North East CCAC Regional Approved Medical Supplies...

North East CCAC Regional Approved Medical Supplies List

APRIL 01 2016

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The NE CCAC Regional Medical Supplies List identifies all the CCAC-funded products available to patients. If different products are ordered, an automatic substitution policy will be initiated to provide the equivalent product approved by the CCAC as identified on the list. Table of Contents (Click on the desired section or page number):

Medical supplies depot/drop-off locations

Wound Care

1

Absorptives 8 Alginates 8 Antimicrobials & Silvers 9 Clear Acrylic 10 Composite Dressings 10 Foams 11 Hydrocolloids 11 Hydrogel 12 Films & Membranes 12 Odour Absorbent Dressings 12 Non-adherent 13 Other & Specialty 13

Negative Pressure Wound Therapy (NPWT) 15

Dressings, Bandages, Compression & Wraps 17

Cleansers & Solutions 21

Feed, Ostomy, Respiratory 23

Urinary & Continence 26

IV, Needles, Syringes 31

Medical Supply Kits 37

Protective Wear 40

Miscellaneous 42 ______________________________________________________________________________

Searching the Medical Supplies Catalogue Electronically

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NORTH EAST CCAC MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS

SAULT STE. MARIE (Questions or issues call: 705-949-1808 / 1-800-668-7705 Ext: 3269)

Service Area

Depot/Drop-Off Location Pick-Up Location Availability For Regular

Scheduled Pick-up* Service Type

URBAN SSM01

Sault Ste. Marie Branch Office

390 Bay Street, Suite 103, Sault Ste. Marie, ON P6A 1X2 705-949-1650/800-668-7705 Fax: 705-949-3844

MON-FRI 8:30AM - 4:30PM

CCAC Medical Supplies

Infusion (IV) Equipment & Supplies

URBAN SSM02

The Medicine Shoppe

316 Second Line West Sault Ste. Marie, ON P6C 2J5 705-253-7656/877-374-6938 Fax: 705-256-7656

MON-FRI 9:00AM– 6:00PM SAT 9:00AM–2:00PM

Medicine Shoppe’s Infusion (IV) Equipment & Supplies

URBAN SSM03

ParMed Clinic 477 Queen Street East Suite 100 Sault Ste. Marie, ON, P6A 1Z5 705-759-0110

MON-FRI 8:00AM– 8:00PM SAT-SUN 8:00AM– 8:00PM

For Clinic patients only


RURAL SSM04

Matthews Memorial Hospital

1180 Richards Street, Richards Landing, ON P0R 1J0 705-246-2570

Orders arrive weekly on Thursdays

Open 24 hrs


RURAL SSM05

Nugget Food Store c/o Copper Bay Shell

9153 Hwy 17 East Bruce Mines P0R 1C0 705-785-3713

Orders arrive weekly on Fridays

MON-SUN 5:30AM – 10:00PM


RURAL SSM06

Thessalon Hospital

135 Dawson Street Thessalon, ON P0R 1L0 705-842-2014

Orders arrive weekly on Thursdays

Open 24 hrs


RURAL SSM07

Pit Stop Gas Bar & Confectionary

3245 Hwy 17 East, Echo Bay, ON P0S 1C0 705-248-3333




RURAL SSM08

Goulais River Country Store

2771 Hwy 17 North Goulais River, ON P0S 1E0 705-649-3811


MON-SUN 6:00AM -11:00PM


RURAL SSM09

McCauley’s Village Store

5235 Hwy 17 North Haviland Bay, ON P0S 1E0 705-649-5813




RURAL SSM10

Elliot Lake PharmaChoice

267 Hillside Drive South Elliot Lake, ON P5A 1N7 705-848-0004

MON-FRI 9:00AM–5:00PM SAT 9:00AM – 1:00PM

Robinson’s Medical Supplies & Infusion (IV) Equipment & Supplies

RURAL SSM11

Home Hardware

275 Imperial St Massey, ON P0P 1P0 705-865-2135

MON-THUR 8:00AM-6:00PM FRI 8:00AM-8:00PM SAT 8:00AM-5:30PM

Robinson’s Medical Supplies

RURAL SSM12

Wawa Satellite Office

17 Government Road Wawa, ON P0S 1K0 705-856-7018 Fax: 705-856-1776

MON-FRI 8:30AM-4:30PM


Deliveries during extended hours: Only available for New Patients or Patient Resumes/ Hospital Discharges/End of Life

Private-Pay Patient Deliveries: IN SSM PROPER $5.00, OUTLYING AREAS $6.00-20.00(STILL WITHIN CITY LIMITS), In ELLIOT LAKE & BLIND RIVER AREA - Call Robinson’s for price

NE CCAC Regional Approved Medical Supplies List - Effective April 01 2016 Page 1 of 42


NORTH BAY (Questions or issues call: 705-476-2220 / 1-888-533-2222 Ext: 2235)


Private-Pay Patient Deliveries: U-Need-A-Cab Phone: 705-497-7777 ($11 - $12 delivery charge). For Supplies and IV from Robinson’s – Call for price.

Service Area

Depot/Drop-Off Location

Pick-Up Location Availability For Regular Scheduled Pick-up*

Service Type

URBAN NB01

North Bay Branch Office

1164 Devonshire Ave. North Bay, ON P1B 6X7 705-476-2222 Fax: 705-474-2369

MON-FRI 8:30AM - 4:30PM CCAC Medical Supplies & IV Supplies

URBAN NB02

VON Clinic 180 Shirreff Avenue Unit #195 North Bay, ON P1B 7K9 705-472-8050 Fax: 705-495-6691

MON-SUN 8:00AM – 8:00PM For Clinic patients only


URBAN NB03

Robinson’s Pharmasave

2547 Trout Lake Road North Bay, ON P1B 7S8 705-495-4515

MON-FRI 9:00AM - 6:00PM SATURDAY 9:00AM - 5:00PM SUNDAY 10:00AM - 2:00PM

Robinson’s Infusion (IV) Equipment & Supplies

RURAL NB04

Burks Falls Satellite Office

150 Huston Street, Suite 122 Burk's Falls, ON P0A 1C0 705-476-2222/888-533-2222 Fax: 705-382-2498

MON-FRI 8:30AM - 4:30PM CCAC Medical Supplies & Robinson’s Infusion (IV) Equipment & Supplies

RURAL NB05

ParaMed Clinic 725 Coursol Road Sturgeon Falls, ON P2B 2Y6 705-753-3110

For Clinic Patients only CCAC Medical Supplies

RURAL NB06

Mattawa IDA 300 Main Street Mattawa, ON P0H 1V0 705-744-2625

MON-THUR 9:00AM – 5:30PM FRIDAY 9:00AM – 8:00PM

SATURDAY 9:00AM – 5:00PM

CCAC Medical Supplies & Robinson’s Infusion (IV) Equipment & Supplies

RURAL NB07

South River Pharmacy

22 Marie St. South River, ON P0A 1X0 705-386-0636

MON-FRI 9:00AM – 5:30PM SATURDAY 9:00AM - 2:00PM


RURAL NB08

Argyle Nursing Station

11851 Hwy 522 Port Loring, ON P0H 1Y0 705-757-1717

MONDAY 10:00AM – 6:00PM TUESDAY 8:00AM - 4:00PM

WEDNESDAY 8:00AM – 8:00PM THURSDAY 8:00AM - 4:00PM

Closed daily between

12:00PM – 1:00PM as well as WEDNESDAY 4:30PM – 5:30PM


RURAL NB09

Loblaws No Frills Pharmacy

12035 Hwy #17 Sturgeon Falls, ON P2B 2S6 705-753-5850

MON-FRI 8:00AM – 8:00PM SATURDAY 8:00AM – 6:00PM

SUNDAY 9:00AM - 5:00PM

Robinson’s Medical Supplies & Infusion (IV) Equipment & Supplies

RURAL NB10

Glenn’s Pharmacy

496 Main St Powassan, ON 705-724-2741



RURAL NB11

Clement’s IDA 497 Main St Powassan, ON P0H 1Z0 705-724-3523


Robinson’s Infusion (IV) Equipment & Supplies

RURAL NB12

Caswell Resort 77 Main St. Sundridge, ON P0A 1Z0 705-384-7600

MON – SUN 8:00AM – 11:00PM Robinson’s Infusion (IV) Equipment & Supplies



TIMMINS (Questions or issues call: 705-267-2234/888-668-2222)

Service Area



Service Type

URBAN TIM01

Timmins Branch Office

330 Second Avenue, Suite 101 Timmins, ON P4N 8A4 705-267-2234/888-668-2222 Fax: 705-267-7795

MONDAY – FRIDAY 8:30 AM – 4:30PM


URBAN TIM02

Bayshore Home Health Clinic

204-119 Pine Street S Timmins, ON P4N 2K3 705-268-6088/866-227-3661 Fax: 705-268-9085

MONDAY – SUNDAY 8:00 AM – 8:00PM

For clinic patients only


URBAN/ RURAL TIM03

Bayshore Specialty Rx

70 Esna Park Drive Unit 11 Markham, ON L3R 6E7 905-474-0822/888-313-6988

Next day delivery from Markham MON 9:00AM – 5:00PM (Only if order sent on previous Friday) TUES-FRI 9:00 AM – 5:00PM

Bayshore Rx IV Supplies & Equipment

RURAL TIM04

Matheson/ Iroquois Falls Satellite Office

Anson General Hospital 58 Anson Drive Iroquois Falls, ON P0K 1E0 1-888-668-2222 Fax: 705-258-2296

MONDAY – FRIDAY 8:30AM – 4:30PM

CCAC Medical Supplies (Bayshore Rx BodyGuard IV pump available at clinic)

RURAL TIM05

Bingham Hospital

Bingham Hospital 507 Eight Avenue (Basement) Matheson, ON P0K 1N0 705-273-4500

For clinic patients only CCAC Medical Supplies (Bayshore Rx BodyGuard IV pump available at clinic)

RURAL TIM06

Smooth Rock Falls Medical Clinic

101 Kelly Road Smooth Rock Falls, ON P0L 2B0 705-338-2788 Fax:705-338-2933

MON 9:00AM – 4:15PM WED/TUES/THURS 9:00AM – 2:00PM

FRI 9:00AM – 12:30PM


RURAL TIM07

Kapuskasing Satellite Office

Sensenbrenner Hospital 101 Progress Crescent Kapuskasing, ON P5N 3H5 888-668-2222 Fax: 705-337-4080



RURAL TIM08

Cochrane Satellite Office

P.O Box 1750, 22E 5th Street Cochrane, ON P0L 1C0 877-513-2626 Fax: 705-272-2600



RURAL TIM09

Hearst Satellite Office

PO Box 547 1403B Edward Street Hearst ON P0L 1N0 705-362-6633 Fax: 705-362-6635


CCAC Medical Supplies (Bayshore Rx BodyGuard IV pump available at clinic and office).

RURAL TIM10

Moosonee Satellite Office

PO Box 57, 48 Revillion St. Moosonee ON, P0L 1Y0 705-336-2233 Fax: 705-336-2919



RURAL TIM11

Honger Redwood Inn Chapleau

12 Birch St. West Chapleau, ON POM 1K0 705-864-1311



Private-Pay Patient Deliveries for CCAC Supplies: C&G delivery ($2 - $3). Note: All IV orders from Bayshore Rx are delivered directly to the patient’s treatment location



KIRKLAND LAKE (Questions or issues call: 705-567-2222) Ext: 7622

Note: All IV orders from Bayshore Rx are delivered to the patient’s treatment location.

