HANDBOOK October 2016 · HANDBOOK October 2016 . Wound Formulary October 2016 Version 7(1) ... when...
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Moisture Risk Risk Ulcer Ulcer Ulcer Ulce Posture Posture Posture Preventio Prevention ention Prevention ound nd Wound re Moisture Moisture Moisture Grade rade Grade Basingstoke, Southampton and Winchester District Prescribing Committee and Portsmouth and South East Hampshire Area Prescribing Committee Pressure Pressure Risk Ulcer Posture Prevention Wound Wound Formulary HANDBOOK October 2016
Transcript of HANDBOOK October 2016 · HANDBOOK October 2016 . Wound Formulary October 2016 Version 7(1) ... when...
1
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
Moisture
Risk
Risk
Ulcer
UlcerUlcer
Ulcer
Posture
PosturePosture
Prevention
Prevention
Prevention
Prevention
Wound
Wound
WoundMoisture
Moisture
Moisture
MoistureGrade
Grade
Grade
Basingstoke, Southampton and Winchester District Prescribing Committee and Portsmouth and South East Hampshire Area Prescribing Committee
Pressure
Pressure
Risk
Ulcer
Posture
Prevention
Wound
Wound FormularyHANDBOOK October 2016
Wo
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d F
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ula
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cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
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e B
asin
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oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
2
Introduction Dressings are only one component of wound care and, on their own, will not heal wounds. It is assumed that each healthcare professional will be responsible for ensuring they are up to date with current wound/skin care practice and ensure they are familiar with the products selected for use.
The purpose of the Hampshire wide Wound Formulary is to provide a list of dressings, bandages, hosiery and topical applications, which based on the evidence available, should be selected for approximately 90% of prescribing in this area.
There may be a small number of occasions when, after using the Wound Formulary 1st and 2nd line, you consider a non-formulary product may be appropriate.
In secondary/acute care settings there may be differences due to availability and procurement routes which will be highlighted where known-please refer to local protocols. These dressings can be switched to formulary equivalents once the patient is discharged to primary care, unless a particular dressing is requested by a TVN or clinical specialist.
The Wound Formulary is a working document with input from all disciplines across nursing, pharmacy and podiatry within acute and primary care. The Wound Formulary Group continues to meet to provide a forum for the evaluation of new and current products and to document the evidence available for
inclusions to the Wound Formulary for consideration by the District Prescribing Committee.
Product selection has been based on evidence of efficacy (although there is little research evidence available), manufacturers literature, practical experience of use and cost effectiveness. The recommendations have been developed by collaboration between health professionals from primary care and secondary care.
In the Wound Formulary we have provided an Exception Reporting form (available electronically) for use when non-formulary products are used. The information that you provide will be reviewed by the Wound Formulary Group and will be taken into consideration when the formulary is revised and updated. The Wound Formulary Group requires feedback/comments/rationales on the form. (See last section at bottom of page).The group also value any comments you have regarding this edition of the formulary.
NB Not all products are available in secondary care. Please refer to local policy. General References sources: BNF Sept 2016: 70, SHIP Guidelines for Antibiotic Prescribing in the Community 2014, Journal of Wound Care Handbook www.woundcarehandbook.com,
www.worldwidewounds.com, www.evidence.nhs.uk, www.nice.org.uk, www.sign.ac.uk, www.tissueviabilityonline.com/, www.ewma.org, www.britishjournalofnursing.com, www.wounds-uk.com/pdf/content_9364.pdf, Drug Tariff December 2016
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asin
gst
oke
, So
uth
amp
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d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
3
Contents
1. Non/Low Adherent Dressings ..................................................... 4
2. Adhesive Film ............................................................................ 4
3. Topical Antibacterials ................................................................. 5
4. Odour Control ........................................................................... 7
5. Alginates ................................................................................... 8
6. Gelling Fibre Dressings ............................................................... 8
7. Hydrogel .................................................................................... 9
8. Foam Dressings ........................................................................ 10
9. Hydrocolloids ........................................................................... 10
10. Paste Bandages ........................................................................ 11
11. Bandages ................................................................................. 11
12. Support Hosiery ....................................................................... 16
13. Adhesive Tape .......................................................................... 18
14. Absorbent Dressings ................................................................ 18
15. Miscellaneous .......................................................................... 19
Appendix 1 Aseptic technique and 2 Protocol for taking swab ..... 21
Appendix 3 Best Practice in Older Persons skin care ...................... 22
Appendix 4a Sign Checker ........................................................... 24
Appendix 4b Sign Checker flow chart .......................................... 25
Appendix 4c Critically Colonised/Infected wound ......................... 26
Appendix 5 Product Selection Tools Skin Tear ........................................................................................ 28 Superficial Burns/Scalds .................................................................. 29 Epithelialising Wounds, Granulating Wounds ................................. 30 Over Granulation ........................................................................... 31 Sloughy Wounds ............................................................................ 32 Necrotic ......................................................................................... 33 Fungating ...................................................................................... 34 Sinus/Cavity Wounds ..................................................................... 35
Appendix 6 Contacts .................................................................... 36
Appendix 7 Signposting /Useful References .................................. 38
Appendix 8 Exception Reporting Form .......................................... 39
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2016 V
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amp
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istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
4
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/D
ress
ing
Co
mm
ents
1. N
ON
/LO
W
AD
HER
ENT
DR
ESSI
NG
S
Atr
aum
an®
5x5c
m
7.5x
10cm
10
x20c
m
20x3
0cm
27p
28p
63p
£1.7
4
Kni
tted
pol
yest
er d
ress
ing
impr
egna
ted
with
neu
tral
trig
lyce
rides
. M
ay n
ot b
e su
itabl
e fo
r pa
tient
s w
ith s
ensi
tiviti
es t
o co
conu
t or
its
deriv
ativ
es. C
onsi
der
Tric
otex
® f
or p
atie
nts
with
coc
onut
alle
rgy.
1. C
onsi
der
Mep
itel®
for
larg
e sk
in t
ears
whe
re t
he s
kin
flap
need
s im
mob
ilisi
ng.
2. T
ricot
ex® is
sug
gest
ed a
s an
alte
rnat
ive
for
sim
ple
non
adhe
rent
dr
essi
ngs
NB
An
Exce
ptio
n re
port
ing
form
will
be
need
ed in
bot
h in
stan
ces.
Plea
se s
tore
flat
to
avo
id s
tick
ing
Ch
oic
e o
f d
ress
ing
fo
r u
se u
nd
er t
op
ical
neg
ativ
e p
ress
ure
is
det
erm
ined
by
loca
l sp
ecia
list
advi
ce
Soft
pore
®6x
7cm
(3
x4cm
) 10
x10c
m
(5x6
cm)
10x1
5cm
(5
x10c
m)
10x2
0cm
5x
15cm
10
x25c
m
(5x2
0cm
) 10
x30c
m
(5x2
5cm
)
6p
13
p 20
p 35
p 40
p 49
p
Not
to
be u
sed
on f
ragi
le s
kin.
For
min
or s
uper
ficia
l wou
nds
whe
re a
ll th
at is
req
uire
d is
pro
tect
ion
from
fric
tion.
Can
be
used
as
a po
st o
p dr
essi
ng w
hich
may
sta
y in
pla
ce 3
– 5
da
ys.
Wou
nd c
onta
ct p
ad s
ize
in b
rack
etts
2. A
DH
ESIV
E FI
LM V
apo
ur
per
mea
ble
fi
lm
Hyd
rofil
m®
6x7c
m
10x1
2.5c
m
10x1
5cm
10
x25c
m
12x2
5cm
15
x20c
m
20x3
0cm
23p
42p
53p
82p
87p
97p
£1.6
1
Dry
, non
-infe
cted
wou
nds;
ret
entio
n of
line
s; fi
xatio
n of
sec
onda
ry
dres
sing
s.
NB:
man
agem
ent
of IV
site
s –
refe
r to
loca
l gui
delin
es
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
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7(1
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asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
5
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
Man
agem
ent
of
crit
ical
ly c
olo
nis
ed a
nd
infe
cted
wo
un
ds
App
endi
ce 4
a, 4
b an
d 4c
for
Sig
n C
heck
er, F
low
Cha
rt a
nd g
uida
nce
on c
hoic
e of
dre
ssin
gs. A
ll an
timic
robi
al d
ress
ings
sho
uld
be
used
for
tw
o w
eeks
onl
y. E
xper
t sp
ecia
list
advi
ce a
nd g
uida
nce
shou
ld b
e so
ught
if a
ntim
icro
bial
dre
ssin
gs a
re r
equi
red
for
a lo
nger
pe
riod.
NB:
som
e an
timic
robi
al d
ress
ings
to
be c
ut t
o si
ze o
f w
ound
. Do
not
appl
y to
inta
ct s
kin
exce
pt f
or M
edih
oney
HC
S
3. T
OPI
CA
L A
NTI
MI-
C
RO
BIA
LS
a. I
od
ine
bas
ed
Inad
ine®
Iodo
flex®
5x5c
m
9.5x
9.5c
m
5g
10g
33p
49p
£4.1
3 £8
.25
Non
-adh
eren
t dr
essi
ng im
preg
nate
d w
ith 1
0% p
ovid
one-
iodi
ne. C
olou
r ch
ange
indi
cate
s w
hen
to c
hang
e dr
essi
ng.
Man
agem
ent
and
prev
entio
n of
infe
ctio
n in
ulc
ers,
min
or b
urns
and
m
inor
tra
umat
ic s
kin
inju
ries.
Not
eff
ectiv
e in
med
ium
to
heav
y ex
udat
e.
Cad
exom
er d
ress
ing
with
iodi
ne. F
or t
he t
reat
men
t of
chr
onic
exu
ding
w
ound
s. N
ot t
o be
use
d on
dry
nec
rotic
tis
sue.
C
an a
pp
ly u
p t
o 5
0g p
er d
ress
ing
ch
ang
e, c
ove
r w
ith
sec
on
dar
y d
ress
ing
; ch
ang
e w
hen
pas
te is
sat
ura
ted
. Do
no
t ex
ceed
150
g
Iod
ofl
ex® p
aste
in o
ne
wee
k o
r m
ore
th
an 3
mo
nth
s si
ng
le c
ou
rse
of
trea
tmen
t. B
E A
WA
RE
OF
CO
NTR
AIN
DIC
ATI
ON
S FO
R U
SE. S
ee S
PC
b. H
on
eyM
edih
oney
®
Ant
ibac
teria
l M
edic
al
Hon
ey
Med
ihon
ey®
Tulle
dre
ssin
g
Med
ihon
ey®
Ant
ibac
teria
l H
oney
A
pina
te
Med
ihon
ey®
HC
S
Adh
esiv
e
20g
50g
10x1
0cm
10x1
0cm
1.
