WOUND MANAGEMENT FORMULARY 2012

• This guide is intended to inform the clinical practitioners who undertake wound management of products available on the formulary.

• It is important that within the NHS we are able to justify our clinical decisions and expenditure on wound management product after considering the efficacy, safety, patient acceptability and costs of the product or dressing.

• Treatment recommendations are selected on the grounds of current clinical opinion and clinical effectiveness.

• Dressings listed in the formulary are to be prescribed following assessment by the practitioner, but it is recognised there may be situations where a non-formulary product is necessary.

• It is intended that each individual prescriber should achieve 80% compliance with Formulary listed products

• This formulary has been approved by Birmingham Community Healthcare NHS Trust and the Birmingham and Solihull Cluster. The formulary lists the products to be used and prescribed by all clinical practitioners who undertake the management of wounds.

• The formulary is intended to support the decision making process in planning cost-effective wound management, but not to replace the clinical judgement of the practitioner.

• The practitioner must take into account three key principles of wound management: o The aetiology of the wound should be established and the cause treated. o Factors that may delay healing must be identified and addressed. o An optimum wound environment must be established using an appropriate dressing regime that

is capable of facilitating warm, moist conditions, in addition to addressing specific conditions such as wound exudate levels, debridement and local wound infection.

All the above will require a holistic and individualised assessment, client support, education and agreement and may require a multi-disciplinary approach.

• Following clinical assessment, wherever possible a formulary product should be chosen as this represents an effective product for the type of wound being managed, based on efficacy, safety, patient acceptability and cost. The formulary supports the following process:

o Decide the current wound dressing aims, using the wound matrix as a guide. Minimum information will be aetiology, wound bed type and exudate level.

o Decide on an appropriate generic type of dressing (see matrix). o Select a product within that generic group, using the formulary product list, choosing first-line

products by default, unless there is a specific reason to use second or third line products. o Non-formulary products should only be selected if formulary products have been tried and found

not suitable, or there is a specific product feature that is needed on an individual basis. It is anticipated that these occasions will be infrequent and non-formulary products should amount to less than 20% of total usage.

o Any practitioner should be able to use this guide to select a first line product or substitute a second line product within the guidance for specific issues.

o Choice of third-line or non-formulary products are not intended for the infrequent practitioner and will require an adequate level of clinical and product knowledge.

o Refer to other sources of information in addition to the guidance in this formulary on choice and how the products are to be used such as the British National Formulary and manufacturer’s literature.

• Particular care should be taken in identifying the presence or absence of wound infection. All

chronic wounds are colonised with bacteria, but do not need topical antimicrobials to progress. Antimicrobials, including silver, should not be used routinely or randomly. Where there is active infection, topical antimicrobials, possibly supported by systemic antibiotics, are indicated for short-term use. Long term or prophylactic use should be avoided, except in specific cases. Taking a wound swab for culture & sensitivity should only be undertaken if clinical signs of infection are actually present; this is to prevent inappropriate use of antibiotics and antibiotic dressings. Antiseptics, chlorinated solutions and antibiotic tulles are of doubtful value in wound healing and may even delay healing.

• Waste should be minimised by prescribing only sufficient for the length of treatment needed or up until the patient’s next review, especially if the dressing is likely to change. Minimise the use of unnecessary multiple dressings which could aggravate the wound and increase cost.

BCHC Community: Generic Dressing Indicator Matrix

Primary dressing: Secondary

dressing:

Primary dressing: Secondary

dressing:

Primary dressing: Secondary dressing:

Primary dressing: Secondary

dressing:

Primary dressing: Secondary

dressing:

HYDROGEL (if eschar lifting)

HYDROGEL Antimicrobial3 cream/contact

layer2

Sloughy Granulating Infected4

Reduce bacterial load

Other significant treatment variations according to wound cause:

Antimicrobial3 contact layer2 /

alginate1 FOAM (or PAD)

Antimicrobial3 contact layer2 /

alginate1

Antimicrobial3 contact layer2 /

alginate1 FOAM (or PAD)

As main advice above

As main advice above

Contact layer2

Absorbent Pad

Contact layer2

Absorbent Pad

Self-adhesive ABSORBENT PAD

Consider referring non-healing/ undiagnosed wounds and wounds due to other conditions such as burns or lymphoedema for specialist advice & treatment plans

1-Alginate OR hydrofibre. 2-Contact layer = Modern low-adherent viscose wound contact layer. 3-Topical antimicobials e.g. silver, honey, etc) are included in many types of dressing product: select the product type appropriate for the level of exudate. Refer to the antimicrobial flow-chart for appropriate use.

Epithelialising

4-Where clinical signs indicate acute infection, take a wound swab (culture & sensitivity) to consider systemic antibiotics. 5-Patients with or at risk of diabetic foot ulcers should be referred to specialist podiatry. 6-Patients with an ischaemic wound should be referred for urgent Vascular opinion. 7-Patients with pressure ulcers should have a holistic plan of care including repositioning and pressure relieving equipment.

Cause of Wound

Wound Bed

Necrotic

Protect Treatment aim

HYDROCOLLOID (use alone if dry) or

FOAM

ALGINATE1 (or HYDROGEL)

FOAM

Debride /

hydrate

HYDROCOLLOID or FOAM

HYDROCOLLOID

ALGINATE1 (or HYDROGEL)

FOAM

ALGINATE1 if a cavity

HYDROCOLLOID or FOAM

ALGINATE1

FOAM (or PAD)

ALGINATE1

FOAM (or PAD)

Deslough / hydrate

Contact layer2

or ALGINATE1

Contact layer2

Protect

HYDROCOLLOID or FILM

HYDROCOLLOID or FOAM

FOAM or PAD

Contact layer2

As main advice above

Antimicrobial3 cadexomer

iodine/alginate1

FOAM

Antimicrobial3

alginate1

FOAM (or PAD)

FOAM secondary

Primary dressing: Secondary

dressing:

Low exudate

Moderate exudate

High exudate

ALGINATE1

FOAM

Pressure ulcers7, open surgical wounds,

haematomas, open trauma, previous ischaemia resolved by vascular surgery, malignant

fungating and other

miscellaneous wounds.

Diabetic neuropathic foot ulcer (if ischaemic see below)5

Ischaemic leg ulcer (if unresolved by vascular surgery or with no vascular plan)6

Secondary dressing not usually required under compression: Where high exudate persists despite

compression, use a low profile dressing such as a super-absorbent or foam.

Consider cause: venous ulcers are not

usually necrotic

As main advice. Consider larvae

if slow to debride

As main advice. Consider larvae if slow to debride

As main advice above

Venous leg ulcer

Under compression

Closed surgical wound or closed trauma (e.g. sutures or skin closures)

Use of topical antimicrobial dressings

Static [i.e. non-healing for 4 wks] or Deteriorating Wound [i.e. deteriorating for 2 dressing changes]

INFECTED? YES NO

Non-Infection Related: Seek other opinion or

underlying causes (poor blood supply, malignancy, non-

infectious inflammatory

conditions, diabetic foot ulcer etc).