Service Area


Pick-Up Location

Availability For Regular Scheduled Pick-up*

Weekly supplies available for patient pick-up each

Wednesday

Service Type

RURAL KL01

Kirkland Lake Branch Office

53 Government Rd W Kirkland Lake, ON P2N 2E5 705-567-2222/888-602-2222 Fax: 705-567-9407

MONDAY - FRIDAY 8:30AM – 4:30PM


RURAL KL02

Haileybury Satellite Office

240 Georgina Avenue, Suite 112 Haileybury, ON POJ 1KO 705-672-2222/888-602-2222 Fax: 705-672-3887 ext:7622



RURAL KL03

Findlay’s Drug Store

25-247 Whitewood Ave. New Liskeard, ON P0J 1P0 705-647-8186

MON-FRI 8:00AM – 8:00PM SATURDAY 8:00AM – 5:30PM SUNDAY 10:00AM – 5:00PM


RURAL KL04

Latchford Town Office

10 Main St. Latchford, ON P0J 1N0



RURAL KL05

Temagami Family Health Team

17 O’Connor Dr. Temagami, ON P0H 2H0 705-569-3244



RURAL KL06

Garlin’s Gift Gallery

56 4th Ave. Englehart, ON P0J 1H0 705-544-8050

MONDAY – THURSDAY 8:00AM – 5:30PM

FRIDAY 8:00AM – 8:00 PM



RURAL KL07

J&S Variety Store

91 Pine Street Elk Lake, ON P0J 1G0

MONDAY – SUNDAY 5:00AM – 11:00PM


RURAL KL08

Larder Lake Co-Op

25 Godrey Street Larder Lake, ON P0K 1L0 705-643-2327

MONDAY – SATURDAY 10:00AM – 8:00PM

SUNDAY 11:00AM – 4:00PM


RURAL KL09

Chez Lucie 1-42 Connell Ave Virginiatown, ON P0K 1X0 705-634-2228



RURAL KL10

Cote’s Variety Store

16 Tenth St. E Earlton, ON P0J 1E0 705-563-2022



RURAL KL11

Matachewan Nursing Station

1 Moyneur Ave Matachewan, ON P0K 1M0 705-565-2351

MONDAY – THURSDAY 9:00AM – 3:00PM

(Closed 12:00-1:00PM)

FRIDAY 9:00AM-11:30PM


RURAL KL12

Bayshore Specialty Rx

70 Esna Park Drive Unit 11 Markham, ON L3R 6E7 905-474-0822/888-313-6988

Next day delivery from Markham

MON 9:00AM – 5:00PM(Only if order sent on previous Friday)

TUES-FRI 9:00 AM – 5:00PM

Bayshore Rx IV Supplies & Equipment



SUDBURY (Questions or issues call: Robinson’s / HealthCare Pharmasave)

Service Area



Service Type

URBAN SUD01

Health Care Pharmacy Pharmasave

1276 Lasalle Blvd. Sudbury, ON P3A 1Y8

MON-FRI 9:00AM-9:00PM SATURDAY 9:00AM-6:00PM

SUNDAY 9:00-6:00PM

Medical Supplies Infusion Equipment & Infusion Supplies

URBAN SUD02

NE CCAC Clinic 865 Regent Sudbury, ON P3E 3Y9


For clinic patients only

Medical Supplies

Infusion Equipment & Infusion Supplies

URBAN SUD03

Corner Clinic

344 Elgin, Sudbury, ON P3E 3N9 705-673-3721

MON-WED 8:00AM-2:30PM THURSDAY 8:00AM-2:00PM

FRIDAY 8:00AM-2:30PM

Closed between 12:00-1:00PM

Medical Supplies

URBAN SUD04

Daffodil Lodge 41 Ramsey Lake Rd. Sudbury, ON P3E 5J1

MONDAY – FRIDAY 9:00AM-5:00PM

Medical Supplies

URBAN SUD05

ICAN (Haig) 765 Brennan Road Sudbury, ON P3C 1C4


Medical Supplies

URBAN SUD06

ICAN (Mont Adam)

117 Mont Adam Sudbury, ON P3B 1E1


Medical Supplies

URBAN SUD07

Sudbury Maison Vale Hospice

1028 South Bay Sudbury, ON P3E 6J7 705-674-9252


Medical Supplies


URBAN SUD08

Health Sciences North

41 Ramsey Lake Rd Sudbury, ON P3E 5J1

CCAC use only - Distributed by the CCAC as required to facilitate hospital discharges only

Medical Supplies


URBAN SUD09

NE CCAC Sudbury

40 Elm St. Suite 41-C Sudbury, ON P3C 1S8 705-522-3460

For CCAC clinicians use only – Not for patient pick-up

Medical Supplies

URBAN SUD10

Chelmsford Guardian Pharmacy

46 Main St. Chelmsford, ON P0M 1L0 705-855-2371

MON – FRI 9:00AM – 9:00PM SATURDAY 9:00AM – 5:30PM SUNDAY 11:00AM – 4:00PM

Medical Supplies

URBAN SUD11

Wellness Shoppe

1769 Regent St. Sudbury, ON P3E 3Z7 705-522-9159

MON – FRI 9:30AM – 7:00PM SATURDAY 9:00AM – 5:00PM

Medical Supplies

URBAN SUD12

Coniston Guardian

24 Amanda St. Coniston, ON P0M 1M0 705-694-5346

MON – WED 9:00AM – 6:00PM THURS-FRI 9:00AM – 9:00PM SATURDAY 9:00AM – 5:30PM

Medical Supplies

URBAN SUD13

Wilson Pharmacy Pharmasave

10 Serpentine St. Copper Cliff, ON P0M 1N0 705-682-2841


Medical Supplies

URBAN SUD14

Nickel Centre Pharmacy, Pharmasave

3098 Falconbridge Hwy, Garson, ON P3L 1P5 705-693-2738


Medical Supplies

URBAN SUD15

Val Est Pharmacy, Pharmasave

3140 Hwy 69 N Val Caron, ON P0M 1E0 705-897-1867


Medical Supplies


URBAN SUD16

Walden Medicine Shoppe

135 Regional Rd. 24 Walden Plaza 705-692-5868


Medical Supplies

URBAN SUD17

Lalonde Pharmacy

23 Yonge St. Capreol, ON 705-858-1231

MON-THURS 9:00AM – 5:30PM FRIDAY 9:00AM – 6:00PM

SATURDAY 10:00PM – 3:00PM

Medical Supplies


NORTH EAST CCAC MEDICAL SUPPLIES DEPOT/DROP-OFF LOCATIONS SUDBURY (Questions or issues call: Robinson’s / HealthCare Pharmasave)


Private-Pay Patient Deliveries: Call Robinson’s for current price.

Service Area



Service Type

URBAN SUD18

Dowling Pharmacy

30 Main St. Dowling, ON 705-855-4562


Medical Supplies

URBAN SUD19

Levack Pharmacy

2 – 1st Ave North Onaping Falls, ON 705-966-3612

MONDAY – FRIDAY 9:00AM - 5:00PM

Medical Supplies

RURAL SUD20

Hagar General Store

7147 Hwy 17 E, Hagar, ON 705-599-2060



Medical Supplies

RURAL SUD21

Noelville Pharmacy

27 St David N, Noelville, ON P0O 2N0 705-898-2999




RURAL SUD22

St. Charles Cooperative Store

25 Main St. St. Charles, ON 705-867-2000


SATURDAY 8:00AM – 7:00PM SUNDAY 8:00AM – 6:00PM

Medical Supplies

RURAL SUD23

Pitfield General Store

7 Channel Killarney, ON P0M 2A0 705-287-2872



Medical Supplies

RURAL SUD24

Robinsons Pharmasave

119 Tudhope Espanola, ON 705-869-1561



RURAL SUD25

Home Hardware

275 Imperial St Massey, ON P0P 1P0 705-865-2135



Medical Supplies

RURAL SUD26

Little Current Guardian

41 Meredith St Little Current, ON P0P 1K0 705-368-2530




RURAL SUD27

Manitowaning Pharmacy

1 Wellington Manitowaning, ON P0P 1N0 705-859-2323


Medical Supplies

RURAL SUD28

Mindemoya Pharmacy 705-377-5411

Guardian Pharmacy 11 Yonge St. Mindemoya, ON P0P 1S0




RURAL SUD29

Robertson IDA 39 Meredith Street Gore Bay, ON P0P 1H0 705-282-2147


Medical Supplies

RURAL SUD30

Central Guardian Pharmacy

Meredith Street Gore Bay, ON P0P 1H0 705-282-2409


Medical Supplies



PARRY SOUND (Questions or issues call: Robinson’s / HealthCare Pharmasave)


Private-Pay Patient Deliveries: Call Robinson’s for current price.

Service Area



Service Type

RURAL PS01

Britt Nursing Station

Box 97 Parry Sound, ON P0G 1A0 705-383-2375

MON - THURS 8:00AM-4:00PM FRIDAY 8:00AM-12:00PM

Medical Supplies

RURAL PS02

Duck Rock General Store

2093 124 Hwy Dunchurch, ON P0A 1G0 705-389-3322


Medical Supplies

RURAL PS03

Lane Family Pharmasave

4 Pine Parry Sound Parry Sound, ON P2A 3B8 705-746-2187


Medical Supplies


RURAL PS04

Rosseau General Store

1 Rice Parry Sound, ON P2A 2W9 705-732-4479

Winter (Sep-June) MON-FRI 7:30AM – 6:00PM


Medical Supplies

RURAL PS05

NE CCAC Parry Sound Office

70 Joseph St. Parry Sound, ON P2A 2G5 705-773-4602

For CCAC clinicians use only Not for patient pick-up

Medical Supplies

RURAL PS06

Parry Sound Hospital

6 Albert Street Parry Sound, ON P2A 3A4

Distributed by the CCAC as required to facilitate hospital

discharges only

Medical Supplies



Wound CareCCAC Code Description Brand Name Manufacturer

Code SizeWeekly

Maximum Qty

Notes

SWC-0107 Absorbent Dressing 5"x6" Mesorb Mölnlycke677201

5" x 6"13 x 15 cm 7


6" x 9"15 cm x 23 cm 7


9" x 12" 23 x 30 cm 7

SWC-0110 Anti-Sheer Absorbent Dressing 4"x6" Exu-Dry Smith & Nephew5999004120

4" x 6"10 x 15 cm 7 For malignant wounds or fungating wounds and burns only

SWC-0111 Anti-Sheer Absorbent Dressing 6"x9" Exu-Dry Smith & Nephew5999006

6" x 9"15 x 23 cm 7 For malignant wounds or fungating wounds and burns only

SWC-0025 Hydrofiber Dressing 4"x4" Aquacel Convatec177902

4" x 4" 10 x 10 cm 4

SWC-0026 Hydrofiber Dressing 6"x6" Aquacel Convatec177903

6" x 6"15 x 15 cm 4

SWC-0106 Hydrofiber Ribbon 1"x18" Aquacel Convatec403770

1" x 18"2 x 45 cm 4

Kaltostat Convatec168212

3" x 5"7 x 12 cm 4

Biatain Coloplast3710

4" x 4" 10 x 10 cm 4

NE CCAC Regional Approved Medical Supplies List

Absorptives: Multi-layer wound covers that provide either a semi-adherent quality or a non-adherent layer, combined with highly absorptive layers of fibers, such as cellulose, cotton or rayon. Designed to minimize adherence to the wound and manage exudate. They may be used as a primary or secondary dressing to manage surgical incisions, lacerations, abrasions, burns, donor or skin graft sites, or any exudating wound.