9x30
cm
6x6c
m
11x1
1cm
11x1
1cm
£3.9
6
£9.9
0
£2.9
8
£3.4
0 £4
.20
£2.2
4 £4
.47
£3.0
6
Med
ical
hon
ey. U
sefu
l on
sinu
s w
ound
s. In
dica
ted
for
infe
cted
or
criti
cally
col
onis
ed w
ound
s. C
an b
e ef
fect
ive
if m
alod
our
pres
ent,
as
a de
slou
ghin
g ag
ent
or in
the
tre
atm
ent
of n
ecro
tic w
ound
s.
Stro
ng w
oven
dre
ssin
g im
preg
nate
d w
ith a
ntib
acte
rial h
oney
, ste
rile.
For
su
perfi
cial
wou
nds.
Non
-adh
eren
t, n
on-a
bsor
bent
, pro
teas
e m
odul
atin
g m
atrix
, ste
rile.
C
onta
ins
calc
ium
and
ant
ibac
teria
l Hon
ey
An
all-i
n-on
e dr
essi
ng t
hat
com
bine
s 63
% M
edih
oney
in a
hyd
roge
l dr
essi
ng w
ith a
sup
erab
sorb
ent
poly
mer
. The
adh
esiv
e dr
essi
ng d
oes
not
requ
ire a
sec
onda
ry d
ress
ing.
For
dry
to
mod
erat
ely
exud
atin
g w
ound
s.
Oth
er s
izes
for
spe
cial
ist
use
only
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2016 V
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oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
6
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
c. T
op
ical
A
nti
mic
rob
ials
(c
on
t) P
HM
B
d.
Irri
gat
ion
e. A
nti
mic
rob
ial
wo
un
d
con
tact
laye
r
Supr
asor
b X
+
PH
MB®
Pron
tosa
n®
Pron
tosa
n®
Cut
imed
So
rbac
t®
swab
5x5c
m
9x9c
m
14x2
0cm
2x
21cm
35
0ml
bott
le
40m
l pod
30m
l gel
4x6c
m
(11x
16cm
) 7x
9cm
(1
7x27
cm)
£2.5
7
£5.1
2 £1
1.64
£7
.25
£4.7
8 £1
4.18
(2
4 po
ds)
£6.3
8
£1.6
5
£2.7
5
Ligh
t to
mod
erat
ely
exud
ing,
sup
erfic
ial a
nd d
eep,
crit
ical
ly c
olon
ised
an
d in
fect
ed w
ound
s. B
io-c
ellu
lose
dre
ssin
g im
preg
nate
d w
ith b
road
-sp
ectr
um a
ntim
icro
bial
(PH
MB
(pol
yhex
amet
hyle
ne b
igua
nide
0.3
%).
Can
be
effe
ctiv
e if
the
wou
nd is
in
fect
ed a
nd p
ainf
ul.
Wou
nd ir
rigat
ion
solu
tion
cont
aini
ng B
etai
ne w
hich
is a
gen
tle e
ffec
tive
surf
acta
nt w
hich
pen
etra
tes,
dis
turb
s an
d re
mov
es b
iofil
m a
nd w
ound
de
bris
, and
PH
MB
to h
elp
cont
rol b
acte
rial l
evel
s on
the
wou
nd.
No
te: f
or
sin
gle
pat
ien
t u
se t
he
350m
l bo
ttle
is m
ore
co
st
effe
ctiv
e an
d h
as a
sh
elf
life
of
8 w
eeks
on
ce o
pen
ed. P
ron
tosa
n
po
ds
sho
uld
be
rese
rved
fo
r ac
ute
use
on
ly.
Cle
ansi
ng, d
econ
tam
inat
ion
and
moi
stur
isin
g of
acu
te a
nd c
hron
ic s
kin
wou
nds,
firs
t an
d se
cond
deg
ree
burn
s.
(Impr
egna
ted
with
dia
lkyl
carb
amoy
l chl
orid
e)
DA
CC
-coa
ted,
hyd
roph
obic
, ant
imic
robi
al w
ound
con
tact
laye
r de
sign
ed t
o bi
nd b
acte
ria u
nder
moi
st w
ound
con
ditio
ns. T
he
dres
sing
can
be
used
fol
ded
or u
nfol
ded.
Prim
ary
dres
sing
for
co
ntam
inat
ed, c
olon
ised
or
infe
cted
sup
erfic
ial o
r de
ep w
ound
s in
clud
ing
supe
rfici
al w
ound
s, t
raum
atic
wou
nds,
pos
tope
rativ
e or
de
hisc
ed w
ound
s, u
lcer
s (v
enou
s, a
rter
ial,
diab
etic
, pre
ssur
e) a
nd
fung
al in
fect
ions
. Sui
tabl
e fo
r fu
ngal
infe
ctio
ns in
the
gro
in, s
kin
fold
s, o
r be
twee
n di
gits
.
f. S
ilver
Dur
afibe
r A
g®5x
5cm
10
x10c
m
15x1
5cm
2x
45cm
4x
10cm
4x
20cm
4x
30cm
£1.7
9 £4
.26
£8.0
1 £4
.27
£2.5
9 £3
.37
£5.0
5
A h
ighl
y ab
sorb
ent,
non
-wov
en, s
ilver
gel
ling
fibre
dre
ssin
g co
mpo
sed
of a
ble
nd o
f ce
llulo
se-b
ased
fibr
es. D
ress
ing
fibre
s co
min
g in
to c
onta
ct w
ith e
xuda
te s
wel
l and
for
m a
sof
t co
hesi
ve g
el s
heet
. Ex
udat
e is
lock
ed in
the
dre
ssin
g st
ruct
ure.
Use
as
a pr
imar
y dr
essi
ng
for
mod
erat
ely
to h
ighl
y ex
udin
g w
ound
s w
here
the
re is
infe
ctio
n.
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d F
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ula
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7(1
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ed b
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asin
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oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
7
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
4. O
DO
UR
C
ON
TRO
L
NB
: ch
arco
al is
n
ot
effe
ctiv
e o
nce
wet
Clin
isor
b®
10x1
0cm
10
x20c
m
15x2
5cm
£1.9
1 £2
.54
£4.0
9
Ster
ile a
ctiv
ated
cha
rcoa
l clo
th s
andw
iche
d be
twee
n la
yers
of
nylo
n/vi
scos
e ra
yon
clot
h. A
pply
as
a se
cond
ary
dres
sing
ove
r an
app
ropr
iate
pr
imar
y dr
essi
ng. E
xuda
te w
ill r
educ
e th
e dr
essi
ng’s
effe
ctiv
enes
s. C
an
be c
ut t
o si
ze. C
an b
e us
ed in
the
man
agem
ent
of m
alod
orou
s w
ound
s su
ch f
unga
ting
wou
nds,
pre
ssur
e ul
cers
, leg
ulc
ers
and
diab
etic
foo
t ul
cers
. May
wis
h to
con
side
r us
ing
Ana
bact
® (n
on f
orm
ular
y).
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
8
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
5. A
LGIN
ATE
S
NB:
Kal
tost
at®
On
cont
act
with
a b
leed
ing
wou
nd, p
rom
otes
ha
emos
tasi
s bu
t sh
ould
not
be
left
in
pla
ce. L
ocal
gu
idan
ce is
to
leav
e fo
r 10
min
s an
d th
en r
emov
e.
Kal
tost
at® is
non
-fo
rmul
ary.
NB:
use
onl
y w
here
you
can
see
th
e ba
se o
f th
e w
ound
as
fibre
s/dr
essi
ng c
an b
e le
ft in
situ
Supr
asor
b A
®
Supr
asor
b A
®
Rope
5x5c
m
10x1
0cm
2g(3
0cm
)
63p
£1.2
3
£2.2
8
Cal
cium
alg
inat
e pr
imar
y dr
essi
ng f
or u
se in
sha
llow
, moi
st w
ound
s.
For
man
agem
ent
of m
oder
atel
y or
hea
vily
exu
ding
wou
nds.
Seco
ndar
y dr
essi
ngs
are
requ
ired
to s
uppo
rt t
he a
lgin
ate
in s
itu a
nd
mai
ntai
n a
moi
st e
nviro
nmen
t.
Is e
asily
rem
oved
by
irrig
atio
n.
For
exud
ate
man
agem
ent
and
wou
nd h
ealin
g of
larg
e op
en o
r ca
vity
wou
nds.
6. G
ELLI
NG
FI
BR
E D
RES
SIN
G
Exufi
ber®
5x5c
m
10x1
0cm
15
x15c
m
2x45
cm
4.5x
10cm
4.
5x20
cm
4.5x
30cm
85p
£2.0
5 £3
.85
£1.8
5 £1
.12
£1.6
4 £2
.48
For
infe
cted
/hea
vily
exu
datin
g w
ound
s. D
o no
t us
e on
a d
ry o
r lo
w
exud
atin
g w
ound
. Req
uire
s se
cond
ary
dres
sing
.
Stro
ng p
olyv
inyl
alc
ohol
(PVA
) fibr
es t
hat
are
enta
ngle
d to
geth
er
in a
ll di
rect
ions
, as
wel
l as
mec
hani
cally
sec
ured
to
each
oth
er,
prov
idin
g hi
gh w
et in
tegr
ity (H
ydro
lock
®Te
chno
logy
). Lo
ckin
g pr
oper
ties
of t
he P
VA t
echn
olog
y, a
nd t
he e
ven
spac
e be
twee
n th
e fib
res,
min
imis
es f
ree
fluid
insi
de t
he p
rodu
ct, g
ive
it hi
gh
abso
rptio
n an
d re
tent
ion
capa
city
.
App
ly in
a c
avity
wou
nd o
r on
sha
llow
wou
nds.
Sho
uld
over
lap
the
wou
nd m
argi
ns.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
9
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
7. H
YD
RO
GEL
NB:
cut
to
size
an
d do
not
pla
ce
on in
tact
ski
n
No
n a
dh
esiv
e
Intr
aSite
C
onfo
rmab
le®
Ker
raLi
te
Coo
l®
10x1
0cm
10
x20c
m
10x4
0cm
6x6c
m
8.5x
12cm
£1.8
2 £2
.46
£4.4
0
£1.7
5 £2
.57
Prim
arily
indi
cate
d fo
r tr
eatm
ent
of n
ecro
tic a
nd s
loug
hy w
ound
s,
e.g.
leg
ulce
rs, p
ress
ure
ulce
rs a
nd n
on-in
fect
ed d
iabe
tic f
oot
ulce
rs.
Effe
ctiv
e fo
r de
slou
ghin
g an
d de
brid
ing
wou
nds.
For
dry
‘slo
ughy
’ or
necr
otic
wou
nds,
ligh
tly e
xuda
ting
wou
nds,
gr
anul
atin
g w
ound
s an
d ca
vitie
s. N
ot s
uita
ble
for
infe
cted
or
heav
ily e
xuda
ting
wou
nds.
Sec
onda
ry D
ress
ings
req
uire
d.
Intr
aSite
Con
form
able
® is
a h
ydro
gel s
heet
. It
has
the
adde
d ad
vant
age
of b
eing
bac
terio
stat
ic d
ue t
o its
pro
pyle
ne g
lyco
l co
nten
t. It
can
be
shap
ed t
o fit
the
wou
nd s
o re
duci
ng t
he r
isk
of
mac
erat
ion.