No antimicrobial dressing indicated.

Infection Related

Local infection Spreading Infection

Swab. Start Systemic

Antibiotics. Start antimicrobial

dressing.

At 2 weeks is there any improvement?

YES NO

At 2 weeks have signs of infection

gone?

NO

Continue antimicrobial dressing for

further 2 weeks

If antimicrobial has not been effective, discontinue. Consider alternative antimicrobial, but avoid using any for longer than 4 weeks (2 reviews) without result. Refer to specialist; TVN, GP for advice.

Continue antimicrobial

dressing. Swab and consider systemic antibiotics.

YES

Stop antimicrobial. Return to non-antimicrobial

dressing

Stop antimicrobial. Return to non-

antimicrobial dressing

Continues to improve?

YES NO

Continue with non-antimicrobial or

other appropriate dressing

Re-start antimicrobial

dressing. Review

strategy at 2 weeks

Critical Colonisation

e.g. malodorous, breakdown

Start antimicrobial dressing.

First-line Products

Second-line products Third-line products, Non-

healing or specific issues

Alternatives Fragile skin Infection

ALGINATES & EQUIVALENTS

Urgosorb Aquacel Algivon

Cadexomer Iodine (caution in thyroid problems) Sorbsan Melgisorb Aquacel Ag

Acticoat Absorbent (high silver content)

Urgosorb Silver

FILM DRESSINGS Hydrofilm Tegaderm Film

Opsite Flexigrid

FOAMS & EQUIVALENTS Allevyn Adhesive

Mepilex Mepilex Border

Tegaderm Foam High Performance Adhesive

Mepilex Border Lite

Allevyn Non-Adhesive Allevyn Gentle Border

ActivHeal Foam (Podiatry only) Allevyn Gentle Border Lite

HYDROCOLLOIDS Duoderm Signal Comfeel Plus Transparent Dressing

Granuflex (for hyperkeratinosis) Duoderm Extra Thin

Tegaderm Hydrocolloid

HYDROGELS & EQUIVALENTS

Aquaform Hydrogel Nu-Gel Flaminol Forte Oxyzyme

ActiformCool Activon Tube Iodozyme

Medihoney

LOW ADHERENT CONTACT LAYERS

Atrauman Activon Tulle Inadine (caution in thyroid problems)

NA Ultra Atrauman Ag

Telfa Clear Cutimed Sorbact

Suprasorb X + PHMB (for infection)

ABSORBENTS Zetuvit E Kerramax CarboFLEX

Eclypse Advadraw Spiral

ADHESIVE POST OP DRESSINGS

Cosmopore E (for post operative wounds)

Softpore

LARVAE BioFOAM /

LarvE

TOPICAL NEGATIVE PRESSURE (TNP)

As per contracted agreement

DRESSING PACKS Dressit Polyfield Nitrile Patient Pack

CLEANSERS Irripod

Stericlens

TAPES Clinipore Mefix

Leukopor

RETENTION Knit-Band Clinifast

Tubegauz (Podiatry only) – non NHS

WOUND DRAINAGE Oakmed Option Wound Manager (drainage bag range)

PROTEASE MODULATORS

Promogran Prisma Matrix UrgoSTART Contact

UrgoSTART

LYMPHOEDEMA COMPRESSION

Lymphoedema bandaging

Comprilan Juxta-Fit Adjust to Fit (compression aid)

Rosidal K

Actico

Cellona Undercast Padding

Lymphoedema hosiery

Lymphoedema Garments (not silk). Use European Classification products

VENOUS & LYMPHO-VENOUS COMPRESSION (also consider the lymphoedema bandage products, which are equally appropriate for this group)

K Four K-Soft

K-Lite

K-Plus

Ko-Flex

K-ThreeC K Two K-Tech

K-Press

K Two Reduced

K Tech Reduced

K-Press

Coban 2

Coban 2 Comfort Foam Layer

Coban 2 Compression Layer

Coban 2 Lite

Coban 2 Lite Comfort Foam Layer Coban 2 Lite Compression Layer

Sub-bandage lining

Cotton Stockinette BP

Hosiery Two-layer hosiery kits (for uncomplicated venous hypertension)

Single layer hosiery. Consider European over British Classification

SHOWER AIDS LimbO Waterproof Protector

Seal-Tight Woundcare Protector

STOCKING AIDS Acti-Glide (for closed toe hosiery)

Easy-Slide (for open toe hosiery)

SURGICAL BOOT Kerraped SOAP SUBSTITUTES Emulsifying Ointment Epaderm Pump

Cream 50g and 500g

EMOLLIENTS LP/WSP 50:50 Dermatonics Heel Balm

Cetraben Pump Cream

Diprobase Pump Cream

BARRIER CREAMS where there is no dressing product

3M Cavilon Durable Barrier Cream (for skin protection on unbroken skin where no dressing is necessary)

Proshield Plus (to protect both unbroken & superficial wounds, where dressings are impractical)

SUB-DRESSING SKIN PROTECTION

3M Cavilon No Sting Barrier Film Pump Spray and Foam Applicator

Sorbaderm No-Sting Barrier Film Spray and Foam

No-Sting Skin-Prep

Referral Pathway for BCHC Podiatry

Low

No Vascular disease

Palpable foot pulses No or mild deformity

No Neuropathy 10g monofilament

felt at all sites No Risk Factors

▼ Advise self-care

(cutting/filing nails) Consider Nail

Carers 0121 250 0777

NO REFERRAL TO PODIATRY REQUIRED

▼ Continue GP

Practice care for annual foot review.

Access to education

session on foot health. ▼

Monitor for development of “at risk” factors

At-Risk

Vascular disease OR

Neuropathy OR

Risk factors

• Callus

• Deformity

• Evidence of poor self-care

• Nephropathy

• Visual impairment ▼

NON-URGENT REFERRAL

▼ Community

Podiatry Referral form

Central & West / South

Tel: 0121 465 3521 Fax: 0121 465 3519

For South: IDB

Service via Choose & Book

East & North Tel: 0121 465 2353/88/00

Fax: 0121 465 2921

High Risk

“At-risk” foot with problems/risk

factors OR

Vascular disease OR

Neuropathy OR

Previous ulcer/amputation

▼ URGENT

REFERRAL (< ONE WEEK)

▼ Specialist

Community High Risk Clinics

SOUTH Poplar Road

4416317 Northfield 478 2511

Hall Green 325 6061

Quinton 427 2511 EAST & NORTH Stockland Green 465 2353/88/00

CENTRAL & WEST 0121 465 3521 Or main office:

Aston for all areas 465 3521

Active

Non-complicated ulceration

▼ Urgent Referral to

Specialist Community High

Risk Clinics

Chronic ulceration (>6 weeks)

With complications Active Charcot

Cellulitis Osteomyelitis

Gangrene/Necrosis ▼

VERY URGENT REFERRAL (24-48

hours) ▼

Refer immediately to Hospital

Diabetic Foot Clinic by phone UHB: 0121 371

6419 BHH: 0121 424

3460 CITY: 0121 424

3460

OUT OF HOURS: A&E

General Points

• This guidance groups products into several categories to assist product choice: o First-line products are coded green and should be the predominant choice for all

prescribers, irrespective of their level of familiarity with wound care. o Second line products are coded amber and represent alternative choices to the core

products. All prescribers should be able to use this guide to identify the appropriate rationales for substituting core products.

o Third line products are also coded amber, but their use should be reserved for prescribers who are more experienced in wound care and product functionality.

o Red coded products are expressly for advanced specialist use only. There are currently no products in this group.

o Non-formulary products are all other prescribable wound care products not listed in this guide. Their use should be minimal and reserved for prescribers who are more experienced in wound care and product functionality.