Alginates: Non-woven, non-adhesive pads and ribbons composed of natural polysaccharide fibers or xerogel derived from seaweed. On contact with exudate these dressings form a moist gel through a process of ion exchange. They are soft and conformable, easy to pack, tuck or apply over irregular-shaped wounds. Indicated for wounds with moderate to heavy exudate, such as pressure ulcers, infected wounds, diabetic ulcers and venous insufficiency ulcers. Alginates generally require a secondary dressing.

SWC-0036 Calcium Alginate Dressing 4"x4"

Either product may be provided depending on the inventory on hand


CCAC Code Description Brand Name ManufacturerCode Size

Weekly Maximum

QtyNotes

SWC-0029 Hydrofiber Silver Impregnated Dressing 4"x4" Aquacel Ag Convatec403708

4" x 4" 10 x 10 cm 4

SWC-0031 Hydrofiber Silver Impregnated Dressing 8"x12" Aquacel Ag Convatec403711

8" x 12" 19 x 29 cm 4

SWC-0032 Hydrofiber Silver Impregnated Ribbon 1"x18" Aquacel Ag Convatec403771

1" x 18"2 x 45 cm 4

SWC-0034 Non-adherent Antiseptic Impregnated Gauze 4"x4" Bactigras Smith & Nephew66003650

4" x 4" 10 x 10 cm 4 For adjunctive treatment and prevention of infection in skin loss

lesions, including wounds, burns and ulcers

SSP-0003 Ointment with Iodine 10Gr Tube Iodasorb Smith & Nephew66060630

10 GramTube 1

Should not be used in patients with known or suspected Iodine sensitivity, history of any thyroid disorder, or pregnant or lactating women

SDR-0078 Non-adhesive Povidone-Iodine Dressing 2"x2" Inadine SystagenixP01481

2" x 2"5 x 5 cm 3 10% Povidone Iodine; equivalent to 1.0% available iodine

SDR-0079 Non-adhesive Povidone-Iodine Dressing 3.7"x3.7" Inadine Systagenix P01512

3.75 x 3.75"9.5 x 9.5 cm 3 10% Povidone Iodine; equivalent to 1.0% available iodine

SWC-0112 Antimicrobial Gauze Sponges 12 Ply 4"x4" Curity AMD Covidien2533

4" x 4" 10 x 10cm 7 Impregnated with 0.2% PHMB

SWC-0113 Antimicrobial Rolled Gauze Roll 6 Ply Kerlix AMD Covidien3332

4.5" x 4 1/8 yd11.4cm x 3.7m 7 Impregnated with 0.2% PHMB

SWC-0115 Antimicrobial Packing Strips 1/4" x 1 yard Curity AMD Covidien7831AMD

1/4" x 3'0.6 x 91.4 cm 7 Impregnated with 0.2% PHMB

SWC-0116 Antimicrobial Packing Strips 1/2" x 1 yard Curity AMD Covidien7832AMD

1/2" x 3' 1.3 x 91.4 cm 7 Impregnated with 0.2% PHMB

SWC-0117 Antimicrobial Packing Strips 1" x 1 yard Curity AMD Covidien7833AMD

1" x 3'2.5 x 91.4 cm 7 Impregnated with 0.2% PHMB

SWC-0118 Gentian Violet Antibacterial Dressing 4"x4" Hydrofera Blue HollisterHB4414

4" x 4" 10 x 10 cm 3 Non-border, Sterile

SWC-0137 Gentian Violet Antibacterial Dressing 6"x6" Hydrofera Blue HollisterHB6614

6" x 6" 15 x 15 cm 3 Non-border, Sterile

SWC-0138 Gentian Violet Antibacterial Tunneling Dressing Hydrofera Blue HollisterHBT0906

9 mm(Pack of 2) 3 Sterile

SWC-0119 Silver Antimicrobial Barrier Dressing Non-Absorbent 4"x4"

Acticoat Flex 3

Smith & Nephew66800399

4" x 4" 10 x 10cm 3 Not compatible with oil-based products, such as petrolatum

Antimicrobials & Silvers: Broad spectrum topical antimicrobials to reduce localized bacteria. Indicated to help reduce the risk of infection in partial- and full-thickness wounds, over percutaneous line sites and surgical incisions, or around tracheostomies. The ability to handle exudate depends on the characteristics and composition of the product. Does not replace systemic antibiotics for deeper tissue infections. Not to be used if known hypersensitivities to any product components.



Weekly Maximum

QtyNotes

SWC-0120 Silver-Coated Antimicrobial Calcium Alginate Absorbent Dressing 4"x5"

Acticoat Absorbent

Smith & Nephew20381

4" x 5"10 x 12.5 cm 3

SWC-0131 Antimicrobial Gel with Silver 0.25 oz SilvaSorb MedlineMSC93025EP 0.25 oz Tube As required For clinic patients only

SWC-0132 Antimicrobial Gel with Silver 1.5 oz SilvaSorb MedlineMSC9301EP 1.5 oz Tube 1 Community patients

SWC-0133 Textile Antimicrobial Silver 10”x36” InterDry AG Coloplast7912 10" x 36" 1 If larger than 36" required, order custom size

SWC-0134 Textile Antimicrobial Silver (Custom size) InterDry AG Coloplast7910 10" x Custom 4 Custom order per 12" lengths

SVS-0008 Non-Elastic Zinc Paste Bandage Viscopaste Smith & Nephew4948 7.5 cm x 6 m 2 Woven cloth impregnated with a paste containing 10 % Zinc Oxide BP

rolled onto a plastic coreSWC-0090 Protease inhibitor dressing with Collagen (‡) Promogran Systagenix

M772028 28 cm2

Hexagonal2 Contraindicated for: • Malignant wounds • Eschar in wounds

• Untreated Wound Infection • Wounds less than 12 weeks old• Diabetic Ulcer not offloaded/uncontrolled diabetes – HbA1C more than 7.9%• Pressure Ulcer not offloaded• Extensive burns • Hypersensitivity • Acute vasculitis• Venous Ulcer not in a compression system of at least 20mmHgProtease Inhibitor should be discontinued if there is no progression towards wound healing (less than 10% healing in 3 weeks).

SWC-0139 Absorbent Clear Acrylic Small Oval 7.6x9.5cm Tegaderm 3M90800

3 in. x 3-3/4 in.7.6 x 9.5 cm 1

SWC-0140 Absorbent Clear Acrylic Medium Oval 11x12cm Tegaderm 3M90801

4-3/8 in. x 5 in.11.1 x 12.7 cm 1

Clear Acrylic: Transparent film contact layer and clear, acrylic polymer pad, topped with breathable, waterproof film. Enables clinicians to monitor small to moderately exuding wounds withoutchanging the dressing • Supports autolytic debridement • Extended wear time • Skin graft donor sites • Skin tears and pre-tibial lacerations • Post-operative wounds • First (superficial thickness) and second (partial thickness) degree burns and abrasions • Do not cut acrylic pad

For pressure ulcers, skin tears and other low to moderately exuding wounds. Dressing should overlap the wound margins by at least 3/8" (1 cm).

Composite Dressings: Multilayered, combination dressings to provide multiple functions, such as a bacterial barrier, absorption and adhesion. Usually, they are comprised of multiple layers and incorporate a semi- or non-adherent pad that covers the wound. Some are appropriate for autolysis. May also include an adhesive border of non-woven fabric tape or transparent film. Composite dressings can function as either a primary or a secondary dressing on a wide variety of wounds and may be used with topical medications. Use with wounds that have moderate to large amounts of exudate.



Weekly Maximum

QtyNotes

SWC-0099 Foam Non-Adhesive Regular or similar 4"x4" Mepilex XT Mölnlycke211100

4" x 4"10 x 10 cm 4

SWC-0100 Foam Non-Adhesive Regular or similar 8"x8" Mepilex XT Mölnlycke211400

8" x 8"20 x 20 cm 4

SWC-0101 Foam Non-Adhesive Lite or similar 6"x6" Mepilex Lite Mölnlycke284300

6" x 6"15 x 15 cm 4

SWC-0102 Foam Adhesive Regular or similar 3"x3" Mepilex Border Mölnlycke295200

3 "x 3"7.5 x 7.5 cm 4


4" x 4"10 x 10 cm 4


6" x 6"15 x 15 cm 4

SWC-0105 Foam Adhesive Lite or similar 6"x6" Mepilex Border Lite

Mölnlycke281300

4" x 4"10 x 10 cm 4

SWC-0129 Foam Non-Adhesive with Ibuprofen 4"x4" Biatain IBU Coloplast4110

4" x 4"10 x 10 cm 4

SWC-0130 Foam Non-Adhesive with Ibuprofen 6"x6" Biatain IBU Coloplast4115

6" x 6"15 x 15 cm 4

SWC-0045 Hydrocolloid Thin 4x4" Tegaderm 3M90022

4" x 4"10 x 10 cm 3

SWC-0047 Hydrocolloid Thin Oval With Border 10x12cm Tegaderm 3M90021

4" x 4.75"10 x 12 cm 3

SWC-0048 Hydrocolloid Thin Oval With Border 13x15cm Tegaderm 3M90023

5.25" x 6"13 x 15 cm 3

SWC-0051 Hydrocolloid Regular 4x4" Tegaderm 3M90002

4" x 4"10 x 10 cm 3

SWC-0052 Hydrocolloid Regular 6x6" Tegaderm 3M90005

6" x 6"15 x 15 cm 3

Foams: Foam dressings are sheets and other shapes of foamed polymer solutions (most commonly polyurethane) with small, open cells capable of holding fluids. They may be impregnated or layered in combination with other materials. Absorption capability depends on thickness and composition. The area in contact with the wound surface is non-adhesive for easy removal. Available with an adhesive border and/or a transparent film coating that acts as a bacterial barrier. Indicated for partial- and full-thickness wounds. Used on lightly- to heavily-exudating wounds, depending on product. Occlusive foams without silver should not be used on infected wounds.

Hydrocolloids: Wafers, powders or pastes composed of gelatin, pectin or carboxymethylcellulose. Moisture-retentive dressing, contributes to autolytic debridement. Creates occlusive barrier against bacterial invasion. Absorption capability depends on thickness and composition. Useful on areas that require contouring, such as heels and sacral ulcers. Powders and pastes require a secondary dressing. Indicated for partial- and full-thickness wounds with or without necrotic tissue. Characteristic odour may accompany dressing change and should not be confused with infection. Caution when used on fragile skin and should not be used on heavily draining or infected wounds.