Con
side
r w
hen
pain
is a
sig
nific
ant
fact
or.
Soot
hing
, deb
ridin
g an
d m
oist
ure-
bala
ncin
g ge
l dre
ssin
g. M
anag
es
wou
nd e
xuda
te le
vels
and
pro
tect
s ag
ains
t w
ound
deh
ydra
tion
and
exte
rnal
bac
teria
l con
tam
inat
ion.
The
gel
pro
vide
s bo
th c
ushi
onin
g an
d ab
sorp
tion.
For
use
on c
hron
ic w
ound
s, p
ainf
ul w
ound
s, a
nd s
kin
cond
ition
s su
ch a
s le
g ul
cers
, rad
iatio
n th
erap
y da
mag
e, b
urns
and
sca
lds.
M
ay b
e us
ed o
n lo
w-e
xudi
ng a
nd n
on-e
xudi
ng w
ound
s to
ass
ist
in
auto
lytic
deb
ridem
ent
by h
ydra
tion
of n
ecro
tic a
nd s
loug
hy t
issu
e an
d fo
r ab
sorp
tion
of e
xuda
te.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
10
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
8. F
OA
M D
RES
SIN
G
Ad
hes
ive
No
n a
dh
esiv
e
Ad
hes
ive
Klin
ider
m®
Foam
Sili
cone
Bo
rder
Klin
ider
m®
Foam
Sili
cone
Biat
ain®
Si
licon
e
7.5x
7.5c
m
10x1
0cm
12
.5x1
2.5c
m
15x1
5cm
10
x20c
m
15x2
0cm
5x5c
m
10x1
0cm
10
x20c
m
15x1
5cm
20
x20c
m
7.5x
7.5c
m
10x1
0cm
12
.5x1
2.5c
m
15x1
5cm
£1.1
8 £1
.63
£2.3
3 £3
.95
£3.2
0 £5
.00
95p
£1.9
5 £3
.49
£3.9
5 £6
.50
£1.4
6 £2
.15
£2.6
3 £3
.90
For
use
on m
oder
atel
y ex
udin
g w
ound
s.
A s
oft,
con
form
able
abs
orbe
nt p
olyu
reth
ane
foam
dre
ssin
g w
ith a
n ad
hesi
ve s
ilico
ne w
ound
con
tact
laye
r an
d a
moi
stur
e pe
rmea
ble
film
bac
king
.
Foam
dre
ssin
gs s
houl
d be
left
in p
lace
for
up
to 7
day
s. T
heir
mod
e of
act
ion
mea
ns e
xuda
tes
will
be
visi
ble
but
this
doe
s no
t m
ean
the
dres
sing
req
uire
s ch
angi
ng. C
hang
e w
hen
strik
e th
roug
h 1c
m f
rom
edg
e.
Foam
dre
ssin
gs
sho
uld
no
t b
e u
sed
fo
r p
ress
ure
rel
ief
A s
oft,
abs
orbe
nt p
olyu
reth
ane
foam
pad
with
a v
apou
r-pe
rmea
ble
film
bac
king
and
a s
ilico
ne a
dhes
ive
bord
er.
9. H
YD
RO
CO
LLO
IDS
Ster
ile, t
hin
hydr
ocol
loid
dre
ssin
g.
Duo
DER
M®
Extr
a Th
in
Com
feel
® P
lus
Ulc
er
5x10
cm
7.5x
7.5c
m
10x1
0cm
4x6c
m
10x1
0cm
15
x15c
m
76p
81p
£1.3
3
96p
£2.4
6 £5
.27
To a
id d
ebrid
ing,
pro
mot
e gr
anul
atio
n, o
cclu
sive
bar
rier.
For
light
to
med
ium
exu
datin
g w
ound
s O
NLY
. Ens
ure
corr
ect
size
of
dres
sing
s ap
plie
d; o
verla
p th
e w
ound
by
at le
ast
two
cms
N.B
. Odo
ur f
rom
the
dre
ssin
g co
nstit
uent
s ca
n be
a
conc
ern
to p
atie
nts.
Not
sui
tabl
e fo
r in
fect
ed w
ound
s un
less
ob
serv
ed f
requ
ently
.
No
t in
dic
ated
ro
uti
nel
y o
n d
iab
etic
fo
ot
wo
un
ds-
co
nta
ct lo
cal D
iab
etic
/Fo
ot
Pro
tect
ion
Tea
m f
or
advi
ce.
Abs
orbe
nt h
ydro
collo
id d
ress
ing
with
add
ed a
lgin
ate
for
abso
rptio
n, a
vap
our-
perm
eabl
e fil
m b
acki
ng a
nd b
evel
led
edge
.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
11
Pro
du
ct T
ype
Pro
du
ct
nam
eSi
zeC
ost
/It
emC
om
men
ts
10.
PAST
E B
AN
DA
GES
Icht
hopa
ste®
7.5x
6m£3
.60
Chr
onic
ecz
ema/
derm
atiti
s w
here
occ
lusi
on is
indi
cate
d. Z
inc
past
e an
d ic
htha
mm
ol b
anda
ge.
Ensu
re a
ny r
esid
ue is
rem
oved
bef
ore
reba
ndag
ing.
Pa
tch
test
ing
requ
ired
prio
r to
use
. To
be a
pplie
d as
per
m
anuf
actu
rer’s
inst
ruct
ions
and
not
as
a pr
imar
y dr
essi
ng o
r as
a p
atch
.
11. B
AN
DA
GES
.
a) L
igh
t w
eig
ht
con
form
ing
b
and
ages
Pad
din
g
Elas
tica
ted
vis
cose
st
ock
inet
te
Ultr
a So
ft®
Ultr
a Li
te®
K-li
te®
Clin
iFas
t® /
Com
fifas
t®
10cm
x 3.
5m
10cm
x4.5
m
10cm
x4.5
m
3.5c
mx1
m
5cm
x1m
7.
5cm
x1m
10
.75c
mx1
m
17.5
cmx1
m
39p
85p
£1.0
1
56p
58p
77p
£1.2
0 £1
.83
Sub
com
pres
sion
pad
ding
ban
dage
use
d to
pro
tect
the
lim
b an
d fo
r sh
apin
g if
requ
ired
This
ban
dage
sho
uld
be u
sed
as a
n al
tern
ativ
e to
K L
ite
whe
re t
here
are
sym
ptom
s of
, or
iden
tified
art
eria
l dis
ease
pr
esen
t in
the
low
er le
g.
For
2nd-
line
use
afte
r U
ltra
Lite
®
Red
line
G
reen
line
Bl
ue li
ne
Yello
w li
ne
Beig
e lin
e
Als
o av
aila
ble
in 3
m a
nd 5
m le
ngth
s fo
r gr
een,
blu
e an
d ye
llow
line
, whi
ch m
ay b
e m
ore
cost
eff
ectiv
e.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
12
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
Plea
se s
ee L
oca
l Leg
Ulc
er T
reat
men
t A
lgo
rith
mA
LL h
ealt
hca
re p
rofe
ssio
nal
s m
ust
en
sure
th
eir
com
pet
enci
es f
or
app
lyin
g c
om
pre
ssio
n b
and
agin
g a
re u
p t
o d
ate
Art
eria
l scr
eeni
ng (i
.e. D
oppl
er u
ltras
ound
) mus
t be
unde
rtak
en b
efor
e co
mpr
essio
n ho
siery
or b
anda
ging
is c
omm
ence
d. N
ote
that
art
eria
l sc
reen
ing
mus
t be
repe
ated
per
iodi
cally
if c
ompr
essio
n th
erap
y is
ongo
ing.
Ref
: Loc
al L
eg U
lcer
Gui
delin
es/S
tand
ard
Ope
ratin
g Pr
oced
ures
11. B
AN
DA
GES
(c
ont’
d)
b) S
hort
str
etch
co
mpr
essi
on
band
ages
pr
ovid
ing
full
and
redu
ced
com
pres
sion
.
Act
ico®
(n
ot la
tex
free
)
Act
ico®
(n
ot la
tex
free
)
Cob
an® 2
laye
r co
mpr
essi
on
syst
em
Cob
an® 2
Lite
co
mpr
essi
on
syst
em
10cm
x6m
8 cm
x6m
12
cmx6
m
£3.3
8
£3.2
5 £4
.31
£8.2
4
£8.2
4
Coh
esiv
e sh
ort
stre
tch
band
ages
for
sin
gle
use
and
adap
ted
acco
rdin
g to
ank
le c
ircum
fere
nce.
Can
be
wor
n fo
r up
to
7 da
ys. R
ecom
men
ded
in
pat
ient
s w
ith a
n A
BPI o
f >
0.8
. 10c
m is
wid
th f
or r
outin
e be
low
kn
ee le
g ul
cer
band
agin
g.
8 an
d 12
cm
Act
ico
band
ages
are
for
use
in p
atie
nts
with
chr
onic
oe
dem
a . 8
cm s
houl
d be
app
lied
to t
he f
oot
and
12cm
to
the
thig
h.
The
Cob
an 2
ban
dage
sys
tem
is t
he s
econ
d lin
e ch
oice
sho
rt s
tret
ch
band
age
syst
em f
or p
atie
nts
requ
iring
ful
l com
pres
sion
whe
re A
ctic
o is
con
side
red
inap
prop
riate
, kno
wn
late
x al
lerg
y, o
r sl
ippa
ge m
ay b
e a
conc
ern.
This
sys
tem
is d
esig
ned
to b
e us
ed a
s a
kit
and
shou
ld n
ot b
e us
ed
with
oth
er w
addi
ng o
r ba
ndag
es.
Two-
laye
r co
mpr
essi
on s
yste
m t
hat
deliv
ers
sust
aine
d, t
hera
peut
ic
com
pres
sion
. To
be u
sed
as a
kit
com
pris
ing
of t
he la
tex-
free
foa
m
padd
ing
laye
r an
d a
late
x-fr
ee c
ohes
ive,
com
pres
sion
ban
dage
. Aft
er
appl
icat
ion
the
two
laye
rs b
ond
to f
orm
a s
ingl
e-la
yer
band
age.
Can
be
wor
n fo
r up
to
7 da
ys. R
ecom
men
ded
in p
atie
nts
with
an
ABP
I of
>
0.8.
10c
m is
the
ban
dage
wid
th f
or r
outin
e be
low
kne
e ba
ndag
ing.
The
Cob
an 2
® L
ayer
Lite
Com
pres
sion
Sys
tem
is d
esig
ned
to b
e co
mfo
rtab
le f
or p
atie
nts
less
tol
eran
t of
com
pres
sion
the
rapy
and
/or
who
re
quire
redu
ced
com
pres
sion
the
rapy
. Th
is s
yste
m is
des
igne
d to
be
used
as
a k
it an
d sh
ould
not
be
used
with
oth
er w
addi
ng o
r ba
ndag
es.