GREEN: First-line products: Standard choice for all prescribers.

AMBER: Second line products: For specific rationales where first line products are sub-optimal or inappropriate. Suitable for all prescribers. Third line products: For specific rationales where the prescriber has advanced wound care and product knowledge to be able to justify their use.

RED: Only used in BCHC

Formulary advice on product use:

• Local BCHC advice on how to use products within formulary. This may differ from manufacturer advice, which can be accessed by using the linked Company web pages or their own printed literature.

• Products listed are specific and should not imply the inclusion of any related ranges or products.

• Product sizes are not specified and should be established by using BNF, NPF, MIMs, Wound Care Handbook or the Company’s own literature.

• Prescribing will be monitored with regard to 80% minimum formulary compliance using ePACT by the Medicines Management teams, Tissue Viability Service and Specialist Practitioners.

GREEN AMBER

Low adherence dressings

N-A Ultra Atrauman Telfa

NA Ultra; Atrauman; Telfa Clear: As a contact dressing for lightly exuding, shallow, granulating or epithelialising wounds with low exudate levels, where a simple absorbent is required as a secondary dressing. Not required beneath any dressing that gels or has its own non adherent contact layer. First line choice beneath compression bandage for venous leg ulcers; use without a secondary dressing, or if necessary use with a low profile secondary such as a non-adhesive foam or a super absorbent. Caution: Known product or component sensitivity. Use with care if wound is bleeding heavily. Frequency: 1-7 days dependant on exudate level. http://www.systagenix.co.uk/lets-heal.php?id=23 http://uk.hartmann.info/atrauman.php http://www.kendallhq.com/kendallhealthcare/pageBuilder.aspx?topicID=78243&breadcrumbs=0:121623,154339:0,155109:0,155139:0,155140:0 Absorbant dressings

Zetuvit E Self-adhesive: Cosmopor E Softpore

KerraMax Eclypse

Zetuvit E: Use as a secondary dressing pad for high exuding wounds such as abdominal surgery or extensive leg ulceration, where a modern interactive dressing is not required or feasible. Use with a low adherent contact layer. Do not use beneath compression. Caution: Known product or component sensitivity. Heavily bleeding wounds. Frequency: Usually daily or more frequently. http://uk.hartmann.info/zetuvit_e.php Kerramax; Eclipse: Second line dressing choice for high exuding wounds such as abdominal surgery or extensive leg ulceration, where a modern interactive dressing is not required or feasible. May not require a low adherent contact layer. Caution: Known product or component sensitivity. Heavily bleeding wounds. Frequency: Usually daily or more frequently. http://www.advancis.co.uk/our_products/eclypse/eclypse/ (Ark Therapeutics; no product information online). Cosmopor E; Softpore: An island dressing, suitable for post-operative closed surgical wounds or simple wounds with up to light amounts of exudate where a modern interactive dressing is not required. Use alone, without other dressing products. Can also be used as a protective dressing for sutured post operative wounds. Cautions: Known product or component sensitivity. Frequency: 1-7 days depending on use & exudate. Must be changed if wet. http://uk.hartmann.info/cosmopor_e.php http://www.richardsonhealthcare.com/softpore.aspx

GREEN AMBER

Hydrogel Dressings

Aquaform Hydrogel Sheet: ActiForm Cool

Nu-Gel

Aquaform hydrogel: Clear amorphous hydrogel suitable as a primary dressing for dry, necrotic, sloughy or granulating wounds that require moisture donation. Not suitable for heavily exuding wounds. Requires a secondary dressing. Caution: Known product or component sensitivity. Full thickness burns or infected wound. Frequency: 1-3 days. http://www.aspenmedicaleurope.com/Pages/WoundcareProductDetail.asp?id=1 ActiFormCool: Hydrogel sheet suitable as a primary dressing for dry, necrotic, sloughy or granulating wounds that require moisture donation. Not suitable for heavily exuding wounds. Requires a secondary dressing. Caution: Known product or component sensitivity. Infected wound. Frequency: Usually 1-3 days. Dressing should be changed if it becomes discoloured or opaque, or at first signs of exudate strike-through. http://www.activahealthcare.co.uk/actiformcool/ Nu-Gel: Clear amorphous hydrogel plus alginate, suitable as a primary dressing for dry, necrotic, sloughy or granulating wounds that require moisture donation. Use second line for wounds requiring more absorbency than a standard hydrogel. Not suitable for heavily exuding wounds. Requires a secondary dressing. Caution: Infected wound. Known product or component sensitivity. Frequency: Usually 1-3 days. http://www.systagenix.co.uk/lets-heal/lets-comfort/nu-gel-hydrogel-21 Film Dressings

Hydrofilm

Tegaderm Opsite Flexigrid

Hydrofilm; Tegaderm Film: Moisture-vapour permeable film dressing suitable for dry or low exuding superficial wounds. Can be used as a secondary dressing. Caution: Not suitable for infected wounds, deep cavity wounds or full thickness burns. Known product or component sensitivity. Frequency: 3-7 days. http://uk.hartmann.info/hydrofilm.php http://solutions.3m.co.uk/wps/portal/3M/en_GB/HealthCare/Home/ProdInfo/SkinWoundCare/WoundManagement/WoundManagementProducts/?PC_7_RJH9U5230GP7F0I2BNIR9C3G70000000_nid=287D1193FRbeV5GKXKF2BGgl Opsite Flexigrid: As above but also has a grid suitable for wound mapping. http://wound.smith-nephew.com/uk/Product.asp?NodeId=813

GREEN AMBER

Hydrocolloid dressings

Duoderm Signal Duoderm Extra Thin Tegadem Hydrocolloid

Comfeel Plus Transparent Dressing Granuflex (for hyperkeratosis)