Weekly Maximum

QtyNotes

SWC-0053 Hydrocolloid Regular With Border 10x12cm Tegaderm 3M90001

4" x 4.75"10 x 12 cm 3

SWC-0055 Hydrocolloid Regular With Border 17x20cm Tegaderm 3M90004

6.75" x 7.75"17 x 20 cm 3

SWC-0056 Hydrocolloid Sacral Tegaderm 3M90007

6 3/4" x 6 3/8"17 cm x 16 cm 3

SWC-0080 Hydrocolloid Regular 8"x8" Duoderm CGF Convatec187662

8"x8"18.9 x 18.9cm 3

SWC-0023 Hydrogel (Low Pectin, Low Saline) Intrasite Gel Smith & Nephew7311 15 g 3

SWC-0072 Transparent Film Dressing 10x12cm Tegaderm 3M1626W

4" x 4.75"10 x 12 cm 3

SWC-0128 Transparent Film Dressing 15x20cm Tegaderm 3M1628

6" x 8"15 x 20 cm 3

SWC-0037 Activated Charcoal Dressing with Silver 4"x4" Actisorb Plus Silver 220

KCI Systagenix MAS105

4" x 4" 10.5 x 10.5 cm 2

SWC-0135 Activated Charcoal Dressing with Silver 2.5 x 3.75" Actisorb Plus Silver 220


2.5" x 3.75"6.5 x 9.5 cm 2

SWC-0136 Activated Charcoal Dressing with Silver 4" x 7.5" Actisorb Plus Silver 220


4" x 7.5"10.5 x 19 cm 2

Hydrogel: Polymers with high water content designed to absorb a small amount of exudate, prevent drying of the wound bed and maintain a moist healing environment. The high moisture content serves to rehydrate wound tissue. Available in gels, solid sheets or embedded into gauze. Can decrease pain. Indicated for partial and full-thickness wounds, wounds with necrosis, minor burns and radiation tissue damage. May require a secondary dressing. Solid sheets should not be used on infected wounds.

Films & Membranes: Transparent film dressings are polymer membranes of varying thickness coated on one side with an adhesive. They are impermeable to liquid, water and bacteria but permeable to moisture vapor and atmospheric gases. Moisture vapour transmission rate (MVTR) varies from film to film. Can help reduce friction to susceptible skin (e.g. heels). Transparency allows visualization of the wound. Indicated for partial-thickness wounds with little or no exudate, wounds with necrosis, and as both a primary or secondary dressing. Also used to cover IV sites, donor sites, lacerations, abrasions and second-degree burns. Available in a wide variety of sizes, both sterile and in bulk. Should not be used on draining or infected wounds.

Odour Absorbent Dressings: Odour absorbent charcoal contained within product that masks the odour. Ensure that dressing edges are sealed to control odour and treat the cause if possible.

Silver is not released into the wound, so can be use on silver-sensitive patients. Remains effective to reduce odour when wet or dry and can be left in place for up to 7 days. NOTE: This product should not be cut



Weekly Maximum

QtyNotes

SWC-0003 Non Adherent Sterile Impregnated Gauze 3"x3" Adaptic Systagenix2012

3" x 3"7.6 x 7.6 cm 4

SWC-0076 Non Adherent Sterile Impregnated Gauze 3"x8" Adaptic Systagenix2015

3" x 8"7.6 x 20.3 cm 7

SWC-0081 Non Adherent Sterile Silicone Dressing 2"x3" Mepitel Mölnlycke290510

2"x 3"5 x 7.5 cm 3

SWC-0086 Non Adherent Sterile Impregnated Gauze 4"x4" Jelonet Smith & Nephew7404

4"x4"10 x 10 cm 4

SCM-0019 Blue Absorbent Pads 24cm x 26cm Each 1/VisitAuthorized for clinic patients for containment of drainageor for methotrexate administration in home/clinicONLY. Approved clinics may order in bulk.

SDR-0011 Sterile Single Use Scissors MED-Rx CHS85-4202 4 1/2"

In-Home: 1 per Week

Clinic: 1 / Visit

Sharp/Blunt

SDR-0012 Sterile Plastic Thumb Forceps MED-Rx CHS85-4200 Each

In-Home: 3 per Week

Clinic: 1 / Visit

SDR-0024 Suture Removal Kit Each 1

SDR-0025 Staple Remover Each 1

SDR-0062 Wound irrigation tip for syringe MED-RX MED-RX20-1104 1 Tip 7 Single use. Syringe must be ordered separately

SDR-0080 Tissue Forceps Metal Sterile Disposable MED-Rx CHS85-9000

1 x 2 teeth4-3/4" 1/Visit For sharp/surgical debridement and should only be performed by

clinicians with this expertise.

SDR-0081 Curved Iris Scissors Sterile MED-Rx CHS85-9411 4 1/2" 1/Visit For sharp/surgical debridement and should only be performed by

clinicians with this expertise

SMK-0042 Initial Wound Care Kit 1 See Medical Supply Kits for description

SWC-0059 Wound Culture Swab Various Each 1

Other & Specialty

Non-adherent: Porous sheets of dressings with low adherence to tissue. Serves as a contact layer that allows the transfer of exudate to secondary dressing. May be composed of silicone or tulles. Facilitates application of topical preparations. Use with wounds that are painful or friable. May require a secondary dressing.



Weekly Maximum

QtyNotes

SWC-0064 Single Use Safety Scalpel - Size 10 Miltex Integra4-510 Size 10 3 Sharp/surgical debridement should only be performed by clinicians with

this expertise.

SWC-0066 Flexible Silver Nitrate Caustic 6" Applicator Stick AMG AMG Medical118-395 Each 3 Silver Nitrate 75%, Potassium Nitrate 25%

SWC-0141 Flexible Silver Nitrate Applicator Stick AMG AMG Medical118-395 Pack of 100 1 For approved ETs nurses and clinic bulk orders only.

SWC-0121 Protective Barrier Wipe Skin-Prep Smith & Nephew59420425 Each 3

Helps reduce friction during removal of tapes and films. Can also be used to prepare skin attachment sites for drainage tubes, external catheters, surrounding ostomy sites and adhesive dressings.

SWC-0122 Dermal Curette with 4mm tip Miltex Integra33-54 Each 1 For sharp/surgical debridement and should only be performed by

clinicians with this expertise.

SDR-0006 Cotton Tipped Applicator Plastic Sterile 2/pk Medline MDS202095 1 Pack of 2 7

SDR-0010 Sterile Tongue Depressor AMG Medical 118-425 Adult 3 Adult size Individually wrapped, single patient use.

SWC-0123 Minor Laceration Tray Kit - Sterile Busse Cardinal Health312-751 Each 1 See Medical Supply Kits for description



Weekly Maximum

QtyNotes

SNP-0001 VAC Adhesive Drape V.A.C. KCIM6275009 30.5 x 26 cm 1

SNP-0007 T.R.A.C. Y Connector V.A.C. KCIM6275066 Each 3 Y-connector to connect two or more dressings

SNP-0008 VAC GranuFoam Standard Dressing Kit Small V.A.C. KCIM8275051 10 x 7.5 x 3.3 cm 3 Includes 1 small black foam dressing, 1 adhesive drape,1 SensaTRAC

Pad

SNP-0009 VAC GranuFoam Standard Dressing Kit Medium V.A.C. KCIM8275052 18 x 12.5 x 3.3 cm 3 Includes 1 medium black foam dressing, 2 adhesive drapes,1

SensaTRAC Pad

SNP-0010 VAC GranuFoam Standard Dressing Kit Large V.A.C. KCIM8275053 26 x 15 x 3.3 cm 3 Includes 1 large black foam dressing, 2 adhesive drapes,1 SensaTRAC

PadSpecial Order Only (SYY)

VAC GranuFoam Standard Dressing Kit XL V.A.C. KCIM8275065 60 x 30 x 1.5 cm 3 Includes 1 large black foam dressing, 5 adhesive drapes,1 SensaTRAC

Pad

SNP-0017 VAC GranuFoam Silver Dressing Kit Small V.A.C. KCIM8275098 10 x 7.5 x 3.3 cm 3 Includes 1 small silver foam dressing, 1 adhesive drape,1 SensaTRAC

Pad

SNP-0018 VAC Granufoam Silver Dressing Kit Medium V.A.C. KCIM8275096 18 x 12.5 x 3.3 cm 3 Includes 1 medium silver foam dressing, 2 adhesive drapes,1

SensaTRAC Pad

SNP-0019 VAC Granufoam Silver Dressing Kit Large V.A.C. KCIM8275099 26 x 15 x 3.3 cm 3 Includes 1 large silver foam dressing, 2 adhesive drapes,1 SensaTRAC

Pad

SNP-0020 VAC WhiteFoam Dressing Kit Small V.A.C. KCIM8275068 10 x 7.5 x 1 cm 3 Less adherent material helps promote graft take. Includes 1 small PVA

foam dressing, 1 adhesive drape, 1 SensaT.R.A.C. Pad

SNP-0022 VAC WhiteFoam Dressing Kit Large V.A.C. KCIM8275067 10 x 15 x 1 cm 3 Less adherent material helps promote graft take. Includes 1 large PVA

foam dressing,1 adhesive drape, 1 SensaT.R.A.C. Pad

SNP-0058 VAC WhiteFoam Small (Foam Only) V.A.C. KCIM6275033 10 x 7.5 x 1 cm 3 1 polyvinyl alcohol (PVA) foam dressing (10 x 7.5 x 1 cm)

SNP-0059 VAC WhiteFoam Large (Foam Only) V.A.C. KCIM6275034 10 x 15 x 1 cm 3 1 polyvinyl alcohol (PVA) foam dressing (10 x 15 x 1 cm)

SNP-0046 VAC Simplace Dressing Kit Small V.A.C. KCIM8275041 Each 3 Includes 1 small Spiral-cut VAC GranuFoam Dressing, 2 adhesive

drapes, 1 SensaT.R.A.C. Pad

Negative Pressure Wound Therapy (NPWT): A therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump (pump rental required in addtion to the dressings).


Negative Pressure Wound Therapy (NPWT)



Weekly Maximum

QtyNotes

Negative Pressure Wound Therapy (NPWT): A therapeutic technique using a vacuum dressing to promote healing in acute or chronic wounds. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump (pump rental required in addtion to the dressings).

SNP-0048 VAC Simplace Dressing Kit Medium V.A.C. KCIM8275040 Each 3 Includes 1 medium Spiral-cut VAC GranuFoam Dressing, 2 adhesive

drapes, 1 SensaT.R.A.C. Pad

SNP-0052 300 mL ActiVAC Canister with Gel V.A.C. KCIM8275058 Each 1 1 canister with gel, tubing, clamp and connector; May be authorized for

more than 1/week if the canister is full.