10cm
is t
he w
idth
for
rou
tine
belo
w k
nee
band
agin
g.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
13
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
Plea
se s
ee L
oca
l Leg
Ulc
er T
reat
men
t A
lgo
rith
mA
LL h
ealt
hca
re p
rofe
ssio
nal
s m
ust
en
sure
th
eir
com
pet
enci
es f
or
app
lyin
g c
om
pre
ssio
n b
and
agin
g a
re u
p t
o d
ate
Art
eria
l scr
eeni
ng (i
.e. D
oppl
er u
ltras
ound
) mus
t be
unde
rtak
en b
efor
e co
mpr
essio
n ho
siery
or b
anda
ging
is c
omm
ence
d. N
ote
that
art
eria
l sc
reen
ing
mus
t be
repe
ated
per
iodi
cally
if c
ompr
essio
n th
erap
y is
ongo
ing.
Ref
: Loc
al L
eg U
lcer
Gui
delin
es/S
tand
ard
Ope
ratin
g Pr
oced
ures
11. B
AN
DA
GES
(c
ont’
d)
b) S
hort
str
etch
co
mpr
essi
on
band
ages
pr
ovid
ing
full
and
redu
ced
com
pres
sion
.
Cob
an® 2
Com
fort
Fo
am L
ayer
(lay
er1)
Cob
an® 2
C
ompr
essi
on L
ayer
(la
yer
2)
Cob
an® 2
Lite
co
mfo
rt f
oam
laye
r (la
yer
1)
Cob
an® 2
Lite
co
mpr
essi
on la
yer
(laye
r 2)
Cob
an® 2
Com
fort
Fo
am L
ayer
(lay
er1)
Cob
an® 2
C
ompr
essi
on L
ayer
(la
yer
2)
10cm
x3.5
m
10cm
x4.5
m
10 c
mx2
.7m
10cm
x3.5
m
15cm
x3.5
m
15cm
x4.5
m
£7.4
5
£4.7
9
£5.8
1
£4.5
9
£11.
32
£7.1
4
Indi
vidu
al c
ompo
nent
s of
Cob
an 2
ban
dage
kit.
The
se m
ay
be r
equi
red
for
the
larg
er/ l
onge
r le
g.
Indi
vidu
al c
ompo
nent
s of
Cob
an® 2
Lite
ban
dage
kit.
Th
ese
may
be
requ
ired
for
the
larg
er/lo
nger
leg.
The
Cob
an®
2 1
5cm
wid
th b
anda
ge s
houl
d be
use
d fo
r ba
ndag
ing
the
knee
and
thi
gh o
f pa
tient
s w
ith c
hron
ic
oede
ma.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
14
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
Plea
se s
ee L
oca
l Leg
Ulc
er T
reat
men
t A
lgo
rith
mA
LL h
ealth
care
pro
fess
iona
ls m
ust
ensu
re t
heir
com
pete
ncie
s fo
r ap
plyi
ng c
ompr
essi
on b
anda
ging
are
up
to d
ate
Art
eria
l scr
eeni
ng (i
.e. D
oppl
er u
ltras
ound
) mus
t be
unde
rtak
en b
efor
e co
mpr
essio
n ho
siery
or b
anda
ging
is c
omm
ence
d. N
ote
that
art
eria
l sc
reen
ing
mus
t be
repe
ated
per
iodi
cally
if c
ompr
essio
n th
erap
y is
ongo
ing.
Ref
: Loc
al L
eg U
lcer
Gui
delin
es/S
tand
ard
Ope
ratin
g Pr
oced
ures
11. B
AN
DA
GES
(c
ont’
d)
b) S
hort
str
etch
co
mpr
essi
on
band
ages
pr
ovid
ing
full
and
redu
ced
com
pres
sion
.
Cob
an® 2
Lite
com
fort
fo
am la
yer
(laye
r 1)
Cob
an® 2
Lite
com
pres
sion
la
yer
(laye
r 2)
Com
prila
n® (L
atex
fre
e)
15cm
x2.7
m
15cm
x3.5
m
10cm
x5m
£8.7
7
£6.2
2
£3.3
7
The
Cob
an® 2
Lite
15c
m w
idth
ban
dage
sho
uld
be u
sed
for
appl
ying
red
uced
com
pres
sion
to
the
knee
and
thi
gh
of p
atie
nts
with
chr
onic
oed
ema.
Reus
able
sys
tem
(was
habl
e). H
igh
cott
on c
onte
nt.
For
spec
ialis
t ch
roni
c oe
dem
a m
anag
emen
t.
c) C
hro
nic
o
edem
aA
ctic
o® (n
ot la
tex
free
)
Com
prila
n® (L
atex
Fre
e)
Cob
an® 2
laye
r co
mpr
essi
on s
yste
m
Cob
an® 2
Com
fort
Foa
m
Laye
r (la
yer1
)
Cob
an® 2
Com
pres
sion
La
yer
(laye
r 2)
8cm
x6m
10
cmx6
m
12cm
x6m
10cm
x5m
Mul
ti-la
yer
com
pres
sion
ba
ndag
e ki
t
10cm
x3.5
m
10cm
x4.5
m
£3.2
5 £3
.38
£4.3
1
£3.4
1
£8.2
4
£7.4
5
£4.7
9
Band
ages
of
choi
ce f
or ly
mph
oede
ma/
chro
nic
oede
ma
man
agem
ent.
Two-
laye
r co
mpr
essi
on s
yste
m t
hat
deliv
ers
sust
aine
d,
ther
apeu
tic c
ompr
essi
on t
o be
use
d as
a k
it co
mpr
isin
g of
late
x-fr
ee f
oam
pad
ding
laye
r an
d a
late
x-fr
ee,
cohe
sive
, com
pres
sion
ban
dage
. App
ly t
he t
wo
laye
rs
whi
ch b
ond
to f
orm
a s
ingl
e-la
yer
band
age.
Can
be
wor
n fo
r up
to
7 da
ys. R
ecom
men
ded
in p
atie
nts
with
an
ABP
I of
> 0
.8.
The
Cob
an 2
® L
ayer
Lite
Com
pres
sion
Sys
tem
des
igne
d to
be
com
fort
able
for
pat
ient
s le
ss t
oler
ant
of
com
pres
sion
the
rapy
and
/or
redu
ced
ABP
I(ank
le b
rach
ial
pres
sure
inde
x).
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
15
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
ALL
hea
lth
care
pro
fess
ion
als
mu
st e
nsu
re t
hei
r co
mp
eten
cies
fo
r ap
ply
ing
co
mp
ress
ion
ban
dag
ing
are
up
to
dat
e A
rter
ial s
cree
ning
(i.e
. Dop
pler
ultr
asou
nd) m
ust b
e un
dert
aken
bef
ore
com
pres
sion
hosie
ry o
r ban
dagi
ng is
com
men
ced.
Not
e th
at a
rter
ial
scre
enin
g m
ust b
e re
peat
ed p
erio
dica
lly if
com
pres
sion
ther
apy
is on
goin
g. R
ef: L
ocal
Leg
Ulc
er G
uide
lines
/Sta
ndar
d O
pera
ting
Proc
edur
es
12.
SUPP
OR
T H
OSI
ERY
Cla
ss 1
Li
ght
(mild
) Sup
port
C
ompr
essi
on a
t an
kle
14-1
7mm
Hg
Cla
ss 2
M
ediu
m (m
oder
ate)
Su
ppor
t C
ompr
essi
on
at a
nkle
18
– 24
mm
Hg
Cla
ss 3
St
rong
Sup
port
C
ompr
essi
on a
t an
kle
25-3
5mm
Hg
Kit
Act
iva®
Act
iva®
Le
g U
lcer
Hos
iery
Kit
Belo
w k
nee
Thig
h le
ngth
Belo
w k
nee
Thig
h le
ngth
Belo
w k
nee
Thig
h le
ngth
1 St
ocki
ng
and
2 lin
ers
£7.5
2 £8
.24
£11.
00
£12.
24
£12.
47
£14.
51
£22.
90
The
mak
e of
hos
iery
sel
ecte
d de
pend
s on
co
mfo
rt, c
osm
etic
app
eara
nce
and
ease
of
appl
icat
ion.
Act
iva®
(Act
iva
Hea
lth C
are)
are
dee
med
the
pr
efer
red
prod
ucts
by
the
Form
ular
y G
roup
.
For
recu
rrin
g le
g ul
cera
tion
and
gros
s va
rices
.
Ava
ilabl
e as
sm
all,
med
ium
, lar
ge, e
xtra
larg
e an
d ex
tra
extr
a la
rge.
Use
ful f
or a
ctiv
e ul
cera
tion
to a
pply
ful
l com
pres
sion
for
pat
ient
s w
ho c
an’t
to
lera
te b
anda
ging
. Ass
essi
ng a
nd m
easu
ring
as
per
sing
le h
osie
ry p
rodu
cts.
Acc
esso
ries
Act
iva®
Li
ner
Pack
Act
i-Glid
e® C
ompr
essi
on
hosi
ery
appl
icat
ion
syst
em
3 Li
ners
£16.
84/
£17.
17
£14.
62
Line
r pa
ck a
vaila
ble
in a
ll si
zes,
ope
n an
d cl
osed
to
e.
Supp
ly o
f si
ngle
uni
t on
ly.
Wat
erp
roo
f Pr
ote
cto
rLi
mbO
®St
anda
rd a
nd
shor
t le
g£1
0.56
Ava
ilabl
e as
slim
, nor
mal
and
larg
e bu
ild.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
16
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
ALL
hea
lth
care
pro
fess
ion
als
mu
st e
nsu
re t
hei
r co
mp
eten
cies
fo
r ap
ply
ing
co
mp
ress
ion
ban
dag
ing
are
up
to
dat
e A
rter
ial s
cree
ning
(i.e
. Dop
pler
ultr
asou
nd) m
ust b
e un
dert
aken
bef
ore
com
pres
sion
hosie
ry o
r ban
dagi
ng is
com
men
ced.
Not
e th
at a
rter
ial
scre
enin
g m
ust b
e re
peat
ed p
erio
dica
lly if
com
pres
sion
ther
apy
is on
goin
g. R
ef: L
ocal
Leg
Ulc
er G
uide
lines
/Sta
ndar
d O
pera
ting
Proc
edur
es
12.
SUPP
OR
T H
OSI
ERY
(c
ont’
d)
Ho
sier
y fo
r C
hro
nic
oed
ema/
lym
ph
oed
ema
Cla
ss 1
18
-21m
mH
g
Cla
ss 2
23
-32
mm
Hg
Cla
ss 3
34
-46m
mH
g
Act
iLym
ph®
Ava
ilabl
e be
low
an
d ab
ove
knee
w
ith a
wid
e or
re
gula
r si
licon
e ba
nd t
o pr
even
t sl
ippa
ge a
t th
igh
1 st
ocki
ng p
er
pres
crip
tion
item
.
Varie
ty o
f co
lour
s,
size
s, o
pen
and
clos
ed t
oe.