Duoderm Signal; Tegaderm Hydrocolloid: Bordered hydrocolloids suitable for low to moderate exuding, necrotic, sloughy, granulating or epithelialising wounds. Usually used without other products but may be suitable as a secondary dressing for low exuding wounds. Caution: not suitable for infected wounds, full thickness burns or wounds with exposed bone, muscle or tendon. Wounds likely to macerate, particularly on the plantar surface of the foot. Known product or component sensitivity. Frequency: Usually 3-7 days. http://www.convatec.co.uk/engb/cvtuk-duodsdbpuk/cvt-portallev1/0/detail/0/1119/2070/duoderm-signaltrade-dressing.html http://solutions.3m.co.uk/wps/portal/3M/en_GB/oem/MedicalOEM/product-info/product-catalog/?PC_7_RJH9U523001ID02FQHR3V31OK6000000_nid=JNZMSSFP36beFVTLXPCW6Rgl Duoderm Extra Thin: As above but only suitable for dry or lightly exuding wounds. Frequency: Usually 3-7 days. http://www.convatec.co.uk/engb/cvtuk-duodetdbuk/cvt-portallev1/0/detail/0/1120/2071/duoderm-extra-thin-dressing.html Comfeel Plus Transparent Dressing: As for Duoderm Extra Thin, but transparent and with wound grid to aid with measurement. http://www.coloplast.com.au/products/woundcare/product.aspx?productid=35982(Coloplast)&categoryid=331(Coloplast)&commcategory=comfeel(coloplast) Granuflex: Unbordered hydrocolloid, as above. Use within formulary for reducing hyperkeratosis caused by lymphoedema or venous hypertension. http://www.convatec.co.uk/engb/cvtuk-productsuk/cvt-products/0/proddett/0/401/793/granuflex-dressing.html?franchise=364&proddett=793&prodfamily=369

GREEN AMBER

Foam dressings

Adhesive: Allevyn Adhesive Allevyn Adhesive Lite Tegadern Foam Adhesive Non-adhesive: ActivHeal (Podiatry only) Allevyn Non-Adhesive

Adhesive: Mepilex Border Mepilex Border Lite Allevyn Gentle Border Allevyn Gentle Border Lite Non-adhesive: Mepilex

Allevyn Adhesive: Foam island dressing, suitable for sloughy, granulating or epithelialising wounds as a single product, or as a secondary dressing. Suitable for moderate exudate level. Lite version suitable for low exudate. When selecting size all foam dressing pads should overlap wound edge by 2-3cm, in addition to the border size. Caution: Known product or component sensitivity. Frequency: 1-7 days dependant on exudate. http://wound.smith-nephew.com/uk/Product.asp?NodeId=452 Tegaderm Foam Adhesive: As above. Oval and heel dressings are particularly suited for difficult to dress areas such as heels or elbows. http://solutions.3m.co.uk/wps/portal/3M/en_GB/oem/MedicalOEM/product-info/product-catalog/?PC_7_RJH9U523001ID02FQHR3V31OK6000000_nid=VN9XRXSZ79beFVTLXPCW6Rgl Mepilex Border; Allevyn Gentle Border: As above. Silicone adhesive is particularly suited for fragile skin. http://www.molnlycke.com/gb/Wound-Care-Products/Product-selector---Wound-division/Tabs/Products/Mepilex-Border/?activeTab=3 http://wound.smith-nephew.com/uk/node.asp?NodeId=3779 Mepilex Border Lite; Allevyn Gentle Border Lite: As above. Suitable for low exudate and skin tears. http://www.molnlycke.com/gb/Wound-Care-Products/Product-selector---Wound-division/Tabs/Products/Mepilex-Border-Lite/?activeTab=2 http://wound.smith-nephew.com/uk/node.asp?NodeId=3852 Allevyn Non-Adhesive; ActivHeal Foam: Non bordered foam suitable where alternative adhesion or retention is appropriate (e.g. Under compression bandage). ActivHeal use within formulary limited to Podiatry. Frequency: 1-7 days dependant on exudate. http://wound.smith-nephew.com/uk/popup.asp?NodeId=414&Hide=True&Tab= http://www.activheal.com/home/product-range/activheal-foam/activheal-non-adhesive-foam.aspx Mepilex: As above but with a light adhesive tack and suitable for cutting to shape around difficult anatomical areas. http://www.molnlycke.com/us/Wound-Care-Products/Product-Selector---Wound-division/Tabs/Products/Mepilex/

GREEN AMBER

Alginates + Hydrofibres

Sorbsan (Dispersable) Urgosorb (Non dispersable)

Aquacel (Non-dispersable) Megisorb (Dispersable)

Sorbsan Flat; Sorbsan Packing: Calcium alginate suitable for sloughy, necrotic or granulating wounds with moderate to heavy exudate. Dispersible alginate; easily shaped to wound bed and requiring removal by wound cleansing solution. Has haemostatic properties. Requires a secondary dressing. Caution: Not suitable for dry wounds. Known product or component sensitivity. Frequency: 1-7 days depending on exudate (1-3 days as a haemostat). http://www.aspenmedicaleurope.com/Pages/WoundcareProductDetail.asp?id=10 Melgisorb: As above, but frequency 1-3 days. http://www.molnlycke.com/us/Wound-Care-Products/Product-Selector---Wound-division/Tabs/Products/Melgisorb/ Urgosorb Pad & Rope: Calcium alginate with hydrocolloid, suitable for sloughy, necrotic or granulating wounds with moderate to heavy exudate. Non dispersible alginate. Remains intact on wound bed and easily removed in one piece. Has haemostatic properties. Requires a secondary dressing. Caution: Not suitable for dry wounds. Known product or component sensitivity. Frequency: 1-7 days, depending on exudate. http://www.urgo.co.uk/71-urgosorb Aquacel: Hydrofibre, suitable for sloughy, necrotic or granulating wounds with moderate to heavy exudate. Non dispersible; remains intact on wound bed and easily removed in one piece. NO haemostatic properties. Requires a secondary dressing. Caution: Not suitable for dry wounds. Known product or component sensitivity. Frequency: 1-7 days, depending on exudate. http://www.convatec.co.uk/engb/cvtuk-aqcdrwsbuk/cvt-portallev1/0/detail/0/1028/2057/aquacel-dressing.html Capillary-action dressings

First consider alginates or hydrofibres Avadraw Spiral

Capillary-action dressings are suitable for use on all types of exuding wounds, but particularly on sloughy wounds where removal of fluid from the wound aids debridement; capillary-action dressings are contra-indicated for heavily bleeding wounds or arterial bleeding. Advadraw Spiral: Absorbent spiral ribbon dressing suitable for insertion into a narrow wound cavity or sinus for control of moderate to high exudate. Can be cut to length. Requires a secondary dressing. Cautions: Bleeding wounds. Low exudate. In narrow wounds check daily to ensure free drainage and non adherence. Known product or component sensitivity. Frequency: 1-7 days, depending on exudate. http://www.advancis.co.uk/our_products/other/advadraw_spiral/

GREEN AMBER

Odour absorbent dressings

Consider first line dressings appropriate to wound bed type and exudate level.