SNP-0060 VAC SensaT.R.A.C. Pad V.A.C. KCIM8275057 Each 1 Includes 1 SensaT.R.A.C. Pad with tubing, clamp and connector

SNP-0061 T.R.A.C Tubing Cap V.A.C. KCIM6275069 Each 1 Cap to secure end of tubing when not in use

Special Order Only (SYY)

VAC GranuFoam Bridge Dressing Kit V.A.C. KCIM8275042 Each 3 Each kit includes black foam, bridge dressing; sensa TRAC pad and

adhesive drape


VAC GranuFoam Bridge XG Dressing Kit V.A.C. KCIM8275044 Each 3 Each kit includes black foam, bridge dressing; sensa TRAC pad and

adhesive drape

SWC-0124 Single Use Negative Pressure System 4x8" PICO Smith & Nephew66800951

4" x 8"10 x 20 cm 1 Each kit contains 2 units. Dressings may be left in place for up to seven

days depending on the amount of fluid from the wound.



days depending on the amount of fluid from the wound. Special Order Only (SYY)

Single Use Negative Pressure System 4x16" PICO Smith & Nephew66800953








days depending on the amount of fluid from the wound. Special Order Only (SYY)














Weekly Maximum

QtyNotes

SDR-0086 White Surgical Tape 1" Single Use Roll Transpore White

3M 1534S-1

1" x 1-1/2 yard 2.5 cm x 1.3 m 1 Universal hypoallergenic tape can be used for all applications

SDR-0087 Blue Silicone Tape 1" Single Use Roll Kind Removal 3M 2770S-1

1" x 54"2.5 cm x 1.3m 1 Only order for patients with very fragile at risk skin who react to

Transpore White SDR-0086

SDR-0037 Wound Closure Strip 1/2" (6 strips) Sterile Steri-Strip 3MR1547

1/2" x 4"12 x 100 mm 2

SDR-0038 Wound Closure Strip 1/4" (3 strips) Sterile Steri-Strip 3MR1541

1/4" x 3"6 x 75 mm 2

SDR-0039 Non Allergenic Self Adhesive Surgical Tape 2" Ultrafix Derma SciencesDUP62036

2" x 1 yrd5 cm x 1 m 7 m A non-sterile and non-woven fixative tape that is breathable and gentle

to the skin. Custom cut by metre lengths

SDR-0040 Non Allergenic Self Adhesive Surgical Tape 4" Ultrafix Derma SciencesDUP62037

4" x 1 yrd10 cm x 1 m 7 m A non-sterile and non-woven fixative tape that is breathable and gentle

to the skin. Custom cut by metre lengths

SDR-0048 Montgomery Straps and Ties Montgomery Derma SciencesDUP97991 18 cm x 28 cm 1

SDR-0017 Sterile Packing Plain 1/4" (Bottle) PAK-ITS Derma SciencesDUP59120

1/4" x 5 yards0.635cm x 4.5m 2

SDR-0018 Sterile Packing Plain 1/2" (Bottle) PAK-ITS Derma SciencesDUP59220

1/2" x 5 yards1.27cm x 4.5m 2

SDR-0019 Sterile Packing Plain 1" (Bottle) PAK-ITS Derma SciencesDUP59320

1" x 5 yards2.54 cm x 4.5m 2

SDR-0088 Sterile Gauze Packing Cotton Single Use 1/4" PAK-ITS Derma SciencesDUP561036

1/4" x 36"0.635cm x 90cm 3

SDR-0089 Sterile Gauze Packing Cotton Single Use 1/2" PAK-ITS Derma SciencesDUP4853

1/2" x 54"1.3 cm x 137cm 3

SDR-0090 Sterile Gauze Packing Cotton Single Use 2" PAK-ITS Derma SciencesDUP4856

2" x 54"5 cm x 137 cm 3

SDR-0020 Sterile 2" Small Woven Gauze Roll for Packing Gazetex Derma SciencesDUP9321

2-1/4" x 3 yards 5.7 cm x 2.7 m 7

Dressings, Bandages, Compression & Wraps: Materials that are dry woven or non-woven and may stretch and conform to body contours. Fabric composition may include cotton, polyester, rayon or nylon. They function for cleansing, packing or to provide absorption as a second layer or dressing, to hold a wound cover in place, to apply pressure or to cushion a wound. Some are sterile or non-sterile in bulk and may be adhesive. Other uses include securing IVs and splints and providing mild compression/support for strains, sprains and edema.


Tape, Dressings, Bandages, Compression & Wraps

100% Cotton, 6 Ply;

Single-ply ribbon gauze strips that can be used dry to absorb drainage in exuding wounds or soaked with a medication of choice. A secondary dressing is needed to hold the strips in place and to protect the wound from outside contaminants.(Bottles not for use at clinic - See single use packs below).



Weekly Maximum

QtyNotes

SDR-0021 Sterile 4" Large Woven Gauze Roll for Packing Gazetex Derma SciencesDUP9322

4-1/2" x 4 yards11.4 cm x 3.7m 7

SDR-0022 Sterile Gauze Packing Cotton 2x36" PAK-ITS Derma SciencesDUP564036

2" x 36"5 cm x 90 cm 3

SDR-0023 Sterile Gauze Packing Cotton Fan Folded 2x72" PAK-ITS Derma SciencesDUP4869

2" x 72" 5 cm x 182 cm 3

SDR-0001 Abdominal Pad Sterile 5"x9" Medline NON21450 5" x 9" 12.7 x 22.8 cm 7

SDR-0002 Abdominal Pad Sterile 8"x10" Medline NON21454 8" x 10"20 x 25 cm 7

SDR-0003 Gauze Sterile Woven 2"x2" AMD AMD-RitemedA2120

2" x 2"5 x 5 cm 28 Cotton, 12 Ply, Pack of 2

SDR-0004 Gauze Sterile Woven 4"x4" AMD AMD-RitemedA4800

4" x 4" 10 x 10cm 28 Cotton, 8 Ply, Pack of 2

SDR-0055 Drain Gauze Sponge Tracheostomy Sterile Woven 4"x4" AMD AMD-Ritemed

A4412T4" x 4"

10 x 10cm 14 Cotton, 12 Ply, Pack of 1Pre-cut notches for use with IV lines, picc lines, drain tubes etc.

SDR-0058 Drain Sponge Sterile Non-woven 4"x4" AMD AMD-RitemedA9210

4" x 4" 10 x 10cm 7 Synthetic, 6 Ply, Pack of 2

Pre-cut notches for use with IV lines, picc lines, drain tubes etc.

SDR-0064 Gauze Sterile Non-Woven 2"x2" AMD AMD-RitemedA2240

2" x 2"5 x 5 cm 25 Synthetic, 4 Ply, Pack of 2

SDR-0065 Gauze Sterile Non-Woven 4"x4" AMD AMD-RitemedA4440

4" x 4" 10 x 10cm 25 Synthetic, 4 Ply, Pack of 3

SDR-0076 Gauze Non-Sterile Non-Woven 4"x4" AMD AMD-RitmedA2100-CH

4" x 4" 10.2 x 10.2 cm

1 Pack of 200 Synthetic, 4 Ply

SDR-0013 Oval Eye Pad Non-woven Sterile Surecare Derma SciencesDUP82911

1-5/8" x 2-5/8"4 x 6.5 cm 7

SDR-0007 Conforming Bandage Wrap Non-Sterile 2" (Roll) Duform Derma SciencesDUP75102

2" x 4.1 yards5 cm x 3.75 m 7

SDR-0008 Conforming Bandage Wrap Non-Sterile 4" (Roll) Duform Derma SciencesDUP75104

4" x 4.1 yards10 cm X 3.75 m 7

SDR-0060 Conforming Bandage Non-Sterile 4" (Roll) Dutex Derma SciencesDUP76783

4" x 4.1 yards10 cm X 3.75 m 7 Cotton, 2 ply woven bandage ideal as a secondary dressing (non-

stretch)

SDR-0027 Tubular Net Elastic Bandage - Fingers/Toes/Small Wrist

Medline Elastic Net NONNET02 7 2/3"

19.5 cm 2 Non-adhesive and holds dressing/devices securely in place while allowing freedom of movement.

SDR-0083 Tubular Net Elastic Bandage - Wrist & Elbow Medline Elastic Net NONNET03 9 1/3"


Used for wrapping or packing large deep wounds

Synthetic knitted stretch bandage ideal as a secondary dressing



Weekly Maximum

QtyNotes

SDR-0028 Tubular Net Elastic Bandage - Elbow & Arm Medline Elastic Net NONNET04 11 2/3"


SDR-0029 Tubular Net Elastic Bandage - Knee & Thigh Medline Elastic Net NONNET05 12 3/8"


SDR-0084 Tubular Net Elastic Bandage - Shoulder Hip Thigh Medline Elastic Net NONNET06 17"

61 cm 2 Non-adhesive and holds dressing/devices securely in place while allowing freedom of movement.

SDR-0030 Tubular Net Elastic Bandage - Chest Back Perineum Axilla

Medline Elastic Net NONNET07 28 2/3"


SDR-0085 Tubular Net Elastic Bandage - Chest Region Large Medline Elastic Net NONNET08 31 1/3"


SYY-0687 Tubular Net Elastic Bandage - Chest Region XL Medline Elastic Net NONNET09 35"

88.9 cm 2 Non-adhesive and holds dressing/devices securely in place while allowing freedom of movement. Special Order SYY only

SYY-0688 Tubular Net Elastic Bandage - Chest Region XXL Medline Elastic Net NONNET10 41"

93.1 cm 2 Non-adhesive and holds dressing/devices securely in place while allowing freedom of movement. Special Order SYY only

SDR-0068 Multipurpose Tubular Elastic Bandage Size C Tubigrip Mölnlycke1443

16 - 20cm L x 6.6 - 7.2 cm W 2

SDR-0069 Multipurpose Tubular Elastic Bandage Size D Tubigrip Mölnlycke1437

20 - 24 cm L x7.3 - 7.9 cm W 2

SDR-0070 Multipurpose Tubular Elastic Bandage Size E Tubigrip Mölnlycke1434

24 - 28 cm L x8.7 - 9.2 cm W 2

SDR-0071 Multipurpose Tubular Elastic Bandage Size F Tubigrip Mölnlycke1438

28 - 36 cm L x9.7-10.3 cm W 2

SDR-0072 Multipurpose Tubular Elastic Bandage Size G Tubigrip Mölnlycke1439

36-46 cm L x11.3-12.7 cm W 2

SCM-0003 Mesh Pants XL Each 1

SCM-0004 Mesh Pants Large Each 1

SCM-0005 Mesh Pants Medium Each 1

SCM-0006 Mesh Pants Small Each 1

SCM-0017 Mesh Pants XXL Each 1

SVS-0003 High Stretch Elastic Stretch Bandage Non-Latex 4" Dusor Derma SciencesDUP71414LF 4" x 5 yards 1* *May order 2 for initial order only. Non-Sterile

- Limb sizes C through G available. Other sizes may available only as an exception item special order with approval. Sizes intended as a guideline only and should be used in conjunction with existing clinical protocols that consider physiological state and wound and skin condition.- Each box is 10 m. If unsure of size, order a 1 metre sample length- If overlapped, applies pressure of 10-15 mm Hg- Can be washed (gentle cycle & air dry) and reused multiple times

Mesh pants are only authorized only for patients requiring this product as a means of containing wound care dressings to coccyx, perineal area, etc.



Weekly Maximum

QtyNotes

SVS-0004 High Stretch Elastic Stretch Bandage Non Latex 6" Dusor Derma SciencesDUP71416LF 6" x 5 yards 1* *May order 2 for initial order only. Non-Sterile

SVS-0006 2 Layer Compression System - 35-40mmHg Coban 2 3M2094N Each 2

2 Rolls - Comfort layer and compression layer. Ideal for majority of patients with venous leg ulcers, lymphedema and other conditions where compression bandage therapy is appropriate.

SVS-0007 2 Layer Compression System - 25-30 mmHg Coban 2 Lite 3M2794N Each 2 2 Rolls - Comfort layer and compression layer. Designed to be more

comfortable for patients less tolerant of compression bandages.