Thes
e pr
oduc
ts in
crea
se t
he v
enou
s an
d ly
mph
atic
ret
urn
by
aidi
ng t
he a
bsor
ptio
n of
exc
ess
limb
fluid
. The
y ca
n he
lp in
th
e m
anag
emen
t of
rec
urrin
g ul
cers
and
whe
n co
nven
tiona
l ho
sier
y no
t co
ntai
ning
oed
ema
of li
mbs
. The
y ha
ve a
hig
her
‘Stif
fnes
s In
dex’
(aid
s st
imul
atio
n to
lym
ph t
o en
cour
age
fluid
ret
urn)
and
can
last
up
to 6
mon
ths
befo
re r
epla
cing
if
unda
mag
ed.
Prov
ide
light
com
pres
sion
for
ear
ly m
ild o
edem
a w
ith li
ttle
le
g di
stor
tion.
Sui
tabl
e fo
r ch
roni
c oe
dem
a, ly
mph
oede
ma,
lip
oede
ma,
pro
phyl
axis
, mai
nten
ance
the
rapy
, pal
liativ
e us
e.
Prov
ide
med
ium
com
pres
sion
for
mod
erat
e to
sev
ere
chro
nic
oede
ma
and
lym
phoe
dem
a, w
here
res
ista
nt o
edem
a oc
curs
an
d so
me
shap
e di
stor
tion.
Prov
ides
str
ong
com
pres
sion
and
sho
uld
be u
sed
for
mai
nten
ance
of
seve
re c
hron
ic o
edem
a an
d ly
mph
oede
ma,
w
here
res
ista
nt o
edem
a pe
rsis
ts, h
isto
ry o
f re
curr
ing
ulce
ratio
n or
whe
re ly
mph
atic
dam
age
is c
onsi
dera
ble
and
whe
n us
e of
lo
wer
cla
sses
has
pro
ved
inef
fect
ive.
Ref
eren
ces:
MO
RRIS
, A. (
2004
) Cel
lulit
is a
nd E
rysi
pela
s. C
linic
al E
vide
nce
12
: 227
1-7
Ava
ilabl
e on
line:
ww
w.c
linic
alev
iden
ce.c
om/c
eweb
/con
ditio
ns/s
kd/1
708/
1708
.jsp
ne
ed t
o up
date
the
se r
efer
ence
s M
OFF
AT,
C. (
2003
) Lym
phoe
dem
a:an
und
eres
timat
ed h
ealth
pro
blem
. Q
ualit
y Jo
urna
l of
Med
icin
e. 9
6: 7
31-8
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
17
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
13.
AD
HES
IVE
TA
PES
Non
-wov
en
synt
hetic
Clin
ipor
e®
Che
mifi
x®
2.5c
mx5
m
5cm
x5m
5cm
x5m
10
cmx5
m
59p
99p
£1.2
5 £2
.10
To b
e us
ed o
nly
whe
n C
linip
ore®
is d
eem
ed u
nsui
tabl
e.
14.
AB
SOR
BEN
T
D
RES
SIN
GS
Hyp
er-a
bso
rben
t A
dh
esiv
e D
ress
ing
Sup
er A
bso
rben
t D
ress
ing
Zetu
vit
E®
Ster
ile
Alle
vyn
Life
®
Fliv
asor
b®
10x1
0cm
10
x20c
m
20x2
0cm
20
x40c
m
12.9
x12.
9cm
15
.4x1
5.4c
m
10x1
0cm
10
x20c
m
20x2
0cm
20
x30c
m
21p
25p
39p
£1.1
1
£2.5
1 £3
.06
88p
£1.0
5 £1
.86
£2.3
5
Abs
orbe
nt a
nd p
rote
ctiv
e. U
sed
as a
sec
onda
ry d
ress
ing.
NB
com
mun
ity n
urse
s ca
n ob
tain
Sur
gipa
ds® f
rom
cen
tral
sto
res.
For
use
on h
igh
exud
atin
g w
ound
s w
here
a w
ear
time
of 5
– 7
da
ys is
req
uire
d.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
18
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
15. M
ISC
ELLA
NEO
US
Ster
ile S
kin
Clo
sure
s
Dre
ssin
g Pa
cks
Non
-wov
en F
abric
Sw
ab
Sodi
um C
hlor
ide
Gau
ze a
nd C
otto
n Ti
ssue
Leuk
ostr
ip®
Poly
field
® N
itrile
®
Patie
nt P
ack
Nur
se It
® d
ress
ing
pack
s
ster
ile (5
pac
k)
Clin
ipod
®
Gam
gee®
Dru
g Ta
riff
(Pin
k)
6.4x
76m
m
7.5x
7.5c
m
20m
l x 2
5
500g
£6.3
8
52p
55p
27p
£4.8
0
£5.4
5
Ava
ilabl
e on
FP1
0, m
ore
cost
eff
ectiv
e th
an S
teri-
strip
®.
Ster
ile d
ress
ing
pack
con
tain
ing
pow
der-
free
nitr
ile
glov
es, l
amin
ate
shee
t, 7
non
-wov
en s
wab
s, t
owel
, ap
ron
and
disp
osab
le b
ag.
Pair
of p
owde
r-fr
ee la
tex
viny
l glo
ves,
7 n
on-w
oven
sw
abs,
1 c
ompa
rtm
ent
tray
, dis
posa
ble
forc
eps,
la
min
ated
pap
er s
teril
e fie
ld, l
arge
apr
on, p
aper
tow
el
and
whi
te p
olyt
hene
dis
posa
ble
bag.
Use
for
gen
eral
pur
pose
sw
abbi
ng a
nd c
lean
sing
.
No
rmal
Sal
ine
– is
the
irrig
atio
n so
lutio
n of
cho
ice.
A
ll irr
igat
ion
solu
tions
sho
uld
be a
pplie
d at
bod
y te
mpe
ratu
re. T
ap w
ater
onl
y to
be
used
acc
ordi
ng t
o lo
cal p
olic
y fo
r le
g w
ashi
ng a
nd a
ll ch
roni
c an
d ac
ute
wou
nds
will
be
clea
nsed
with
a s
teril
e, s
ingl
e us
e so
lutio
n, if
req
uire
d.
Gam
gee
® -
For
use
to
abso
rb la
rge
amou
nts
of
exud
ate.
Not
to
be u
sed
as p
rimar
y dr
essi
ng. I
f us
ed in
le
g m
anag
emen
t al
way
s pa
d O
UTS
IDE
the
band
age
to
mai
ntai
n ad
equa
te p
ress
ures
(if
com
pres
sion
) to
the
leg.
C
an b
e cu
t to
siz
e if
requ
ired.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
19
Pro
du
ct T
ype
Pro
du
ct n
ame
Size
Co
st/
Item
Co
mm
ents
15. M
ISC
ELLA
NEO
US
(con
t’d)
Skin
Pro
tect
ant
Pota
ssiu
m
perm
anga
nate
LBF®
Ste
rile
No
Stin
g Ba
rrie
r Fi
lm
Perm
itabs
®
5x1m
l 5x
2ml
30
£3.8
2 £5
.07
£11.
45
Plea
se r
efer
to
loca
l for
mul
ary/
derm
atol
ogic
al g
uida
nce
for
deta
iled
prod
uct
list
and
advi
ce. T
able
of
all t
he p
rodu
cts
can
be f
ound
in M
IMS
and
incl
udes
the
pot
entia
l sen
sitis
ers.
ht
tp://
ww
w.m
ims.
co.u
k/Ta
bles
/882
437/
Emol
lient
s-Po
tent
ial-
Skin
-Sen
sitis
ers-
Ingr
edie
nts/
To p
rote
ct s
urro
undi
ng s
kin
in h
igh
exud
ate
wou
nds
to
prev
ent
mac
erat
ion.
For
use
ove
r ex
coria
ted
skin
and
aro
und
stom
as. U
se in
moi
st a
reas
whe
re it
is d
ifficu
lt to
get
dre
ssin
g ad
hesi
on.
Whe
n us
ed a
ppro
pria
tely
LBF
® r
educ
es w
ound
tra
uma.
Th
e 2m
l LBF
stic
k, w
hen
eval
uate
d w
as f
ound
to
prov
ide
adeq
uate
cov
erag
e in
com
paris
on t
o a
3ml s
tick.
(Med
i D
erm
a S
may
be
sele
cted
at
the
disc
retio
n of
loca
l tru
sts
follo
win
g gu
idan
ce f
rom
the
ir pr
ocur
emen
t te
am)
Adj
unct
the
rapy
onl
y. S
hort
-ter
m t
reat
men
t fo
r w
et w
eepy
, in
fect
ed o
r ec
zem
atou
s le
gs.
One
tab
let
diss
olve
d in
4 li
tres
of
wat
er.
Indi
cate
d fo
r sh
ort
term
use
onl
y. M
axim
um
of
2 w
eeks
in
conj
unct
ion
with
ass
essm
ent
to a
scer
tain
cau
se o
f in
fect
ion
or w
eepi
ng a
nd t
reat
und
erly
ing
caus
e.
War
n p
atie
nts
ab
ou
t st
ain
ing
. If
trea
tin
g f
eet
sug
ges
t u
sin
g w
hit
e so
ft p
araf
fin
aro
un
d t
he
toe
nai
ls t
o
red
uce
sta
inin
g.
Plea
se s
ee d
ocum
ent
at li
nk b
elow
for
fur
ther
gui
danc
e
http
://w
ww
.sou
ther
nhea
lth.n
hs.u
k/kn
owle
dge/
clin
ical
-su
ppor
t-se
rvic
es/m
edic
ines
-man
agem
ent/
form
s/
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
20
APP
END
IX 1
A
sep
tic
No
n T
ou
ch T
ech
niq
ue
R
efer
to
org
anis
atio
nal
po
licy
APP
END
IX 2
Pr
oto
col F
or
Taki
ng
Sw
ab F
rom
A S
usp
ecte
d
Infe
cted
Or
No
n-H
ealin
g W
ou
nd
Bact
erio
logi
cal s
wab
s sh
ould
onl
y be
tak
en w
hen
ther
e is
cl
inic
al e
vide
nce
of in
fect
ion
in a
wou
nd (s
ee a
ppen
dix
4)
For
exam
ple
1. S
prea
ding
cel
lulit
es a
nd
/or
2. N
ew o
r in
crea
sed
pain
not
acc
ount
ed f
or b
y un
derly
ing
arte
rial d
isea
se o
r
3. P
atie
nt is
sys
tem
ical
ly u
nwel
l pos
sibl
y w
ith a
bnor
mal
ly
high
or
low
tem
pera
ture
, rai
sed
puls
e, r
aise
d re
spira
tion
or r
aise
d w
hite
blo
od c
ell c
ount
Cle
an t
he w
ound
with
a s
teril
e so
lutio
n to
rem
ove
debr
is,
slou
gh, p
us o
r ot
her
fore
ign
mat
eria
l. Sw
abs
shou
ld
be t
aken
fro
m t
he d
eepe
st p
art
of t
he c
lean
ed w
ound
. G
ently
pas
s th
e sw
ab o
ver
the
area
in a
zig
zag
mot
ion
ensu
ring
it is
tur
ning
in a
circ
ular
mot
ion
so t
he e
ntire
sw
ab is
cov
ered
. Sw
ab f
rom
the
cen
tre
to t
he o
utsi
de
of t
he w
ound
and
ens
ure
that
if t
here
is a
ny e
xuda
te
pres
ent
it is
tho
roug
hly
abso
rbed
ont
o th
e sw
ab.