CarboFLEX

Charcoal dressings have a limited use in odour control. First address other issues that can also control malodour, such as ensuring effective exudate control, bacterial balance, good fit and adhesion. CarboFlex: Non- adhesive dressing with an absorbent wound contact layer, an activated charcoal central pad and a water resistant top layer. Suitable for moderately exuding malodorous wounds. Can be used as a primary dressing over a shallow wound or as a secondary dressing over an alginate or hydofibre in a cavity wound. Cautions: Known product or component sensitivity. Frequency: 1-7 days. NB change when wet as charcoal inactivated. http://www.convatec.co.uk/engb/cvtuk-productsuk/cvt-products/0/proddett/0/401/786/carboflex-dressing.html?franchise=364&typesearch=431&proddett=786&prodfamily=402 Antimicrobial enzyme

Consider other recommended antimicrobials. Avoid routine or prophylactic use of antimicrobials on non-infected wounds.

Flaminol Forte

Flaminal Forte: Alginate gel containing two antimicrobial enzymes. Use as a primary dressing for infected shallow or cavity wounds with low to moderate exudate. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: Full thickness burns. Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.flaminal.co.uk/ Glucose oxidase-iodide enzyme

Before using active products, ensure all potential reasons for non-healing have been explored.

Oxyzyme Iodozyme

Oxyzyme: Hydrogel sheet with a catalyst to produce oxygen and iodine at the wound bed. Suitable for small, shallow, lightly exuding non-healing chronic wounds. Requires a foam or absorbent pad secondary dressing; avoid hydrocolloids or alginates. Local guidance: All active products are preferable for short term use; review after two weeks. Cautions: thyroid disorders. Known product or component sensitivity. Frequency: every 2-4 days. Iodozyme: As oxyzyme, but with higher concentration of iodine making it also suitable for chronic infection. http://www.archimed.co.uk/

GREEN AMBER

Honey

Avoid routine or prophylactic use of antimicrobials on non-infected wounds. Also see alternative indications for short-term use below.

Medihoney Algivon Activon Tube Activon Tulle

In addition to its use as an antimicrobial, honey may be considered second line for short-term use on necrotic wounds that prove difficult to debride, or to control malodour: Review after 2 weeks. Activon Tube; Medihoney antibacterial medical honey: Amorphous medical grade manuka honey dressing. Use as a primary dressing for infected shallow or cavity wounds, particularly if necrotic, sloughy or malodorous, with low to moderate exudate. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: May produce stinging sensation. Monitor blood glucose in diabetics. Known product or component sensitivity. Do NOT use if sensitive to honey or bees. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.advancis.co.uk/our_products/manuka_honey/activon_tube/ http://www.comvita.co.uk/medihoney/medihoney-first-aid/medihoney-antibacterial-honey.html Algivon: Calcium alginate impregnated with manuka honey. Use as a primary dressing for infected shallow or cavity wounds, particularly if necrotic, sloughy or malodorous, with moderate exudate. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: Wounds with active blood loss. May produce stinging sensation. Monitor blood glucose in diabetics. Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.advancis.co.uk/our_products/manuka_honey/algivon/ Activon Tulle: Non-adherent primary dressing impregnated with manuka honey. Requires a secondary dressing. Suitable for shallow infected wounds particularly if sloughy or malodorous. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: May produce stinging sensation. Monitor blood glucose in diabetics. Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.advancis.co.uk/our_products/manuka_honey/activon_tulle/

GREEN AMBER

Iodine

Consider other recommended antimicrobials.

Iodoflex, Iodosorb Inadine (limited use; see below)

Inadine: Non-adherent dressing impregnated with povidone iodine. Local guidance: use within formulary should be limited to management of ischaemic, dry, gangrenous digits where the aim is desiccation and auto amputation. May also be used to dry-manage external fixator sites. Caution: Thyroid disorders, concurrent lithium therapy, severe renal impairment. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Contra indications: known or suspected iodine sensitivity, not recommended for use in children, pregnancy or breast feeding. Frequency: 1-3 days, according to exudate; antimicrobial effect inactivated when wet. http://www.systagenix.co.uk/lets-heal/lets-protect/inadine-1 Iodoflex; Iodosorb: Cadexomer iodine paste suitable for infected sloughy wounds with moderate exudate. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Cautions: Dry, necrotic wounds, thyroid disorders, concurrent lithium therapy, severe renal impairment. Do not use more than 50g in a single application and not more than 150g in one week. Contra indications: known or suspected iodine sensitivity, not recommended for use in children, pregnancy or breast feeding. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://wound.smith-nephew.com/uk/node.asp?NodeId=3296

GREEN AMBER

Silver

Avoid routine or prophylactic use of antimicrobials on non-infected wounds.

Urgosorb Silver Aquacel Ag Atrauman Ag Acticoat Absorbent

Silver dressings are to be used on a restricted basis and a non-silver based dressing should be tried first. Silver dressings should not be used on the basis of preventing a possible microbial infection that has not yet happened (prophylactic or in critical colonisation) but can be used for active infective wounds. There is insufficient evidence to make recommendations on the routine use of silver dressings. Current literature states that the content and type of silver manufacture in such dressings varies widely making it difficult to ascertain the true benefits in terms of clinical effectiveness and cost. In addition recent comparative studies of silver with more conventional antimicrobials such as iodines and honey have shown poor performance indicators favouring more conventional antimicrobials (Thorn et al 2009, Du Toit & Page, 2009). With these findings in mind it is advocated that silver dressings should not be routinely chosen as the default antimicrobial, but that all antimicrobials should be equally considered. Where a clinician considers treatment with a silver dressing is appropriate, the dressing with the lowest acquisition cost appropriate to the clinical indication should be selected. Treatment should normally last no longer than 14 days and should not be continued without review and evidence of improved healing. The reason for the trail should be clearly documented in the patient’s notes. The use of silver dressing will be monitored and may be the subject of future clinical audit. Urgosorb Silver: Calcium alginate with hydrocolloid, impregnated with silver. Suitable for infected wounds that are sloughy, necrotic or granulating, with moderate to heavy exudate. Non dispersible alginate. Remains intact on wound bed and easily removed in one piece. Has haemostatic properties. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: Not suitable for dry wounds. Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.urgo.co.uk/213-urgosorb-silver Aquacel Ag: Hydrofibre impregnated with silver. Suitable for infected wounds that are sloughy, necrotic or granulating, with moderate to heavy exudate. Non dispersible; remains intact on wound bed and easily removed in one piece. NO haemostatic properties. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: Not suitable for dry wounds. Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.convatec.co.uk/engb/cvtuk-productsuk/cvt-products/0/proddett/0/401/778/aquacel-ag-hydrofiber-dressing.html?franchise=364&proddett=778&prodfamily=365 Acticoat Absorbent: Calcium alginate impregnated with nanocrystalline silver. Consider as a second line product for infected wounds that are sloughy, necrotic or granulating, with moderate to heavy exudate. Not for use as a haemostat. May discolour the wound bed and surrounding skin. Requires a secondary dressing. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Caution: Not suitable for dry wounds. Do not use with oil based products. Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://wound.smith-nephew.com/uk/Product.asp?NodeId=3832 Atrauman Ag: Silver impregnated non adherent contact layer. Suitable for shallow infected wounds. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Cautions: Known product or component sensitivity. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://productcatalogue.hartmann.info/PHb2c/b2c/Z_init.do?shop=DE_EN_CAT&language=en&Z_areaID=4132F315E55F0004E10000000A808F21

GREEN AMBER

Other antimicrobials

Avoid routine or prophylactic use of antimicrobials on non-infected wounds.