Cleansers & SolutionsCCAC Code Description Brand Name Manufacturer

Code SizeWeekly

Maximum Qty

Notes

SSO-0001 Chlorhexidine 500mL 2% 500 mL 1

SSO-0002 Hydrogen Peroxide 3% 500mL 500 mL 1

SSO-0004 Povidone Iodine 1% 100mL bottle (‡) Betadine 100 mL 2Contraindicated for: • Malignant Wounds • Exposed Bone• Exposed Tendon • Patient with Extensive Burns • Hypersensitivity to iodine (Hyperthyroidism)

SSO-0006 Chlorhexidine Swabsticks with alcohol Each 8

SSO-0019 Normal Saline 500cc bottle (‡) Baxter BaxterJF7633 500 cc 1

SSO-0023 Normal Saline 118cc Irrigation Bottle Sterile (‡) Derma Derma Sciences DUP48501N 118 cc 7

SSO-0031 Sterile Water 500cc bottle (‡) Baxter BaxterJF7624 500 cc 1

SSO-0052 Alcohol Wipe Each 28

SSO-0053 Benzalkonium Chloride Wipe Each 28

SSO-0063 Chlorhexidine Wipe (Alcohol Free) Solu-I.V. 3M S10108 Each 28

SSO-0054 Povidone Iodine Wipe Betadine Each 3

SSO-0067 Povidone Iodine Swabstick (Single) Betadine Each 8

SSO-0068 Povidone Iodine Swabstick (3 pack) Betadine Each 3

SSO-0011 Hygeol 1:20 500 mL 500 mL 7 per 2 wks Maximum 14/patient

Cleansers


The items are approved only for:1) Immunocomprimised patient (i.e. BMT, Oncology, Organ Transplant patient); 2) Well water (untreated) or 3) Environmental considerations (i.e. concerns of hygiene)



Weekly Maximum

QtyNotes

SSO-0021 Normal Saline 10cc Pre-Filled Syringe PosiFlush BD306572 10 cc 14

SSO-0024 Normal Saline IV 100cc Bag 100 cc 7




SSO-0029 Normal Saline 10cc Vial 10 cc 7

SSO-0032 Sterile Water 10cc Vial 10 cc 7

SSO-0033 Dextrose 3%/0.3 saline IV 500cc Bag 500 cc 7

SSO-0034 Dextrose 3%/0.3 saline IV 1000cc Bag 1000 cc 7

SSO-0037 Dextrose 5% IV 50cc Bag 50 cc 7




SSO-0045 Ringers Lactate IV 500cc Bag 500 cc 7

SSO-0046 Ringers Lactate IV 1000cc Bag 1000 cc 7

Solutions



Weekly Maximum

QtyNotes

SFS-0005 Enteral Feeding Gravity Bag Kangaroo Covidien8884702500 1000 ml 2 To be used in the absence of a feeding pump. Non-sterile

SFS-0006 Enteral Feeding Pump Set 500 ml Kangaroo Joey Covidien762055 500 ml 2

SFS-0031 Enteral Feeding Pump Set 1000 ml Kangaroo Joey Covidien763656 1000 ml 2

SFS-0035 Enteral Feeding Pump Set with Flush Set 1000ml Kangaroo Joey Covidien 763662 1000 ml 2 For continuous overnight feeds ONLY

SFS-0010 Gastrostomy Tube with Y Port 16 Fr Kangaroo Covidien 8884720163

16 Fr x 9"20 cc

1/Patient Admission

SFS-0036 Gastrostomy Tube with Y Port 20 Fr Kangaroo Covidien 8884720205

20 Fr x 9"20 cc

1/Patient Admission

SFS-0012 Nasogastric Feeding Tube 5 Fr (Infant) Kangaroo Covidien461412

5 Fr x 20"1.7 mm x 51 cm 1/month Remains in situ for 30 days

Purple Polyurethane Sterile

SFS-0037 Nasogastric Feeding Tube PVC 5 Fr (Infant) Kangaroo Covidien460802

5 Fr x 16"1.7 mm x 41 cm 2/week Used only for patients who pull them out frequently

PVC Sterile

SFS-0038 Nasogastric Feeding Tube 6.5 Fr (Infant) Kangaroo Covidien461438

6.5 Fr x 36"2.2 mm x 91 cm 1/month Remains in situ for 30 days

Purple Polyurethane Sterile

SFS-0015 Nasogastric Feeding Tube 12 Fr KangarooEntriflex

Covidien8884721252

12 Fr x 43"4 mm x 109 cm 1/month With stylet and rigid outlet port

SFS-0039 Nasogastric Tube Stabilization Device (Pediatric) Statlok BardNG0100 Pediatric 1 Order for babies and small children

For nasogastric tubes and feeding tubes

SFS-0019 Nasogastric Tube Stabilization Device (Adult) Statlok BardNG0120 Adult 1 For nasogastric tubes and feeding tubes

SFS-0040 Adapter Y-Port-G-tube/P.E.G. 16 Fr Kangaroo Covidien 8884751622

Fits all G-Tubes16 Fr or smaller

1/Patient Admission

SFS-0041 Adapter Y-Port-G-tube/P.E.G. 20 Fr Kangaroo Covidien 8884752042

Fits all G-Tubes18 Fr or bigger

1/Patient Admission

SFS-0042 Purple Oral Syringe 3 ml Monoject Covidien403S 3 ml 3 Non sterile; reusable, can be washed

Feed, Ostomy, Respiratory: Initial supply authorization for four weeks for short-term treatment and to allow Patient to coordinate insurance or ADP applications. Supplies will only continue to be provided after 4 weeks if Patient continues to have nursing services AND is not eligible for any other funding program up to a maximum total period of six months. Feeding supplies are for the CCAC provided Kangaroo ePump or Joey Pump and may not be compatible with other pumps.


Feed, Ostomy, Respiratory

Non-Sterile. For use with the Kangaroo P.E.G. Kits and can be used as the replacement Y-port on all Kangaroo gastrostomy tubes. 1 per patient admission. CCAC will replace only if port is clogged or broken when patient still eligible for CCAC supplies.



Weekly Maximum

QtyNotes

SFS-0043 Purple Oral Syringe 10 ml Monoject Covidien410S 10 ml 3 Non sterile; reusable, can be washed

SFS-0044 Feeding Tube Extension Set MIC-KEYSecur-Lok

Kimberly Clark0121-12 12 inch 1 Includes right-angle connector, 2 Port "Y" and clamp

SOS-0001 Ostomy Flange and Pouch Max. 4 week supply

SOS-0013 Nephrostomy Pouch Each 3

SOS-0014 Stomadhesive Paste (tube) Each 1/Patient

SOS-0015 Stomadhesive Powder Each 1/Patient

SOT-0032 Tracheostomy Tray Each 7

SOT-0033 Tracheostomy Brush Each 1

SOT-0034 Tracheostomy Ties Adult Each 1

SOT-0035 Tracheostomy Ties Pediatric Each 1

SOT-0036 Tracheostomy Drain Sponges 2x2 2" x 2"5 x 5 cm 14

SOT-0037 Tracheostomy Drain Sponges 4x4 4" x 4" 10 x 10 cm 14

SOT-0051 Nebulizer Mask Kit Each 1

SOT-0052 Filter for Nebulizer Unit Each 1

SOT-0053 Suction Catheter 8 FR Covidien1180-851089 Each 7

SOT-0054 Suction Catheter 12Fr Covidien1180-851121 Each 7

SOT-0055 Suction Catheter 14Fr Covidien1180-851147 Each 7

SOT-0057 Yankauer Suction Bulb Tip Each 1

Specifiy Brand, Product Code, Type and Size when ordering



Weekly Maximum

QtyNotes

SOT-0072 Connecting tubing to suction catheter Med-RX MED-RX70-8072 1/4" X 72" 1

SOT-0073 Trach kit for compressor item ETM-1013 Covidien47800 Each 1

SOT-0077 Inner Cannula Disposable Size 4 Shiley Covidien4DIC Each 21 For use with Tracheostomy Tubes 4DCT, 4DFEN, 4DCFS, 4DCFN

SOT-0078 Inner Cannula Disposable Size 6 Shiley Covidien6DIC Each 21 For use with Tracheostomy Tubes 6DCT, 6DFEN, 6PERC, 6DCFS,

6DCFN

SOT-0079 Inner Cannula Disposable Size 8 Shiley Covidien8DIC Each 21 For use with Tracheostomy Tubes 8DCT, 8DFEN, 8PERC, 8DCFS,

8DCFN

SOT-0080 Fenestrated Inner Cannula Disposable Size 4 Shiley Covidien4DICFEN Each 21 For use with Tracheostomy Tubes 4DFEN, 4DCFN





Weekly Maximum

QtyNotes

SDR-0005 Dressing Tray Kit - Disposable Single Use MED-Rx CHS85-4010 Each 1 For catheter treatments only (PNT or PICC). Not for use in wound care.

See Medical Supply Kits for description of contents

SUR-0001 Foley 2 way Latex 12Fr 5cc 2/month












SUR-0027 Foley 2 way 100% Silicone 12 Fr 5/10cc 2/month

Urinary & Continence: Medical supplies may be authorized only while the patient is in need of nursing services. ODSP, social assistance, private insurance, DVA must be accessed as possible sources of funding on a long term basis. Individual supplies required to support percutaneous nephrostomy care may be ordered weekly when an entire PNT Kit SMK-0008 is not required.


Urinary & Continence



Weekly Maximum

QtyNotes

SUR-0028 Foley 2 way 100% Silicone 14Fr 5/10cc 2/month



SUR-0031 Foley 2 way 100% Silicone 20Fr 5/10 cc 2/month

SUR-0032 Foley 2 way 100% Silicone 16Fr 30cc 2/month




SUR-0036 Foley 2 way 100% silicone 24 Fr 30cc 2/month

SUR-0038 Foley 2 way Hydromer Coated 14Fr 5/10cc 2/month


SUR-0040 Foley 2 way Hydromer Coated 18FR 5/10cc 2/month



SUR-0043 Foley 2 way hydromer Coated 16Fr 30cc 2/month

SUR-0044 Foley 2 way hydromer Coated 18Fr 30cc 2/month

SUR-0045 Foley 2 way Hydromer Coated 20Fr 30cc 2/month



Weekly Maximum

QtyNotes

SUR-0048 Red Rubber Silicone 10 Fr 2/month

SUR-0049 Red Rubber Silicone 12Fr 2/month





SUR-0055 Intemittent 6" female 12Fr 2/month

SUR-0056 Intermittent 6" Female 14Fr 2/month

SUR-0057 Intemittent 6" female 16Fr 2/month

SUR-0059 Intermittent Regular 12Fr 2/month



SUR-0062 Intermittent regular 18Fr 2/month

SUR-0074 Bladder Irrigation Tubing 5/week

SUR-0075 Catheter Anchor Device 2/month

SUR-0076 Catheter adapter 2/month

SUR-0077 Catheter Clamp 2/month



Weekly Maximum

QtyNotes

SUR-0078 Catheter Plug 2/month

SUR-0079 Foley Catheter Tray 2/month

SUR-0080 Irrigation Tray Kit with 60 cc Piston Syringe MED-Rx CHS85-5042 Each 1/week Disposible Single Use

SUR-0081 Leg Bag Strap Large Reusable 1/month

SUR-0082 Leg Bag Strap Medium Reusable 1/month

SUR-0083 Leg Bag Strap Small Reusable 1/month

SUR-0085 Leg Bag 500mL with drain and extension tubing 2/month

SUR-0086 Leg Bag 500mL with drain, without extension tubing 2/month

SUR-0087 Leg Bag 1000ml with extension tubing 2/month

SUR-0089 Leg Bag 1000ml without extension tubing 2/month

SUR-0090 Night Bag 2000ml 2/month

SUR-0091 Sterile Lubricant Water Based 2/month

SUR-0092 Xylocaine Jelly 2% 2/month

SUR-0094 Urinary Extension Tubing with connector 18" Covidien 8884731998 2/month

SUR-0103 PNT Ext. Tube 2/month

SUR-0104 Statlock Universal Plus Catheter Stabilization Device Large 14-16 FR StatLock Bard

VUPD1416 14 - 16 fr 2/month

SUR-0105 StatLock Universal Plus Catheter Stabilization Device Medium 10 - 12 FR StatLock Bard

VUPD1012 10 - 12 fr 2/monthRestricts catheter motion and fits virtually all catheter sizes.For biliary and nephrostomy drainage and peritoneal lavage catheters.