Send
the
sw
ab t
o th
e pa
thol
ogy
depa
rtm
ent
as s
oon
as
poss
ible
incl
udin
g th
e fo
llow
ing
info
rmat
ion:
1. P
atie
nt n
ame,
dat
e of
birt
h an
d N
HS
num
ber
2. L
ocat
ion
of t
he p
atie
nt, i
dent
ity o
f w
ho h
as t
aken
the
sw
ab a
nd w
here
the
res
ults
sho
uld
be d
irect
ed
3. S
ite w
here
the
sw
ab w
as t
aken
fro
m
4. C
linic
al in
dica
tors
for
tak
ing
the
swab
5. A
ny a
ntib
iotic
s th
e pa
tient
may
be
on c
urre
ntly
or
rece
ntly
6. T
he c
linic
al in
vest
igat
ion
requ
ired
7. W
ound
his
tory
and
oth
er t
reat
men
t tr
ied
8. A
ny r
elev
ant
co-m
orbi
ditie
s or
cur
rent
dis
ease
s
Reco
rd t
he t
akin
g of
the
sw
ab in
the
pat
ient
’s no
tes.
It is
th
e pr
actit
ione
r’s r
espo
nsib
ility
, as
the
patie
nt’s
advo
cate
, to
acc
ess
the
resu
lts a
nd li
aise
with
the
med
ical
sta
ff t
o ac
t on
the
sw
ab r
esul
t if
indi
cate
d.
Any
sys
tem
ical
ly u
nwel
l pat
ient
sho
uld
have
a N
EWS
scor
e (o
r si
mila
r) t
o as
sess
for
sig
ns o
f se
psis
.
Infe
ctio
n is
not
impl
ied
by t
he m
ere
pres
ence
of
orga
nism
. The
mic
robi
olog
y re
sult
mus
t be
tak
en in
to
acco
unt
alon
g w
ith t
he c
linic
al in
dica
tors
for
infe
ctio
n.
Ref:
Pat
ten,
H. (
2010
) Ide
ntify
ing
wou
nd in
fect
ion:
Tak
ing
a sw
ab.
Wou
nd e
ssen
tials
.64-
66
Ant
ibio
tic P
resc
ribin
g in
Com
mun
ity 2
014
Pg 5
4 &
55
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
21
APP
END
IX 3
B
est
Prac
tice
in O
lder
Per
son
’s S
kin
Car
e
(Bes
t Pr
actic
e St
atem
ent:
Car
e of
the
Old
er P
erso
n’s
Skin
. Lo
ndon
: Wou
nds
UK
, 201
2. D
ownl
oad
from
w
ww
.wou
nds-
uk.c
om)
Aim
: To
Mai
nta
in t
he
Inte
gri
ty o
f th
e Sk
in
As
a pe
rson
age
s, c
hang
es in
the
ski
n oc
cur,
incr
easi
ng
skin
vul
nera
bilit
y to
a v
arie
ty o
f da
mag
e. O
lder
ski
n is
le
ss a
ble
to r
egen
erat
e &
pro
tect
, inc
reas
ing
the
risk
of
skin
bre
akdo
wn
Dry
& v
uln
erab
le s
kin
Old
er s
kin
is t
hinn
er a
nd d
ryer
mak
ing
it vu
lner
able
to
split
ting
and
bact
eria
l inv
asio
n an
d th
e dr
ynes
s is
oft
en a
ca
use
of it
chin
g. E
mol
lient
s ap
plie
d tw
ice
daily
are
see
n as
the
firs
t lin
e of
tre
atm
ent
and
will
hel
p re
hydr
ate
and
mai
ntai
n sk
in in
tegr
ity. T
radi
tiona
l soa
ps d
ry t
he s
kin
out,
in
crea
sing
the
pro
blem
.
Emol
lient
the
rapy
is r
ecom
men
ded
as b
est
prac
tice
for
care
of
olde
r pe
rson
’s sk
in a
nd s
houl
d be
use
d as
an
alte
rnat
ive
to s
oap.
Ade
quat
e qu
antit
ies
shou
ld b
e us
ed
acco
rdin
g to
the
pat
ient
’s ne
ed (r
efer
to
BNF
for
type
s of
pr
epar
atio
ns a
nd q
uant
ities
)
Tota
l em
olli
ent
ther
apy
(Law
ton
, 200
9)
Soap
sub
stitu
tes
Soap
is a
n irr
itant
and
can
mak
e th
e sk
in it
chy.
Soa
p su
bstit
utes
cle
anse
ef
fect
ivel
y bu
t do
not
leav
e th
e sk
in
feel
ing
dry.
Pro
duct
s co
ntai
ning
SLS
(e
g. A
queo
us c
ream
) sho
uld
not
be
used
as
a so
ap s
ubst
itute
.
Bath
oils
*A
dd t
o ba
th w
ater
to
help
moi
stur
ise
the
skin
. Bat
h ad
ditiv
es le
ave
a la
yer
of o
il af
ter
bath
ing*
War
ning
: bat
h oi
ls c
an m
ake
the
bath
slip
pery
. Ris
k as
sess
pat
ient
and
env
ironm
ent
for
suita
bilit
y.
Moi
stur
iser
sM
oist
uris
ers
are
‘leav
e on
’ em
ollie
nts.
Th
ey a
re a
vaila
ble
as:
Oin
tmen
ts: t
hey
have
the
hig
hest
oi
l con
tent
and
are
gre
asy.
The
y ca
n be
mes
sy t
o ap
ply,
leav
e th
e sk
in
look
ing
shin
y an
d st
ain
clot
hes.
The
y ar
e su
itabl
e fo
r ve
ry d
ry s
kin
and
may
be
bes
t ap
plie
d at
nig
ht. O
intm
ents
us
ually
wor
k by
occ
lusi
on.
Cre
ams:
the
y ar
e qu
ickl
y ab
sorb
ed
and
mor
e co
smet
ical
ly a
ccep
tabl
e.
Cre
ams
are
good
for
day
time
use
and
wor
k by
occ
lusi
on o
r ‘a
ctiv
e’
hum
ecta
nt e
ffec
t, b
ut a
re m
uch
less
ef
fect
ive
than
oin
tmen
ts.
Loti
on
s: t
he li
ghte
st a
nd le
ast
grea
sy
emol
lient
s (c
onta
in le
ss o
il). T
hey
are
not
suita
ble
for
dry
skin
con
ditio
ns.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
22
APP
END
IX 3
(C
on
’d)
Dam
age
rela
ted
to
mo
istu
re f
rom
mac
erat
ion
& in
con
tin
ence
Exce
ss fl
uid
on t
he s
kin
from
wou
nds,
sw
eatin
g, u
rine
and/
or f
aeca
l inc
ontin
ence
and
per
i-sto
mal
exu
date
are
like
ly t
o in
crea
se t
he d
amag
e to
the
ski
n ca
usin
g m
acer
atio
n. E
xces
sive
moi
stur
e du
e to
urin
e/fa
ecal
inco
ntin
ence
can
lead
to
skin
dam
age
pres
entin
g as
a m
oist
ure
lesi
on. A
pro
tect
ive
skin
bar
rier
is r
equi
red
as p
reve
ntio
n, p
leas
e se
e pa
ge 2
0.
Prod
uct
choi
ce f
or a
n in
divi
dual
pat
ient
invo
lves
con
side
ratio
n of
pat
ient
pre
fere
nce,
con
sist
ency
req
uire
d, in
gred
ient
s in
clud
ing
pote
ntia
l alle
rgen
s, s
uita
ble
pack
agin
g an
d co
st. T
he p
rodu
cts
of c
hoic
e ar
e th
eref
ore
ones
whi
ch a
re
effe
ctiv
e, t
he p
atie
nt fi
nds
acce
ptab
le a
nd is
pre
pare
d to
use
on
a re
gula
r ba
sis.
Ref
er t
o lo
cal
form
ular
y/de
rmat
olog
ical
gui
danc
e fo
r m
ore
deta
iled
prod
uct
list
and
advi
ce. T
able
of
all t
he p
rodu
cts
can
be f
ound
in
MIM
S an
d in
clud
es t
he p
oten
tial s
ensi
tiser
s.
ww
w.m
ims.
co.u
k/Ta
bles
/882
437/
Emol
lient
s-Po
tent
ial-S
kin-
Sens
itise
rs-In
gred
ient
s
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
23
APP
END
IX 4
Cri
tica
lly C
olo
nis
ed o
r In
fect
ed W
ou
nd
s SI
GN
CH
ECK
ER
Plea
se u
se in
co
nju
nct
ion
wit
h lo
cal A
nti
bio
tic
Gu
idel
ines
Sig
n C
hec
ker
Syst
emic
Infe
cted
✔Lo
cally
Infe
cted
✔C
riti
cally
Co
lon
ized
✔C
olo
niz
ed✔
r
edne
ss >
2cm
& p
ain
Loca
l red
ness
<2c
m o
r sm
all
flare
& p
ain
No
chan
ge (a
t ≥2
wee
ks) &
no
cel
lulit
isEx
pect
ed p
rogr
ess
(exp
ecte
d in
flam
m.)
Wid
e he
at/s
wel
ling
Loca
l hea
t/sw
ellin
g
Rapi
d on
set
new
site
nec
rosi
sN
ew n
ecro
sis
on w
ound
bed
Thic
k sl
ough
not
res
pond
ing
Nec
rosis
/thic
k slo
ugh
but d
ebrid
ing
Exte
nsio
nEx
tens
ion
Blis
terin
g or
sat
ellit
es
w
etne
ss w
etne
ssC
ontin
uing
wet
ness
Wet
/moi
st a
s st
age
of h
ealin
g
Puru
lenc
ePu
rule
nce
Puru
lenc
eEx
udat
e as
sta
ge o
f he
alin
g
Hae
mor
rhag
ic p
atch
es/s
pots
Blue
gre
en e
xuda
te
n
ecro
tic t
issu
e
nec
rotic
tis
sue
Fast
ret
urni
ng s
loug
hLi
ght
mob
ile s
loug
h
CRP
CRP
W
BC
WBC
Pyre
xia/
Rigo
r
Con
fusi
on (e
lder
ly)
Mal
odou
r
siz
e in
last
1-2
wks
Bact
erae
mia
Dis
colo
ured
gra
nula
tion
Nor
mal
gra
nula
tion
Lym
phan
gitis
/ade
nitis
Fria
ble
gran
ulat
ion
Epith
elia
l tis
sue
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
24
APP
END
IX 4
bC
om
ple
te S
ign
Ch
ecke
r -
Man
agem
ent
of
low
er le
g w
ou
nd
s o
n p
atie
nts
wit
h d
iab
etes
req
uir
es r
efer
ral t
o
you
r lo
cal s
pec
ialis
t te
am.