Cutimed Sorbact Suprasorb X + PHMB

Cutimed Sorbact: Antimicrobial contact layer. Suitable for shallow infected wounds. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Inactivates bacteria by binding them to the dressing by hydrophobic action. No chemical agent, making it hypoallergenic and safe for children & for pregnant & breastfeeding women. Frequency: Daily for acute infection, up to 7 days for more chronic infection. http://www.cutimeduk.com/cutimed-sorbact.html Suprasorb X + PHMB: Antimicrobial sheet hydrogel contact layer. Suitable for shallow infected, low to moderate exuding wounds. Local guidance: All antimicrobial products are preferable for short term use; review after two weeks. Active antimicrobial; PHMB. If sheet dries out, remove by moistening with saline. Frequency: Daily for acute infection, up to 4 days for more chronic infection. http://www.activahealthcare.co.uk/suprasorb-x-phmb/ Protease-modulating matrix dressings

Before using active products, ensure all potential reasons for non-healing have been explored.

Promogran Prisma Matrix UrgoSTART UrgoSTART Contact

Promogran Prisma Matrix: Protease (MMP) modulator, indicated for non-healing wounds or wounds where there are known excessive MMP levels. Freeze dried collagen, cellulose, & silver. Absorbed by the wound, so requires no removal. Needs a secondary dressing. Local guidance: All active products are preferable for short term use; review after two weeks. Cautions: Known product or component sensitivity. Frequency: Every 1-3 days depending on exudate. http://www.systagenix.co.uk/lets-heal.php?id=3 UrgoSTART & UrgoSTART Contact: Protease (MMP) inhibitor, indicated for non-healing wounds or wounds where there are known excessive MMP levels. UrgoSTART is a foam dressing with contact layer containing a non-adherent lipido-colloid and NOSF protease inhibitor. UrgoSTART Contact consists of the contact layer alone and requires a secondary dressing. Local guidance: All active products are preferable for short term use; review after two weeks. Contra-indications: Critically colonized or infected wounds. Cautions: Known product or component sensitivity. Frequency: 1-7 days depending on exudate. http://www.urgo.co.uk/102-urgostart http://www.urgo.co.uk/215-urgostart-contact

GREEN AMBER

Wound drainage pouches

Consider standard interactive dressings first. Oakmed Option Wound Manager

Oakmed Option Wound Manager: Range of wound drainage bags, indicated for chronic, non-healing or post surgical sinuses with high exudate. Consider first the “Options Manager” with drainable bags:

• Small (OM-S), up to 30mm wound size, 100ml capacity

• Medium (OM-M), up to 50mm wound size, 150ml capacity

• Large (OM-L) up to 50mm wound size, 300ml capacity Other products are available for specific needs. Frequency: May be left in place for up to 4 days, depending on good adhesion and seal. http://www.oakmed.co.uk/wound.asp Topical negative pressure therapy

Consider standard interactive dressings first. Dressings advised by TVN

Products used on the advice of TVN and in alignment with local arrangements. Topical Negative Pressure (TNP) or Negative Pressure Wound Therapy (NPWT): The use of sub-atmospheric pressure to promote or assist wound healing or to remove fluids from a site. Basic components are pump, connecting tube, sealed dressing and canister to collect exudate. One product (PICO) dispenses with the canister, and uses dressing absorbency alone to collect exudate. Made by various manufacturers; each has unique components and must be used as part of a kit. There is no common standard and product types are not interchangeable; pump and dressings and canister must all come from the same manufacturer and model. These components are either “rented” reusable pumps and charged to the Trust (note that these units are high cost & may be billed to the Trust if lost or damaged) or “consumables”; the prescribed single use dressings & tubing, canisters and single-use pumps. Rental pumps are charged to the Trust on a day-by-day basis. Trust rental contracts are likely to be limited to a specific company or companies and cannot be initiated outside of these contracts. Examples of NPWT: •Renasys-Go (Smith & Nephew); Rental pump, prescribable dressings (gauze or foam) & tubing, canister. http://wound.smith-nephew.com/uk/Product.asp?NodeId=3842 • V.A.C. Freedom (KCI); Rental pump, prescribable dressings (gauze or foam) & tubing, canister. http://www.kci-medical.co.uk/cs/Satellite?c=KCI_Product_C&childpagename=UK-ENG%2FKCILayout&cid=1229538575349&p=1229538577639&packedargs=locale%3Den_UK&pagename=UK-ENGWrapper • V.A.C. Via (KCI); Prescribable single-use pump, dressings (foam) & tubing, canister. http://www.kci-medical.co.uk/cs/Satellite?c=KCI_General_C&childpagename=UK-ENG%2FKCILayout&cid=1229636818988&p=1229538577639&packedargs=locale%3Den_UK&pagename=UK-ENGWrapper • PICO (Smith & Nephew); Prescribable single-use pump, dressings (pad) & tubing. No canister; change when exudate has soaked pad, before tubing is wet. http://wound.smith-nephew.com/uk/Standard.asp?NodeId=3865 Frequency for all TNP prescribed consumables: • Canisters, 1-4 days • Dressings; 2-4 days • Single-use pumps; 1 per week

GREEN AMBER

Larvae

Consider standard dressings first. LarvE (free range or in BioFOAM dressing)

Larval therapy has been used to treat most types of infected, sloughy or necrotic wounds, irrespective of aetiology. Examples of wounds that have been treated with larvae include leg ulcers, pressure ulcers, infected surgical wounds, malignant wounds and diabetic ulcers. Wounds that are not generally suitable for larvae therapy: Dry necrotic wounds ( these require softening first), fistulae, wounds that bleed easily, wounds close to major blood vessels or nerves and any situations where the blood supply is insufficient to permit healing to take place. Larvae should not be applied to patients with clotting disorders, or individuals receiving anticoagulant therapy unless they are under constant medical supervision in a healthcare facility. Considerations during larvae therapy: Exudate production is often increased during larvae therapy, and there is sometimes an initial increase in wound odour. This is only temporary and usually resolves after the first dressing change. Sometimes patients with ischemic wounds complain of increased wound pain during treatment. Management of pain is easier when utilising the Biofoam dressing. Pain is thought to result from a change in wound pH - analgesia can be used. BioFOAM & LarvE: Surgical debridement of a necrotic or sloughy wound bed using live maggots. LarvE are pots of loose maggots and BioFOAM are maggots in sealed dressing bags. Seek advice from Tissue Viability or an experienced practitioner before use. Can only be accessed by Medical or Independent prescribers. State date and place of delivery; product must be applied on the same day & is removed 3-5 days later. Frequency; for single treatment only, then review; do not prescribe more than one treatment at a time. Future applications may be necessary. http://www.biomonde.com/product/index

