 - 25 cm Profore - for ankle circumference <18 cm,18-25 cm, 25-30 cm, >30 cm
Multilayer
Components Profore (L3 based) Components
DT Price NHS Price
Profore # 1 £0.66 £10.09
(12)
Profore # 2 £1.27 £17.15
(12) L 3 (Class 3a Light Compression layer) £2.11 £24.84 Profore # 4 £3.06 £3.77 Total ( #1,#2,L3,#4 components)
£7.10 £8.52
Profore + £3.46 £57.18 (12)
Latex Free
Formulation
(LFF)
Profore (L3 based) Latex Free Components
Profore # 1(LFF) £0.72 £10.98
(12)
Profore # 2 (LFF) £1.35 £20.55
(12)
L3 (LFF) £2.11 £24.84
(10)
Profore # 4 (LFF) £3.32 £50.77
(12) Total (#1,#2,L3,#4 components) £7.35 £9.34
Profore (+) LFF £3.60 £57.18(
12)
- 89 -
Use Venous leg ulceration and lymphoedema
Application Education required in the correct application. Doppler assessment required prior to the application of compression therapy. Always measure above the malleoli at each application
Tips Apply as manufacturer’s instructions Remember to measure each leg on each application
Avoid Arterial disease, arterial ulcers, diabetes and those with small vessel disease Do not mix components from different companies as bandages are designed to be used as a system
Product Pro guide compression kits
Sizes & Prices DT Price NHS Price Red 18 - 22 cm £9.23 £11.80
Yellow 22 - 28 cm £9.75 £12.45
Green 28 - 32 cm £10.24 £13.07
Use For compression therapy Application Education required in the correct
application. Kit includes wound contact layer padding and compression. Apply as manufacturer’s instructions
Tips May be left in place for 7 days
Avoid In those requiring reduced compression NOT FOR USE IN WAHNHST
- 90 -
Product Short stretch cohesive Compression bandage Actico
Size & Price DT Price
NHS Price
4 cm x 6 m
£2.25 £2.90 each
6 cm x 6 m
£2.64 £3.40 each
8 cm x 6 m
£3.03 £3.89 each
10 cm x 6 m
£3.15 £4.17 each
12 cm x 6 m
£4.02 £5.07 each
Flexi-ban padding 10 cm x 3.5 m
47p
Not listed
Use Venous leg ulceration, Lymphoedema and Chronic Oedema. Standard limb size
18 - 25 cm use I bandage >25 cm need 2 bandages
For use with mobile and immobile patients Not available in WAHNHST
Application Applied at full stretch using circular, spiral or figure of 8 technique over adequate padding Education required in the correct application. Doppler assessment required
Tips Apply as manufacturer’s instructions
Avoid Arterial disease, arterial ulcers, diabetes and those with small vessel disease
- 91 -
Product Coban 2. Multi-layer compression bandage kit
Size& Price DT Price NHS Price £8.08 £10.00 each
Use 2 layer latex free, foam bandage and cohesive. Only one size available
Avoid In those whose limb needs re-padding and re-shaping
Application Education required in the correct application. Doppler assessment required.
Tips Kit contains 1 roll padding foam and bandage
Product High compression bandage system
Size) & Price DT Price NHS Price Tensopress 10 cm x 3 m
£3.29 37.25 (10)
Use Venous leg ulceration and lymphoedema Avoid Arterial disease, arterial ulcers, diabetes and
those with small vessel disease
Application Always measure above the malleoli at each application Education required in the correct application. Doppler assessment required prior to the application of compression therapy. Spiral bandage application
Tips Apply as manufacturer’s instructions
- 92 -
Retention
Product Actiwrap Tape free retention cohesive bandage
Sizes & Prices (x 4 m each) DT Price NHS Price 6 cm 44p Not listed 8 cm 64p Not listed
10 cm 75p Not listed Use Retention bandage that is cohesive and
conformable Avoid Do not use to apply compression.
Patients with latex allergy
Product Tubular retention bandaging – elasticated viscose stockinette.
Sizes & Prices Actiifast DT Price NHS Price Some also as 3m & 5m
Primary Care
Secondary Care
3.5 cm x1 m (red) 56p Not listed 5 cm x1 m (green) 58p Not listed
7.5 cm x1 m (blue) 77p Not listed 10.75 cm x1 m (yellow)
£1.20 Not listed
17.5 cm x1 m (beige)
£1.83 Not listed
Use Retention
- 93 -
Chronic Oedema/Lymphoedema A number of products are used in Chronic Oedema and Lymphoedema which are already listed in this Formulary and include: Page Activa hosiery 76-82 Medi hosiery 76-82 Jobst 78 Actiglide 82 Actico 90 Cellona 85 Aqueous Cream 96 50/50 ointment 97 Juxtafit Any wound management dressing Other garments may be used in Lymphoedema management. As there are many options and an increasing range, the appropriate websites are listed: Medis: www.mediuk.co.uk Haddenan: www.hadhealth.com Sigvaris: www.sigvaris.com Juzo: www.juzo.com As more bandages become available on FP10, please contact the Lymphoedema service on 01386 502030 for advice.