Syst
emic
or
activ
e In
fect
ion
Refe
r to
Tis
sue
Via
bilit
y if
requ
ired
Take
a s
wab
Seek
med
ical
opi
nion
Sele
ct t
opic
al a
ntim
icro
bial
No
impr
ovem
ent
afte
r
10 -
14
days
Che
ck s
wab
sen
sitiv
ities
C
hang
e an
tibio
tics
if re
quire
d Re
fer
to T
issu
e V
iabi
lity
Reas
sess
ant
imic
robi
al d
res
sin
g af
ter
2 w
eeks
Goo
d cl
inic
al o
utco
me
Com
plet
e an
tibio
tics
Reas
sess
wou
nd a
fter
2
wee
ks
Star
t br
oad
spec
trum
an
tibio
tics
whi
le a
wai
ting
cultu
re r
esul
ts
If sy
stem
ic s
igns
on
ly:
Look
out
side
w
ound
for
sou
rce
of in
fect
ion
Con
tinue
with
an
timic
robi
al f
or
2 w
eeks
Take
a s
wab
If w
ound
un
chan
ged
or
dete
riora
ting
disc
uss
with
TV
N
Dis
cont
inue
an
timic
robi
al
afte
r 2
wee
ks a
nd
mon
itor
If w
ound
de
terio
rate
s or
any
sig
ns
of s
yste
mic
in
fect
ion
Loca
lly in
fect
ed
Sele
ct a
ppro
pria
te
antim
icro
bial
dre
ssin
g
Mon
itor
clos
ely
Goo
d cl
inic
al
outc
ome
No
impr
ovem
ent
afte
r 10
- 1
4 da
ysN
o im
prov
emen
t af
ter
10 -
14 d
ays
Goo
d cl
inic
al
outc
ome
Crit
ical
ly c
olon
ised
Sele
ct a
ppro
pria
te
antim
icro
bial
dre
ssin
g.
Mon
itor
clos
ely
Col
onis
ed (p
rogr
essi
ng n
orm
ally
)
Use
sig
n ch
ecke
r re
gula
rly t
o m
onito
r pr
ogre
ssio
n
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
25
APP
END
IX 4
c
Cri
tica
lly C
olo
nis
ed o
r In
fect
ed
Wo
un
ds
Man
agem
ent
of
low
er le
g w
ou
nd
s o
n p
atie
nts
wit
h d
iab
etes
re
qu
ires
ref
erra
l to
yo
ur
loca
l sp
ecia
list
team
. Man
agem
ent
of
foo
t u
lcer
s o
n p
atie
nts
wit
h o
r w
ith
ou
t d
iab
etes
req
uir
es
refe
rral
to
yo
ur
loca
l sp
ecia
list
team
.
Des
crip
tio
n
See
SIG
N c
heck
er a
nd fl
ow c
hart
for
iden
tifica
tion
Aim
To
red
uce
cri
tica
l co
lon
isat
ion
or
infe
ctio
n t
o r
edu
ce
wo
un
d b
io-b
urd
en a
nd
infe
ctio
n.
It is
exp
ecte
d th
at a
ll nu
rsin
g st
aff
will
fam
iliar
ise
them
selv
es w
ith t
he p
rodu
cts
sugg
este
d an
d th
eir
appr
opria
te u
se. T
his
guid
e is
inte
nded
for
fir
st li
ne t
reat
men
t/pr
oduc
t co
nsid
erat
ion.
It is
not
con
side
red
as a
n ex
haus
tive
list
or t
o be
app
licab
le f
or a
ll pa
tient
s. A
ll he
alth
care
pro
fess
iona
ls a
re e
xpec
ted
to u
se t
heir
clin
ical
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
26
judg
emen
t w
hen
asse
ssin
g pa
tient
s an
d w
ound
s.
Pres
enta
tio
n -
ref
er t
o S
IGN
ch
ecke
r.
Trea
tmen
t
Prim
ary
dre
ssin
g
Low
to
mod
erat
e ex
udat
e –
Inad
ine
or C
uti
med
So
rbac
t or
Med
iho
ney
ran
ge
or S
up
raso
rb X
an
d P
HM
B
Mod
erat
e to
hig
h ex
udat
e –
Iod
ofl
ex o
r C
uti
med
So
rbac
t or
Med
iho
ney
ran
ge
or D
ura
fib
er A
g
Seco
nd
ary
dre
ssin
g
abso
rben
t dr
essi
ngs
such
as
Zetu
vit
E (s
teri
le)
or F
livas
orb
Fact
ors
to
co
nsi
der
– C
linis
orb
fo
r o
do
ur
con
tro
l
Oth
er f
acto
rs t
o c
on
sid
er
Ant
imic
robi
al d
ress
ings
sho
uld
be u
sed
initi
ally
for
tw
o w
eeks
onl
y; if
aft
er re
asse
ssm
ent
the
need
for
fur
ther
an
timic
robi
al u
se is
indi
cate
d, t
his
shou
ld b
e ac
tione
d an
d do
cum
ente
d in
the
pat
ient
’s no
tes
toge
ther
with
the
rat
iona
le.
Not
e: in
flam
mat
ion
arou
nd w
ound
edg
es is
an
expe
cted
par
t of
the
infla
mm
ator
y pr
oces
s of
wou
nd h
ealin
g in
ac
ute
wou
nds
and
may
be
evid
ent
for
up t
o th
ree
days
pos
t w
ound
ing.
Pat
ient
s w
ho a
re im
mun
o-co
mpr
omis
ed,
diab
etic
s or
eld
erly
may
not
sho
w t
he c
lass
ic s
igns
of
infe
ctio
n.
Plea
se r
efer
to
loca
l Sep
sis
gu
idel
ines
or
NIC
E G
uid
elin
es
htt
ps:
//w
ww
.nic
e.o
rg.u
k/g
uid
ance
/ng
51?u
nlid
=28
0104
1072
0161
1917
351
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
27
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Skin
Tea
rs
Pres
enta
tio
n -
Sup
erfic
ial o
r tr
aum
atic
wou
nd, w
here
the
ski
n rip
s,
com
mon
ly o
ccur
s in
the
eld
erly
and
the
deh
ydra
ted
Aim
s -
Prom
ote
atra
umat
ic r
emov
al p
reve
nts
infe
ctio
n, c
over
and
pro
tect
Trea
tmen
t –
Cle
an w
ith n
orm
al s
alin
e
Whe
re s
kin
flap
can
be r
ealig
ned
gent
ly r
epos
ition
ski
n ba
ck w
ith g
love
d fin
ger
and
appl
y A
trau
man
wit
h g
auze
pad
sec
ure
d w
ith
Co
mfi
fast
/C
linif
ast,
sec
onda
ry d
ress
ing
Soft
po
re o
r K
linid
erm
/Bia
tain
Sili
con
e
Whe
re t
he e
dges
can
not
be a
ligne
d ap
ply
Klin
ider
m/B
iata
in S
ilico
ne
Fact
ors
to
co
nsi
der
– D
ate
dres
sing
and
pla
ce a
n ar
row
on
dres
sing
to
show
di
rect
ion
for
rem
oval
. Rem
ove
dres
sing
aft
er 2
4 to
48
hour
s to
che
ck w
ound
fo
r in
fect
ion
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
28
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Sup
erfi
cial
Bu
rns/
Scal
ds
Pres
enta
tio
n –
Par
tial
th
ickn
ess
- Re
d in
flam
ed s
kin,
pot
entia
lly
with
blis
terin
g
Aim
s –
To c
over
and
pro
tect
& m
inim
ise
scar
ring
Trea
tmen
t –
Cov
er w
ith A
trau
man
an
d g
auze
pad
/Fliv
aso
rb a
s se
cond
ary
dres
sing
or
Klin
ider
m/B
iata
in S
ilico
ne
whi
lst
seek
ing
furt
her
advi
ce f
rom
TV
N
Fact
ors
to
co
nsi
der
- F
or s
cald
s, m
onito
r in
itial
ly a
s ef
fect
s ca
n co
ntin
ue f
or a
few
day
s af
ter
even
t
NB
: mo
nit
or
inte
nsi
vely
init
ially
an
d s
eek
imm
edia
te a
dvi
ce
fro
m y
ou
r lo
cal b
urn
s u
nit
if b
urn
pro
gre
sses
Bu
rns
Hel
plin
e -
Sal
isbu
ry P
last
ics
Trau
ma
Team
sup
port
/hel
p-lin
e em
ail i
s: S
hc-t
r.Pla
stic
sTra
uma@
nhs.
net
If le
avin
g an
em
ail p
leas
e in
form
Bur
ns C
o-or
dina
tor
via
switc
hboa
rd
on 0
1722
336
262
– Bl
eep
102
Plea
se s
eek
advi
ce if
uns
ure,
pa
rtic
ular
ly if
the
bur
n is
on
the
hand
Poly
mem
- m
ay b
e u
sed
fo
r ra
dio
ther
apy
bu
rns
– fo
r sp
ecia
list
use
on
ly
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
29
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Epit
hel
iasi
ng
Wo
un
ds
Pr
esen
tati
on
- T
he w
ound
is p
ink
in c
olou
r; t
he t
issu
e is
fra
gile
with
evi
denc
e of
he
alin
g w
ound
bed
and
/or
mar
gins
Aim
- P
rote
ct n
ew t
issu
e an
d su
ppor
t w
ound
clo
sure
Trea
tmen
t -
Prim
ary
Dre
ssin
g –
cove
r w
ound
with
Atr
aum
an o
r H
ydro
film
or
Klin
ider
m/B
iata
in S
ilico
ne
or
Du
od
erm
Ext
ra T
hin
Gra
nu
lati
ng
Wo
un
ds
Pres
enta
tio
n -
Wou
nd c
ould
be
red
in c
olou
r an
d ha
s a
gran
ular
‘bub
bly’
ap
pear
ance
Aim
- T
o pr
omot
e he
alin
g an
d su
ppor
t w
ound
to
epith
elia
sing
sta
ge
Trea
tmen
t -
low
exu
date
– A
trau
man
or
Klin
ider
m/B
iata
in S
ilico
ne
Trea
tmen
t -
mod
erat
e to
hig
h ex
udat
e -
Exu
fib
er w
ith
Fliv
aso
rb a
s se
cond
ary
dres
sing
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e,
whi
ch a
ll ar
e ke
y to
ach
ieve
the
bes
t ou
tcom
e.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
30
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Ove
r-G
ran
ula
tin
g w
ou
nd
s
Pres
enta
tio
n -
Cha
ract
eris
ed b
y pr
oud-
flesh
occ
urrin
g af
ter
the
wou
nd b
ed
has
fille
d w
ith g
ranu
latio
n tis
sue
Aim
– T
o re
duce
the
exc
essi
ve la
ying
dow
n of
new
blo
od v
esse
ls
Trea
tmen
t -
One
fing
ertip
uni
t of
a m
ild t
opic
al s
tero
id s
uch
as
Hyd
roco
rtis
on
e or
Hae
lan
(Fl
ud
roxy
cort
ide)
Tap
e/C
ream
.