Weekly Maximum

QtyNotes

SUR-0106 StatLock Universal Plus Catheter Stabilization Device Small 6 - 8 FR StatLock Bard

VUPD68 6 - 8 fr 2/month

SUR-0108 Specimen container Starplex 00529 2



Weekly Maximum

QtyNotes

SIV-0001 Blunt Plastic Cannula Interlink BD303345 Each 7 For use with Baxter Interlink, Abbott LifeShield or McGaw SafeLine

Systems

SIV-0002 Clave Extention Tubing 7" 7" 7

SIV-0003 Clave Multidose Vial Adapter Each 7

SIV-0004 Clave Needleless Connector Each 7

SIV-0005 Clave Port Male adapter Plug Each 7

SIV-0006 Clave Primary IV Administration Set Each 3

SIV-0007 Clave Secondary IV Administration Set Each 7

SIV-0008 Clave "Y" Connector Each 7

SIV-0009 Positive Displacement Device MaxPlus Clear Care Fusion MP1000-C Volume: 0.28ml 7 Clear needleless connector

SIV-0010 Positive Displacement Catheter Extension Set MaxPlus Clear Care Fusion MP9001-C 8" / 20 cm 7 Extension set with removable needleless connector

SIV-0012 Microbore Y Type Catheter Extension Set MaxPlus Clear Care FusionMP2202-C

Volume: 1.2ml Length: 13cm 3 Extension set with clear needleless connector

SIV-0013 Dual Luer Lock Cap Baxter Baxter 2C6250 Each 3 Male / female port protector; No open fluid path

SIV-0015 Interlink Universal Vial Adapter Interlilnk Baxter2N3395 Each 7

SIV-0016 Interlink 20ml vial adapter 20 mL 7

SIV-0017 Interlink 3cc syringe with cannula 3cc 7

IV, Needles, Syringes


IV, Needles, Syringes



Weekly Maximum

QtyNotes

SIV-0018 Interlink Continuous Flow Primary IV Administration Set Interlink Baxter

JC6519 85” (2.2 m) 3

SIV-0019 Interlink Secondary Medication Set Interlink BaxterJC7451 37" 3 With Lever lock cannula (detached) and male Luer lock adapter,

hanger

SIV-0020 Interlink PRN adapter Each 3

SIV-0021 Interlink IV Extension Tubing Each 3

SIV-0026 Hemostat Clamps untoothed Each 1

SIV-0027 Hemostat Clamps padded Each 1

SIV-0042 Ambulatory Infusion Pump Administration Set Each 7

SIV-0043 Ambulatory Infusion Pump High Volume Administration Set Each 7

SIV-0044 Ambulatory Infusion Pump Administration Set Filtered Each 7 Filtered for administration of Cephalosporins, Vancomycin, Ceftazidine

SIV-0045 Ambulatory Infusion Pump Extension Tubing 30 inches 30 inches 3

SIV-0046 Ambulatory Infusion Pump Extension Tubing 45 inches 45 inches 3

SIV-0047 Ambulatory Infusion Pump Medication Cassette 50ml 50 mL 7

SIV-0048 Ambulatory Infusion Pump Medication Cassette 100ml 100 mL 7

SIV-0052 PRN Adapter Long Each 7

SIV-0079 Syringe Luer Lok 1cc 1 cc 7



SIV-0082 Syringe Luer Lock 10cc 10 cc 7



Weekly Maximum

QtyNotes


SIV-0084 Syringe Luer Lok 30cc 30 cc See Notes-->

For IV: 7 / Patient / Week

For Wound Care: 1 / Patient / Week In-Home or 1 / Visit in ClinicAlso order Wound Irrigation Tip for syringe for each dressing change (SDR-0062)


SIV-0088 Syringe Catheter Tip 10cc 10 cc 7




SIV-0111 Vial Access Adapter for Interlink-single use Interlink BD 303367 15 gauge 7 Designed for use with Interlink injection sites. Used for a one time

access to 10 ml vials

SIV-0113 IV Extension Tubing for use with Clave Port 3

SIV-0114 Luer Lock Extension Tubing 8" 8" 3

SIV-0117 Blunt Fill Needle 18g 1.5" 18g 1.5" 3

SIV-0120 PleurX Drainage Kit 1000ml Sterile PleurX CareFusion50-7510 Each 3 For use with Pleurovac. Includes bottle and supplies

SIV-0121 Bodyguard Tubing without filter 3

SIV-0123 Continuflo Extension Sets with 3 injection sites 7

SIV-0125 Inter cannula 3

SIV-0126 3cc syringe with cannula 3 cc 14

SIV-0127 5 cc syringe with cannula 5 cc 14



Weekly Maximum

QtyNotes

SIV-0131 Sharps Disposal Container 1

SIV-0132 Sterile non fenestrated drape 18x26" 2

SIV-0133 Statlock PICC II Cook Double Lumen 1 Specific catheter stabilization device for 6 7 Fr PICC lines

SIV-0134 Sterile Universal IV Catheter Stabilization Device Statlock PICC Plus

Bard Limited PIC0220 Adult 1 PICC Sutureless, Tricot Anchor Pad

SDR-0077 Catheter Ported Dressing 7 x 9 cm IV3000 Smith & Nephew4006

2.75" x 3.5"7 x 9 cm 3 For peripheral IVs

SDR-0082 Catheter Central/PICC Dressing 10 x 12 cm IV30001-Hand

Smith & Nephew 4008

4" x 4-3/4"10 x 12 cm 3 Indicated for peripheral and central venous catheter fixation and to

keep the catheter site dry

SWC-0067 Transparent Film IV Dressing with Border Tegaderm IV 3M1633

2.75" x 3.25"7 x 8.5 cm 3 For winged and ported peripheral catheters

SIV-0135 Microclave connector 7

SIV-0137 Tourniquet 1

SIV-0138 IV Hook 1

SIV-0143 Butterfly Catheter 19g - BD Winged Infusion Set 3/4 "12" tubing 3



SIV-0146 Butterfly Catheter 25g - BD Winged Infusion Set 3


SIV-0148 IV Catheter 18g 1/16" - Smith Medical IV Protective V-Point 3

SIV-0149 IV Catheter 20g - Smith Medical Protective V-Point Smiths Medical 3067 3

SIV-0150 IV Catheter 22g - Smith Medical IV Protective V-Point Smiths Medical 3060 3



Weekly Maximum

QtyNotes

SIV-0151 IV Catheter 24g - Smith Medical IV Protective V-Point Smiths Medical 3063 3

SIV-0152 Subcutaneous Administration Needle 6 mm 24" Tubing CLEO 90 Smiths Medical21-7220-24

6 mm cannula24 inch tubing 3 Compatible with any open system insulin pump

31" & 42" tubing may be available as exception item

SIV-0201 Subcutaneous Administration Needle 9 mm 24" Tubing CLEO 90 Smiths Medical21-7230-24

9 mm cannula24 inch tubing 3

SIV-0153 Needle 18g 1" Edge Smiths Medical 401810 18g 1" 7

SIV-0154 Needle 18g 1-1/2" Edge Smiths Medical 401815 18g 1-1/2" 7

SIV-0155 Needle 20g 1" Edge Smiths Medical 20g 1" 7

SIV-0156 Needle 21g 1" Edge Smiths Medical 21g 1" 7





SIV-0161 Needle 23g 1-1/2" Edge Smiths Medical 23g 1-1/2" 7

SIV-0162 Needle 25g 5/8" Edge Smiths Medical 402558 25g 5/8" 7


SIV-0166 Needle 25g 1-1/2" Edge Smiths Medical 25g 1-1/2" 7

SIV-0167 Needle 27g 1/2" Edge Smiths Medical 27g 1/2" 7

SIV-0172 Needle with Syringe 3cc 22g 1 1/2" Edge Smiths Medical 432215 3cc 22g 1 1/2" 7

SIV-0173 Needle with Syringe 3cc 23g 1" Edge Smiths Medical 432310 3cc 23g 1" 7



Weekly Maximum

QtyNotes

SIV-0175 Needle with Syringe 1cc 25g 5/8" Edge Smiths Medical 1cc 25g 5/8" 7

SIV-0177 Needle with Syringe 1cc 27g 1/2" Edge Smiths Medical 1cc 27g 1/2" 7

SIV-0181 Needle with Syringe 3cc 25g 5/8" Edge Smiths Medical 432558 3cc 25g 5/8" 7

SIV-0182 Needle with Syringe 3cc 25g 1" Edge Smiths Medical 3cc 25g 1" 7

SIV-0186 Needle with Syringe Insulin 1cc 28g 1/2" Edge Smiths Medical 1cc 28g 1/2" 7

SIV-0187 Infusion Set - 22 Gauge x 0.75" Saf-T-Intima BD383329

22 gauge0.75" 3 Safety system with wings, extension tubing and Y adapter

SIV-0203 Infusion Set - 24 Gauge x 0.75" Saf-T-Intima BD383319

24 gauge0.75" 3 Safety system with wings, extension tubing and Y adapter

SIV-0189 Tubercullin 1cc slip tip syringe BD BD309659 1 cc 14

SIV-0190 10cc syringe with 21g 1.5" needle Edge Smiths Medical 10 cc 14

SIV-0191 3cc syringe with 21g 1.5" needle Edge Smiths Medical 3 cc 14

SIV-0192 Gripper 22g x 3/4"- Portacath Gripper Plus Gripper Plus Smiths Medical21-2766-24 1

SIV-0193 Gripper 19g x 1.25" - Portacath Gripper Plus Gripper Plus Smiths Medical 21-2765-24 1

SIV-0196 Heparin Lock Syringe 10 USP units/mL - 5 mL Fill in 10 mL Diameter Syringe PosiFlush BD

306414 10 USP/mL

5 mL/mL 3 For flushing Vascular Access Devices as per nursing guidelines and manufacturer’s recommendations.


306413 10 USP/mL

3 mL 3 For flushing Vascular Access Devices as per nursing guidelines and manufacturer’s recommendations.