GREEN AMBER

Dressing packs

Dressit Polyfield Nitrile Patient Pack

Dressit: Sterile procedure pack; specify small/medium or medium/large glove size. http://www.richardsonhealthcare.com/dressit.aspx Polyfield Nitrile Patient Pack: Sterile procedure pack; specify small, medium or large glove size. http://shop.shermond.com/catalogue_1.aspx?&id=4:18560&id2=4:47022&id2=4:47159&id2=4:47230 Surgical adhesive tapes

Clinipore Leukopor

Mefix

Clinipore; Leukopor: Non-woven synthetic adhesive tape. Use for securing bandages, or non-adhesive dressings. http://www.clinisupplies.co.uk/Products/Wound_and_Skin_Management_Products/Surgical_Tape# http://www.bsnmedical.co.uk/en/products/productlist/tapes/fixation/leukopor/popupclose.html Mefix: Flexible polyester elastic non-woven adhesive tape. Use for non-adhesive dressings. http://www.molnlycke.com/gb/Wound-Care-Products/Product-selector---Wound-division/Tabs/Products/Mefix/?activeTab=1 Protectors and aids

LimbO Waterproof Protector Seal-Tight Woundcare Protector Acti-Glide Easi-Slide

LimbO Waterproof Protector; Seal-Tight Woundcare Protector: Protector for lower leg bandages allowing showering or bathing. Reusable. http://www.limboproducts.co.uk/ http://www.autonomed.co.uk/shop/dept.asp?dept_id=32 Acti-Glide: Application aid for closed or open toe compression hosiery. http://www.activahealthcare.co.uk/actiglide/ Easy-Slide: Application aid for closed toe compression hosiery. http://www.credenhill.co.uk/easyslide.htm Light-weight conforming bandages

Knit-Band

Knit-Band: Polyamide & cellulose contour bandage used for retention of non-adhesive dressing products. Latex free. http://www.clinisupplies.co.uk/Products/Wound_and_Skin_Management_Products/Dressing_Retention_Bandage

GREEN AMBER Multilayer bandages

K-Two (K-Tech, K-Press) K-Four (K-Soft, K-Lite, K-Plus, Ko-Flex, K-ThreeC) Coban Coban Lite

Multilayer (also termed four-layer) and two-layer compression bandaging indications: Venous (or lympho-venous) leg ulceration. Doppler assessment (ABPI) and/or specialist assessment are required before use. Only to be applied by trained individuals – refer to manufacturers application guidelines for details: Multi-layer has common principles of application, irrespective of manufacturer, but two-layer systems are unique to each manufacturer. Two different levels of compression are available for all of these systems; either full (40mmHg at the ankle) or reduced (approximately 20mmHg at the ankle) compression. Full compression is the first line treatment of uncomplicated venous ulcers. Reduced compression should be selected only if full compression is inappropriate, because of specialist advice, complicating factors or client concordance. Can be prescribed as individual items or as a ‘kit’, consisting of the correct bandage types for the required level of compression for the individual’s leg circumference. K-Two: Two layer cohesive high compression bandage indicated for venous ulcers. Used as a kit, undercast padding may be added for non-standard legs shapes. Prescribe kit size appropriate to ankle circumference; 18-25cm or 25-32cm. All compression bandages must be applied by a trained practitioner. Frequency: designed to be once every 7 days, but high exudate may require changing more often. Contraindications: patients with an ABPI of less than 0.8 or with diabetes unless advised by vascular specialist. http://www.urgo.co.uk/197-k-two K-Two Reduced: as above, but reduced compression, indicated for mixed venous disease where specified by a vascular specialist or where high compression cannot be tolerated by the individual. http://www.urgo.co.uk/197-k-two K-Four: multi layer high compression bandage with cohesive outer layer, indicated for venous ulcers. Prescribe kit size appropriate to ankle circumference; <18cm, 18-25cm, 25-30cm, >30cm. All compression bandages must be applied by a trained practitioner. Frequency: designed to be once every 7 days, but high exudate may require changing more often. Contraindications: patients with an ABPI of less than 0.8 or with diabetes unless advised by vascular specialist. http://www.urgo.co.uk/202-k-four Coban: Two layer cohesive high compression bandage indicated for venous ulcers. Used as a kit, not compatible with additional undercast padding. All compression bandages must be applied by a trained practitioner. Frequency: designed to be once every 7 days, but high exudate may require changing more often. Contraindications: patients with an ABPI of less than 0.8 or with diabetes unless advised by vascular specialist. http://solutions.3m.co.uk/wps/portal/3M/en_GB/Coban/home/ Coban Lite: as above, but reduced compression, indicated for mixed venous disease where specified by a vascular specialist or where high compression cannot be tolerated by the individual. http://solutions.3m.co.uk/wps/portal/3M/en_GB/Coban/home/ Medicated bandages

Not recommended for routine use

Paste bandages are associated with hypersensitivity reactions and should be used with caution. They are indicated for treating some skin conditions beneath compression bandages.

GREEN AMBER

Graduated compression hosiery

Based on assessment

Compression (elastic) hosiery is used to treat conditions associated with chronic venous insufficiency (including small venous ulcers), to prevent recurrence of thrombosis, or to reduce the risk of further venous ulceration after treatment with compression bandaging. Doppler testing to confirm arterial sufficiency is required before recommending the use of compression hosiery. Recommendations: Various manufacturers are available; at present this guide does not specify specific manufacturers, given the importance of individual client choice in this personal product. Leg measurements are required and size specified. Hosiery is available in off-the-shelf sizes or made-to-measure hosiery (for the more difficult leg shape or specific need). Consult manufacturers for product-specific sizing charts or made-to-measure order forms. 2-layer hosiery kits provide high compression (40mmHg), whereas single layer hosiery provides near-high compression or more reduced levels of compression; choose the highest level based on client comfort & practicality. When prescribing single layer hosiery, the strength of compression must be specified. Two different strength classifications are commonly in use – British and European. For hosiery conforming to European classification choose from Class 2 (23-32mmHg) or Class 1 (18-21mmHg). For British classification choose from Class 3 (25-35mmHg), Class 2 (18-24mmHg) or Class 1 (14-17mmHg). Contraindications: patients with an ABPI of less than 0.8 or with diabetes unless advised by vascular specialist. Frequency of renewal: Stockings should be replaced at least 6 monthly. Lymphoedema garments