- 94 -
Product Hosiery – ActiLymph – European
Hosiery
Prices DT Price NHS price Class 1 18 - 21 mmHg Below Knee
£26.21 N/A
Class 1 18 - 21mmhg Thigh
£51.36 N/A
Class 2 23 - 32mmHg Below Knee
£26.21 N/A
Class 2 23 - 32mmHg Thigh
£51.36 N/A
Class 3 34 - 46mmHg Below Knee
£29.35 N/A
Class 3 34 - 46mmHg Thigh
£53.46 N/A
Sizes Requires measurement of 2cm above ankle, length of foot, widest part of calf, and for thigh length measure 5 cm below groin Available in open and closed toe S,M,L,XL,XXL
Use Prevention & recurrence of Venous leg ulceration after bandaging of limbs with Chronic Oedema /Lymphoedema
- 95 -
Application Use Acti-glide to assist with application Patient may select colour Doppler assessment required prior to the application of compression therapy
Tips Apply as manufacturer’s instructions Remember to measure each leg on each application
Avoid Arterial disease, arterial ulcers, diabetes and those with small vessel disease THOSE UNSUITABLE FOR COMPRESSION Circumferential leg ulceration due to high exudate level
- 96 -
Cream Product Aqueous cream Sizes & prices
DT Price NHS Price 50g, 100g & 500g
50p for 100gram
Not listed
Use As a soap substitute for patients with eczema and very sensitive skin As a moisturiser for dry skin
Application Moisturiser- apply until absorbed into the skin. Soap substitute - rub well into dry skin and then apply water to remove Apply to skin following direction of hair growth (to avoid Folliculitis)
Tips Apply frequently, even after improvement occurs. First choice agent in mild cases, as approximately five times cheaper than E45
Avoid If sensitisation occurs (rarely)
Product Liquid and White Soft Paraffin Ointment 50% liquid paraffin, 50% white soft paraffin
Sizes & prices
DT Price NHS Price 250gram £3.24 Not listed 500gram N/A Not listed
Use As a moisturiser for very dry skin Application Apply until absorbed into the skin
Apply to skin following direction of hair growth (to avoid Folliculitis)
Avoid Any source of open heat If sensitisation occurs (very rarely)
Please note This product is not listed within some primary care prescribing systems and may therefore require handwritten prescriptions Nb. Unlicensed product
- 97 -
Product Eucerin Intensive
Sizes & prices
10% cream DT Price NHS Price 100 ml £7.15 Not listed
10% lotion £6.67 Not listed 250 ml £7.93 Not listed Use Used on hyperkeratosis Application Apply sparingly twice daily
Product Flamazine (independent prescribers only)
Sizes &
Prices
DT Price
Central Contract from S&N
20g £2.91 £2.20 50g £3.85 250g £10.32 £8.98 500g £18.27 £15.55
Use Burns - If referring the patient do not apply before seen by specialist apply cling film to allow extent of the injury to be seen Abrasions and finger tip injuries, Infected / critically colonised & low exuding wounds
Application Apply 5 mm layer of cream directly to wound Requires absorbent secondary dressing Apply daily for burns Apply three times weekly for chronic wounds
Avoid SENSITIVITY TO SILVER & SULPHONAMIDES Exposure to sunlight causes discolouration (agyria) Renal/hepatic insufficiency, pregnant women and neonates
- 98 -
roduct Haelan Cream/ointment Sizes & Prices
DT
Price NHS Price
60g cream £3.26 Not listed 60g ointment £3.26 Not listed
Use Contains fludroxycortide 4 mcg/cm2 Moderate potency For use in over-granulation. GP prescribing and Advanced Nurse prescribing only
Avoid Prolonged use, particularly on the face. Contra-indicated in bacterial, fungal or viral lesions. Also see www.bnf.org
Application Apply thinly 1-2 times daily
Product Haelan Tape Sizes & Prices
DT
Price NHS Price
7.5 cm x 50 cm £9.27 Not listed 7.5 x 200 cm £24.96 Not listed
Use Contains fludroxycortide 4 mcg/cm2 Moderate potency For use in over-granulation.
Application Cut tape to fit lesion and apply for 12 hours daily.
- 99 -
Product Metronidazole Gel (independent prescribers only)
DT Price NHS Price Anabact 0.75% 15g
£4.47 Not listed
30g £7.89 Not listed Metrotop 0.8% 15g
£4.73 Not listed
30g £8.36 Not listed
60g N/A Not listed Use To control malodour from superficial
anaerobic colonisation especially in fungating carcinomas and chronic wounds
Application Apply liberally to wound surface once or twice daily. For infected leg ulcers- use one- two weeks treatment Use tubes for single patient use Requires a secondary dressing
Tips Occluding wound with suitable dressing will help to control odour. If signs of systemic infection apparent swab wound. Treatment of anaerobic infection requires administration of oral metronidazole, 200mg - 400mg three times a day for 7-10 days. Data sheet for topical and oral available on www.medicines.org.uk
Avoid Use in pregnancy or lactation Known hypersentivity to metronidazole
- 100 -
Product Sorbaderm barrier film / cream Sizes & prices
DT Price NHS Price 1 ml £4.45 £4.80 (5) 3 ml Pack of 5 £7.20 £7.91(5)
28 ml spray £5.99 £7.19 (each)
Cream 2g sachet x 20
£6.66 £8.13 (20)
Cream 92g tube
£7.19 £8.22 (each)
Use Protection from body fluids including wound exudate Protection from tapes and dressings
Application Apply film to clean dry skin Apply cream very sparingly after every third episode of incontinence (NB Cream is not no-sting) Film will aid adhesion of tapes and adhesive dressings, creams will not prevent dressings from sticking
Tips Lasts for 72 hours When used under a dressing to protect fragile skin, apply at every dressing change Use single application when there is a need to spray upwards/avoid spraying near eyes
Avoid Infected skin Very fragile skin, as Sorbaderm film will aid adhesion of the dressing