306424 100 USP/mL



306423 100 USP/mL


SIV-0202 Antibiotic IV Medication Refill Solution Bag 7 Solution bag - not a cassette. For IV Med Refill orders only


CCAC Code Qty Per Kit Notes

SIV-0082 Syringe Luer Lock 10cc 2

SS0-0052 Alcohol wipe 6

SUR-0079 Foley Catheter Tray 2

SUR-0085 Leg Bag 500ml with drain and extension tubing 1

SUR-0090 Night Bag 2000mL 1


SDR-0005 Dressing Tray 2

SDR-0055 Drain Gauze Sponge Tracheostomy Sterile Woven 4"x4" 2

SOT-0001 Disposable Procedural Mask 2

SOT-0021 Sterile Nitrile Gloves Medium (Pair) 2

SSO-0021 Normal Saline 10cc Pre-Filled Syringe 1

SSO-0052 Alcohol wipe 14

SUR-0086 Leg Bag 500mL with drain, without extension tubing 1

SWC-0128 Transparent Film Dressing 15x20cm 2

SUR-0103 PNT Ext. Tube 2


SDR-0003 Gauze sterile woven 2"x2" 2

SDR-0005 Dressing Tray Kit 1

SDR-0028 Net Elastic Bandage 4 (arm, elbow) 1

SDR-0037 Wound Closure Strip 1/2" (Pkg) 1

SDR-0082 Catheter Central/PICC Dressing 10 x 12 cm 2

SIV-0009 Positive Displacement Device 1

SIV-0134 Sterile Universal IV Catheter Stabilization Device 1

SOT-0001 Disposable Procedural Mask 2

SOT-0021 Sterile Nitrile Gloves Medium (Pair) 1

SSO-0006 Chlorhexidine swabsticks with alcohol 4

SSO-0063 Chlorhexidine Wipes without alcohol 2




Medical Supplies Kits: Most items in each kit can be ordered individually if an entire kit is not required if an individual CCAC code is listed below. Additional items may also be ordered as needed.

SMK-0003Foley Catheter Kit

Maximum Quantity: 1 Kit/Week

Order catheters separately

SMK-0008:Percutaneous Nephrostomy Kit

Maximum Quantity: 1 Kit/WeekIf a night bag is required, it may be ordered using the regular item code SUR-0090

Dressing Tray SDR-0005 may be ordered individually if an entire kit is not required

If a Statlock is required add:SUR-0104 Statlock Universal Plus Catheter Stabilization Device Large 12 - 14 fr; orSUR-0105 StatLock Universal Plus Catheter Stabilization Device Medium 10 - 12 fr; orSUR-0106 StatLock Universal Plus Catheter Stabilization Device Small 6 - 8 fr

SMK-0029:PICC Dressing Kit


All PICC/central lines require pump for infusion therapy.A large Ambulatory Infusion Pump carrying bag may be required, if necessary.

Add: 2 of Ambulatory Infusion Pump Administration Sets (SIV-0042) OR Ambulatory Infusion Pump Administration Sets Filtered for administration of Cephalosporins, Vancomycin, Ceftazidine (SIV-0044) and 2 Alcohol Wipes (SS0-0052) AND 2 Normal Saline Syringes (SSO-0021) per day of infusion

Add: Portacath Gripper item SIV-0192 or SIV-0193 as required.

Add: Prefilled Heparin Lock Syringes as per nursing guidelines (See IV, Needles, Syringes )

Dressing Tray SDR-0005 may be ordered individually if an entire kit is not required

Description

For double lumen add:


Medical Supply Kits

Description

Description




SWC-0072 Transparent Film Dressing 10cm x 12cm 2

SDR-0086 White Surgical Tape 1" Single Use Roll 1

SIV-0020 Interlink PRN adapter 2

SIV-0152 Subcutaneous Administration Needle 6 mm 24" Tubing 3

SIV-0080 Syringe Luer Lok 3cc 10

SIV-0147 Butterfly Catheter 27g Winged Infusion Set 3

SIV-0158 Needle 22g 1" - Smith Medical Edge 4

SIV-0175 Needle with Syringe 1cc 25g 5/8" 20

SSO-0006 Chlorhexidine Swabsticks with alcohol 4

SSO-0029 Normal Saline Injectable 10cc Vial 1

SSO-0052 Alcohol Wipe 10




SDR-0008 Conform Wrap Non Sterile 4" (Roll) 1

SDR-0028 Net Elastic Bandage 4 (arm, elbow) (Mtr) 1

SDR-0086 White Surgical Tape 1" Single Use Roll 1


SIV-0114 Extension Tubing Luer Lock 8" 1

SIV-0137 Tourniquet 1

SIV-0150 IV Catheter 22g - IV Protective V-Point 2

SIV-0151 IV Catheter 24g - IV Protective V-Point 2

SSO-0063 Chlorhexidine Wipes (Alcohol Free) 6

SWC-0067 Transparent Window Dressing 7.5cm x 8.5cm 2



SIV-0018 Interlink Continuous Flow Primary IV Administration Set 3

SIV-0019 Interlink Secondary Medication Set 3

SIV-0052 PRN Adapter Long 2

SSO-0025 Normal Saline IV 250cc Bag 3

SSO-0052 Alcohol Wipes 6


SMK-0041:Gravity IV Administration Kit

SMK-0040:Peripheral IV Start/Restart


For infusion via pump order: Ambulatory Infusion Pump Administration Set (SIV-0042) OR Ambulatory Infusion Pump Administration Set Filtered for administration of Cephalosporins, Vancomycin, Ceftazidine (SIV-0044) AND 2 Chlorhexidine Wipes (SS0-0063) AND 2 Normal Saline Syringes (SSO-0021) per day of infusion


Provides 3 days of infusion

For increased frequency of medication administration beyond once daily, order additional Alcohol wipes (SSO-0052) and Prefilled Normal Saline Syringes (SSO-0021) per day of infusion

SMK-0039:Subcutaneous Administration of Pain Management Medications via Infusion Pump: Initial Start Up Kit


Add: 3 Extension tubing (SIV-0045 or SIV-0046) if being used with medication cassette.

Description

Description

Description




SWC-0023 Hydrogel 15g (Low Pectin, Low Saline) 1

SDR-0039 Non Allergenic Self Adhesive Surgical Tape 2" (Metre) 1



SDR-0006 Cotton Tipped Applicator Plastic Sterile 2/pk 1

SIV-0084 Syringe Luer Lok 30cc 1

SDR-0062 Wound irrigation tip for syringe 1

SWC-0107 Absorbent Dressing 5"x6" 2


1

5

1

1

2

1

1

1


1

6

4

3

1

1

1

For catheter treatments only (PNT or PICC). Not for use in wound care.

CSR Sterile Field Towel

Fenestrated Waterproof Drape

Absorbent Towels

Tissue Forceps

Needle Holder

Description

Description

Description

Plastic Tray

Gauze Sponges

Waterproof Sterile Field

SWC-0123:Minor Laceration Tray Kit - Sterile


Disposable single useFor sharp/surgical debridement and should only be performed by clinicians with this expertise.

SMK-0042:Initial Wound Care Kit

Maximum Quantity: 1 Kit/Patient Admission

Nurse to identify and order regular wound care supplies after initial visit

Scissors

SDR-0005Dressing Tray Kit - Disposable Single Use

3 Compartment 1200 CC Outer Tray

Rayon Cotton Balls Large Absorbent

Gauze 4" x 4" - 8 Ply

Absorbent Towel - 3 Ply

Waste Bag with Tie

4" Plastic Transfer Forcep



Weekly Maximum

QtyNotes

SOT-0001 Disposable Ear Loop Surgical Face Mask Each 7

SOT-0003 Disposable Isolation Gown Small Each 1 per Visit

SOT-0004 Disposable Isolation Medium Each 1 per Visit

SOT-0005 Disposable Isolation Gown Large Each 1 per Visit

SOT-0006 Disposable Isolation Gown Extra Large Each 1 per Visit

SOT-0007 Non-Sterile Vinyl Gloves Small (Pair) Disposamed Cardinal HealthMDS192474 Each Pair 7 Non-latex, powder free, vinyl examination gloves

SOT-0008 Non-Sterile Vinyl Gloves Medium (Pair) Disposamed Cardinal HealthMDS192475 Each Pair 7 Non-latex, powder free, vinyl examination gloves

SOT-0011 Non-Sterile Vinyl Gloves Medium (Box) Disposamed Cardinal HealthMDS192475 Box of 100 1 Non-latex, powder free, vinyl examination gloves

Bulk orders only available for ETs, NPs, Clinic, Hospice, RRNs

SOT-0009 Non Sterile Vinyl Gloves Large (Pair) Disposamed Cardinal HealthMDS192476 Each Pair 7 Non-latex, powder free, vinyl examination gloves

SOT-0019 Eye Protection Safety Glasses Each 1 For procedures and patient-care activities likely to generate splashes or sprays of blood or body fluids

SOT-0020 Sterile Nitrile Gloves Small (Pair) Flexam Cardinal HealthN8830 Each Pair 3 Non-latex, powder free, nitrile examination gloves

SOT-0021 Sterile Nitrile Gloves Medium (Pair) Flexam Cardinal HealthN8831 Each Pair 3 Non-latex, powder free, nitrile examination gloves

SOT-0022 Sterile Nitrile Gloves Large (Pair) Flexam Cardinal HealthN8832 Each Pair 3 Non-latex, powder free, nitrile examination gloves

Protective Wear: Personal protective equipment (PPE) may be authorized for NE CCAC staff to protect employees from exposure to workplace hazards as per policy. Service Providers are expected to provide their own personal protective equipment to their own staff to protect from infectious diseases. Non-Sterile PPE may be authorized for contracted service providers by the CCAC only when the on-going patient-specific treatment requires protective wear be worn to minimize risk to patient or specialty PPE is required. Clean PPE is standard in community care, and sterile PPE supplies are only to be authorized when treatments require a sterile technique as per approved guidelines.


Protective Wear



Weekly Maximum

QtyNotes

SOT-0023 Sterile Nitrile Gloves Extra Large (Pair) Flexam Cardinal HealthN8833 Each Pair 3 Non-latex, powder free, nitrile examination gloves

SOT-0012 Sterile Nitrile Gloves Medium (Box) Flexam Cardinal HealthN8831 Box of 40 Pairs 1 Non-latex, powder free, nitrile examination gloves

Bulk orders available for ETs, NPs, Clinic, Hospice only

SOT-0013 Non-skid shoe covers (one size fits all) Each Pair 1 per Visit

SOT-0085 N95 Respirator Surgical Small 3M 3M Healthcare1860s Small 1 PPE for CCAC employees only (Not provided to patients or SPOs)

SOT-0086 N95 Respirator Surgical Medium 3M 3M Healthcare1860 Medium 1 PPE for CCAC employees only (Not provided to patients or SPOs)

SOT-0087 N95 Respirator Surgical Large Aura 3M Healthcare1870+ Large 1 PPE for CCAC employees only (Not provided to patients or SPOs)

SOT-0088 Surface Disinfectant Wipes (Flat Pack) Caviwipe Metrex11-1224 45 Wipes 1 PPE for CCAC employees only (Not provided to patients or SPOs)

SOT-0089 Alcohol-Based Hand Sanitizer Rub Purell Advanced

Gojo9651-24-CAN00 118 mL Bottle 1 PPE for CCAC employees only (Not provided to patients or SPOs)



Weekly Maximum

QtyNotes

SOT-0038 9 Volt Batteries for Ambulatory Infusion Pump As needed As required for pumps

SOT-0042 Forceps Locking 1/patient admission

SOT-0043 TENS Electrolodes Reusable 1.5 (pckg of 2) 1/patient admission

SOT-0044 TENS Electrolodes Reusable 3.5 (pckg of 2) 1/patient admission

SOT-0045 TENS Electrolodes Reusable 2x4 (pckg of 2) 1/patient admission

SOT-0083 Oral Swab sticks Latex-free Plain Untreated (Box 250) Dynarex 1217 Box of 250 Hospice only Palliative patients only

SOT-0084 Oral Swab sticks Latex-free Plain Untreated (Each) Each 21 Palliative patients only

Miscellaneous


Miscellaneous


North East CCAC Regional Approved Medical Supplies...

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