Based on assessment Lymphoedema garments (Not silk garments) Juxta-Fit

Recommendations: For long-term management of lymphoedema. Various manufacturers are available; at present this guide does not specify specific manufacturers, given the importance of individual client choice in this personal product. Before prescribing these products for the first time clients may require specialist treatment to reduce lymphoedema. Either flat-bed or circular-knitted garments are used. Seamless circular-knitted garments in standard sizes can be used to prevent swelling if the lymphoedema is well controlled and if the limb is in good shape and without skin folds. Flat-knitted garments (usually made-to-measure) with a seam provide greater rigidity to maintain reduction of lymphoedema following treatment with compression bandages. Contraindications; patients with an ABPI of less than 0.8 or with diabetes unless advised by vascular or lymphoedema specialist. Frequency of renewal: Stockings should be replaced at least 6 monthly. Juxta-Fit: An inelastic, adjustable compression garment for the management of lymphoedema. Available in two lengths and five sizes. Latex free. Seek lymphoedema specialist advice before using this product. http://www.mediuk.co.uk/drug-tariff/lower-limb/juxta-leg0.html

GREEN AMBER

Wound Irrigation

Irripod Stericlens

Irripod: Single use 25ml sodium chloride 0.9% solution in a pod for wound irrigation. http://www.cdmedical.co.uk/irripod.html Stericlens: Sterile sodium chloride 0.9% solution in a spray for wound irrigation. http://www.cdmedical.co.uk/stericlens.html Soap Substitutes

Emulsifying Ointment

Epaderm Pump Cream 50g and 500g

Emulsifying ointment: Use first line as a soap substitute. Epaderm Cream: Use as a soap substitute or emollient.

Emollients

Liquid paraffin / white soft paraffin 50:50 Cetraben Pump Cream Diprobase Pump Cream

Dermatonics Heel Balm

Fire hazard with paraffin-based emollients: Emulsifying ointment or 50% Liquid Paraffin and 50% White Soft Paraffin Ointment in contact with dressings and clothing is easily ignited by a naked flame. The risk is greater when these preparations are applied to large areas of the body, and clothing or dressings become soaked with the ointment. Patients should be told to keep away from fire or flames, and not to smoke when using these preparations. The risk of fire should be considered when using large quantities of any paraffin-based emollient.

Liquid Paraffin/ White Soft Paraffin 50:50: For first line moisturisation of dry skin in leg ulcer prevention or management or for intact bony prominences for pressure ulcer prevention. Diprobase pump cream, Cetraben emollient cream pump: Emollient, moisturising and protective cream for the symptomatic relief of red, inflamed, damaged, dry or chapped skin, especially when associated with endogenous or exogenous eczema. Dermatonics Heel Balm: Urea cream for short-term moisturisation of hyperkeratosis. http://www.dermatonics.co.uk/heel_balm.html

GREEN AMBER

Barrier Preparations

3M Cavilon Durable Barrier Cream

3M Cavilon No Sting Barrier Film Pump Spray and Foam Applicator Sorbaderm No-Sting Barrier Film Spray and Foam No-Sting Skin-Prep Proshield Plus

Primary barrier against body fluids such as incontinence or wound exudate. 3M Cavilon Durable Barrier Cream: concentrated barrier cream to protect against body fluids and moisturise skin. Frequency: apply sparingly. Reapply after every third episode of cleansing. http://solutions.3m.co.uk/wps/portal/3M/en_GB/Cavilon/skin-care/products/durable-barrier-cream/ Proshield Plus: Barrier cream indicated for use on incontinence or friction and shear lesions up to Grade 2 EPUAP. Can be applied to both intact and damaged skin. Frequency: reapply after each episode of cleansing. http://www.hrhealthcare.co.uk/proshield-plus.html 3M Cavilon No Sting Barrier Film, Sorbaderm No-Sting Barrier Film, No-Sting Skin-Prep: alcohol free barrier film designed to be used in conjunction with a wound dressing where there are problems of maceration or dressing adhesion. Frequency: reapply every 3 days. http://solutions.3m.co.uk/wps/portal/3M/en_GB/Cavilon/skin-care/products/no-sting-barrier-film/ http://www.aspenmedicaleurope.com/Downloads/Sorbaderm_Barrier_Cream_A5_Brochure_100L_0910_XS266.pdf http://wound.smith-nephew.com/uk/Product.asp?NodeId=3929 Multi-use Boot

First consider clients own footwear options. Kerraped Kerraped: Footwear to accommodate bulky bandages. Prescribed as a single boot, universal for either foot. Specify size; Small, Medium, Large, Extra Large http://www.kerraped.com/media/Kerraped_Information_Brochure_V3.pdf

Acknowledgements: This Formulary has been developed independently by the multi-disciplinary Birmingham Community Healthcare NHS Trust Wound Care Group, who will update the formulary on an ongoing basis. Supporting Companies: Companies assisting with the print, launch & dissemination of the formulary have freely contributed after this guideline was developed and did not influence its content or impartiality. 3M Health Care 3M House Morley Street Loughborough LE11 1EP 01509 611611 Web: www.3mhealthcare.co.uk Activa Healthcare Ltd 1 Lancaster Park Newborough Road Needwood Burton on Trent Staffordshire DE13 9PD Customer Services 08450 606707 International +44 1283 576800 Facsimile 01283 576808 Web www.activahealthcare.co.uk Advancis Medical Lowmoor Business Park Kirkby-in-Ashfield Nottingham NG17 7JZ Customer Services Tel: 01623 751500 Fax: 0871 264 8238 Email: info@advancis.co.uk Web: www.advancis.co.uk Aspen Medical Europe Ltd Thornhill Road North Moons Moat, Redditch, Worcestershire, B98 9NL Tel no: 01527 587700 0800 0323399 Web: www.aspenmedicaleurope.com

ConvaTec Ltd Harrington House Milton Rd, Ickenham Middlesex, UB10 8PU Mobile: +44 (0) 7528 380617 ConvaTec Clinical Support Line: 0800 289 738 Web: www.convatec.co.uk Paul Hartmann Limited Heywood Distribution Park Heywood Lancashire OL10 2TT Phone +44 (0)1706 363200 for customer service and sales. Web: www.hartmann.co.uk Molnlycke Health Care Arenson Centre Arenson Way Dunstable LU5 5UL Freephone 08007311876 (24hrs) www.molnlycke.com Smith & Nephew Healthcare Ltd Healthcare House 101 Hessle Road Kingston Upon Hull HU3 2BN T 44 (0) 1482 222200 F 44 (0) 1482 222211 Web: www.smith-nephew.com Urgo Medical Limited Sullington Road , Shepshed Leics LE12 9JJ Telephone 01509 502051 Web: www.urgo.co.uk