Klin
ider
m/B
iata
in S
ilico
ne
as s
econ
dary
dre
ssin
g (if
ble
edin
g or
infe
ctio
n su
spec
ted
con
sid
er a
nti
mic
rob
ial a
s pr
imar
y dr
essi
ng)
Revi
ew w
ound
aft
er 3
-4 d
ays
Hae
lan®
tap
e –
SPC
htt
p://w
ww
.mhr
a.go
v.uk
/hom
e/gr
oups
/spc
pil/d
ocum
ents
/sp
cpil/
con1
4691
6193
8832
N
B: H
aela
n ha
s be
en re
-nam
ed u
nder
its
gene
ric n
ame
Flud
roxy
cort
ide
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
31
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Slo
ug
hy
Wo
un
ds
Pres
enta
tio
n -
Pre
senc
e of
yel
low
or
soft
bro
wn/
grey
dev
italis
ed t
issu
e
Aim
- T
o re
hydr
ate
in o
rder
to
supp
ort
proc
ess
of d
ebrid
emen
t an
d th
e re
mov
al o
f de
vita
lised
tis
sue
To p
rovi
de a
cle
an w
ound
bas
e fo
r gr
anul
atio
n
Trea
tmen
t –
pri
mar
y d
ress
ing
low
to
mod
erat
e ex
udat
e -
In
traS
ite
Co
nfo
rmab
le o
r K
erra
Lite
Co
ol o
r
C
om
feel
Plu
s
o
r (M
edih
on
ey if
wou
nd in
fect
ed)
mod
erat
e to
hig
h ex
udat
e -
Exu
fib
er o
r Su
pra
sorb
A
Seco
nd
ary
dre
ssin
g
low
exu
date
- G
auze
an
d H
ydro
film
mod
erat
e to
hig
h ex
udat
e -
Zet
uvi
t E
(ste
rile
) or
Fliv
aso
rb f
or f
requ
ent
dres
sing
cha
nges
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
32
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Nec
roti
c W
ou
nd
s Pr
esen
tati
on
- T
he p
rese
nce
of b
lack
or
yello
wis
h br
own
devi
talis
ed /d
ead
tissu
e
Aim
-
To re
hydr
ate
and
‘bre
ak d
own’
or
soft
en d
evita
lised
tis
sue
To
rehy
drat
e tis
sue
and
prom
ote
debr
idem
ent
Trea
tmen
t –
Prim
ary
dre
ssin
g –
In
traS
ite
Co
nfo
rmab
le, o
r K
erra
lite
Co
ol
If
wo
un
d is
infe
cted
Io
do
flex
or
Med
iho
ney
HC
S
pr
otec
t w
ound
edg
es w
ith L
BF b
arrie
r fil
m
Seco
nd
ary
dre
ssin
g –
abs
orbe
nt d
ress
ing
such
as
Zetu
vit
E (s
teri
le)
or
Fliv
aso
rb
NB
: Bla
ck, h
ard
, dry
nec
roti
c ti
ssu
e to
hee
ls t
o b
e le
ft e
xpo
sed
N
B: D
ress
ing
s w
ill n
eed
rev
iew
ing
dai
ly if
hig
h e
xud
ate
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
33
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Fun
gat
ing
Wo
un
ds
Pres
enta
tio
n –
dis
char
ging
lesi
ons/
tum
our
that
bre
aks
thro
ugh
the
skin
sur
face
Aim
– c
ompl
ex w
ound
req
uirin
g m
anag
emen
t of
exu
date
, ble
edin
g, o
dour
and
pai
n
Trea
tmen
t –
Pro
nto
san
so
ak
Prim
ary
dre
ssin
g –
low
to
mod
erat
e ex
udat
e –
Pro
nto
san
gel
or
Sup
raso
rb X
and
PH
MB
or
Med
iho
ney
HC
S
Prim
ary
dre
ssin
g –
mod
erat
e to
hig
h ex
udat
e -
Exu
fib
er o
r Su
pra
sorb
X a
nd
PHM
B o
r M
edih
on
ey m
edic
al h
on
ey
Seco
nd
ary
dre
ssin
g –
Zet
uvi
t E
(ste
rile
) or
Fliv
aso
rb
NB
: Clin
iso
rb f
or
od
ou
r co
ntr
ol i
s es
sen
tial
. See
k ad
vice
if b
leed
ing
or
un
con
tro
lled
od
ou
r
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
34
APP
END
IX 5
Pro
du
ct S
elec
tio
n T
oo
ls
Sin
us/
Cav
ity
wo
un
d
Pres
enta
tio
n –
tra
ck t
hat
exte
nds
from
ski
n su
rfac
e to
an
unde
rlyin
g ca
vity
Aim
– e
stab
lish
exte
nt a
nd d
epth
of
tissu
e da
mag
e
Trea
tmen
t –
Cav
ity; P
ront
osan
soa
k, S
inus
; irr
igat
e w
ith s
alin
e
Prim
ary
dre
ssin
g –
Ex
ufi
ber
rib
bo
n g
ently
pac
ked
into
wou
nd o
r
If
wo
un
d is
infe
cted
M
edih
on
ey m
edic
al h
on
ey v
ia s
yrin
ge i
nto
wou
nd
bed
or
D
ura
fib
er A
g r
ibb
on
gen
tly p
acke
d in
to w
ound
bed
.
Seco
nd
ary
dre
ssin
g –
Klin
ider
m/B
iata
in S
ilico
ne
for
low
to
mod
erat
e
exud
ate
Ze
tuvi
t E
(ste
rile
) o
r Fl
ivas
orb
for
mod
erat
e to
hig
h
ex
udat
e.
NB
. Co
nsi
der
To
pic
al N
egat
ive
Pres
sure
– c
on
tact
TV
N f
or
advi
ce
Dia
bete
s Fo
ot U
lcer
atio
n –
Refe
r al
l pat
ient
s w
ith a
n ac
tive
ulce
r w
ithin
24
hour
s to
you
r lo
cal D
iabe
tes
Foot
Pro
tect
ion
team
. Ear
ly r
efer
ral t
o sp
ecia
list
team
s fo
r di
abet
es m
anag
emen
t, o
ffloa
ding
, deb
ridem
ent
and
appr
opria
te w
ound
-car
e, w
hich
all
are
key
to a
chie
ve t
he b
est
outc
ome.
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
crib
ing
Co
mm
itte
e an
d P
ort
smo
uth
an
d S
ou
th E
ast
Ham
psh
ire
Are
a Pr
escr
ibin
g C
om
mit
tee
35
APP
END
IX 6
Co
nta
cts
Nam
eTi
tle
Tru
stPh
on
e n
um
ber
sEm
ail
Mon
ique
Ros
ell
TV N
urse
Spe
cial
ist
(Sou
tham
pton
)
Sole
nt N
HS
Trus
t
0238
0608
042
mon
ique
.ros
ell@
nhs.
net
Mar
jole
in.w
oodh
ouse
@so
lent
.nhs
.uk
Mar
j Woo
dhou
seC
linic
al A
dvis
or T
issu
e V
iabi
lity
&
Pres
sure
Rel
ief
0239
2007
838
Mar
jole
in.w
oodh
ouse
@so
lent
.nhs
.uk
Mag
gie
Sim
mon
sSe
nior
Sta
ff N
urse
Tis
sue
Via
bilit
y07
8762
3072
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ons@
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Laur
a Ev
ans
Seni
or S
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Nur
se T
issu
e V
iabi
lity
0787
6654
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Laur
a.ev
ans@
sole
nt.n
hs.u
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Kat
hlee
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ayes
Wou
nd F
orm
ular
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Lead
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nt N
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t07
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haye
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tSi
ngle
Poi
nt o
f A
cces
s fo
r A
llied
Hea
lth P
rofe
ssio
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Sole
nt W
est
Podi
atry
0300
3002
011
0238
0608
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debr
a.ob
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nhs.
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Shar
on S
teel
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tham
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)So
utha
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on C
ity C
CG
023
8029
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0
0789
9 98
7 46
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sue.
law
ton@
nhs.
net
Lisa
Ric
eA
dvan
ced
Clin
ical
Nur
se S
peci
alis
t (W
inch
este
r/A
ndov
er)
Sout
hern
Hea
lth N
HS
Foun
datio
n Tr
ust
Team
em
ail h
p-tr
.ha
mps
hire
tvte
am@
nhs.
net
0238
0 67
3988
0774
7 79
2895
lisa.
rice@
nhs.
net
Car
yn C
arr
TV L
ead
Nur
se07
7898
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0ca
ryn.
carr
@so
uthe
rnhe
alth
.nhs
.uk
Jane
Bar
ker
Adv
ance
d C
linic
al N
urse
Sp
ecia
list
0774
0852
241
jane
bark
er@
nhs.
net
Wo
un
d F
orm
ula
ry O
cto
ber
2016 V
ers
ion
7(1
) R
atifi
ed b
y th
e B
asin
gst
oke
, So
uth
amp
ton
an
d W
inch
este
r D
istr
ict
Pres
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APPENDIX 8 Generic Exception Reporting Form (add organisational logo)
WOUND CARE FORMULARY Exception Reporting Form
Mandatory requirement when using wound and skin care products not on formulary. (no patient ID to be seen)
This will aid the Formulary Group to ensure the most appropriate products are included in the Formulary and highlight products for evaluation.
Your Name, Base, Designation and Contact Details:-
Name, type and size of non-formulary product used:-
Who was the product initiated/suggested by:- (e.g. GP/hospital ward/community/practice/specialist nurse/company representative):-
Name & base of WISH/ANTS Link Nurse/HCP/nurse specialist you discussed this with:-
Why has this non-formulary product been chosen: - (+ Description of the wound if a dressing)
What products have already been tried and what were the results:-
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ula
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ers
ion
7(1
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39
OUTCOMES AND COMMENTS
STATE outcome of using non-formulary product (please include frequency of use, increase/reduce visits, how long the product was used for, amount used and whether appropriate and successful)
Any other comments:- ie. Would you use this again, pt experience, other factors eg. Pain, ease of use, availability, has a formal evaluation been done and fed back etc
Please send a copy of this form (no patient data) to your local nurse specialist or prescribing advisor (see resource page for email addresses) and keep a copy for your reference.
Moisture
Grade
Pressure
Pressure
Risk
Risk
Ulcer
UlcerUlcer
Ulcer
Posture
PosturePosture
Prevention
Prevention
Prevention
Prevention
Wound
Wound
WoundMoisture
Moisture
Moisture
MoistureGrade
Grade
Grade
Pressure
Pressure
Risk
Ulcer
Posture
Prevention
Wound
Risk
Posture
Moisture
Printed in association with: 3M United Kingdom PLCColoplast LtdSmith & Nephew Healthcare LtdPaul Hartmann LTDCrawford Healthcare LtdCliniMed LtdMolnlycke Health CareBSN Medical LtdDerma Sciences Europe LtdBbraun Medical Ltd
Become a member of our Trust. Email [email protected]
or call 023 8087 4253
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