wound dressing guidelines · wound care grid 145x214mm 50 odour control for use on wounds which...
TRANSCRIPT
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Wound Dressing
Guidelines
This guideline is written for use within Harrogate & District NHS Foundation
Trust, Primary and Secondary care settings. It is based on the best
evidence available at the time of publication. This guidance includes
evidence-based recommendations from which it is intended decisions can
be made for use in daily practice
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Acknowledgements
This document was produced by: - Alison Elsworth Tissue Viability Nurse Specialist HDFT (01432 812844) Vera Nedyalkova Tissue Viability Nurse Specialist, HDFT (01423 812844) Lynne Boyd Matron for Adult Community Services, HDFT (01423 545769) Ann Cobb Community Services Senior Nurse, (Quality) HDFT (01423 812844) Sarah Turnbull Governance Pharmacist, Pharmacy dept. Harrogate and District NHS Foundation Trust (01423 554403) This Guideline has been produced in consultation and collaboration with clinicians throughout the Harrogate and District NHS Foundation Trust area. The wound continuums have been adapted from work carried out by David Gray & his team at Wounds UK (Aberdeen & London).
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Contents
Wound Dressing Guidelines
Ordering codes for products
The Wound Continuum
Principles of wound assessment
Hand washing
Wound aetiology
Leg Ulceration
Lymphoedema
Diabetic / Ischaemic Ulceration
Burns
Skin Tears
Malignant / Fungating wounds
Reduced Skin Integrity
- Pressure Ulcers - Moisture Lesions
Issues that may complicate healing
Wound Pain
Infection
Hypergranulation
Slough
Exudate
Periwound dermatology problems
Nutrition
Other information
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
November 2013 Wound Dressing Guidelines
The aim of this evidence based guideline is to aid the practitioner in the choice of dressings and not to remove clinical expertise or skill of any individual. It should be noted that patients should be assessed holistically and treatment planned appropriately for their individual needs. Consent must be obtained prior to procedure. Guidelines to be used in conjunction with the relevant wound management, pressure ulcer and leg ulcer policies within your organisation.
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Sterile Dressing Packs
Both types of dressing packs contain latex free gloves
Dressit (medium/large) contains: 1 pair Vitrex Gloves / 1 Large Apron 1 Disposable bag / 1 Paper towel 4 Softswabs 4ply / 1 Absorbent pad 1 Sterile field / Tape Measure Nurse It contains 1 pair of powder free, latex free nitrile gloves,1 large apron, 1 Disposable bag/2 sterile fields, paper towel, paper measuring tape, seven non-woven swabs, disposable forceps, disposable bag
Wound cer 3 contains: 5 x Swab Non Woven 7.5 x 7.5cm 4ply 1 x Paper Towel 1 x Orange Bag 1 x Pair of Medium Latex Gloves Powder Free Walleted 1 x Triangular Gallipot Tray 1 x Sterile Field
Dressit Small/medium Medium/large
(For use on FP10)
Or
Nurse It Small/medium Medium /large
(For use on FP10)
Wound care 3- national opt II (From NHS supplies)
1
1
1
60
52
60
36
Solutions for Irrigation
For Irrigation. Use at room
temperature. (Warm before
use).
Irripod Sodium Chloride 0.9%
Stericlens
Sodium Chloride 0.9%
20ml (x 25 pods)
100ml bottle
23 576
200
23 576
460
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
ADD note
Place Prontosan “gauze soak”
to the wound bed for 10
minutes. Remove then apply
appropriate wound dressing.
Prontosan Solution Wound irrigation solution
containing Betaine which is a gentle effective surfactant which
penetrates, disturbs and removes biofilm and wound debris
40ml amp x24
350ml
14.00
4.58
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Adhesive Remover
No-sting, non -cold, silicone-based medical adhesive remover
Peel-easy
50ml Spray
Wipes (30)
7.10
11.66
Skin Protectants
Apply sparingly. If the after-feel is oily, too much has been applied.
Prevents skin breakdown associated with incontinence and other bodily fluids. Moisturises and replenishes severely dry skin without reducing tape and dressing adhesion
Protective, transparent barrier film
A dimethicone-based skin
protectant. Indicated for intact
and injured skin
Cavilon Durable Barrier Cream
Cavilon No Sting Barrier Film
Proshield Plus
2g sachet (20 pack)
28g
92g
28ml spray
5 x 1ml foam
applicator
5 x 3ml foam
applicator
115g
666
719
813
822
Foam Cleansers
For use as an alternative to soap and water for cleansing skin following contamination with urine, faeces, perspiration where there is high risk of skin breakdown.
Proshield Foam & Spray cleanser
Vernacare – Senset Foam (Only available through NHS Supplies)
235 ml
300ml
638
DT
NA
110
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Emollients
To re-hydrate dry skin. If applying to leg, ensure product is applied in downward strokes to reduce risk of folliculitis Dermol 500 lotion is an anti-microbial for direct application onto skin or can be used as a soap substitute Requires prescribing by GP
Add 1 -2 capfuls of bath and shower emollient to warm water in a lined bowl or bucket for washing legs when required. Humectant containing emollient-urea and glycerine. Urea retains water and increases skin moisture restoring the barrier function of the skin Lauromacrogols act as a topical anaesthetic and have an anti-puritic effect.
Doublebase gel
Epaderm Cream
Dermol 500 lotion
Hydromol ointment (Hospital Use)
Doublebase bath and shower emollient
Balneum Cream
Balneum Plus Cream
100g 500g
50g 500g
500ml
125g 500g
500ml 1 litre
50g 500g
100g 500g
265 583
168 686
604
284 482
361 411
285 997
329 1499
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Wound measurement grids Only available from NHS Supply Chain or direct from manufacturers
Wound care grid
145x214mm
50
Odour control
For use on wounds which require management of malodour, a charlcoal Can be applied directly to the wound or as a secondary dressing if exudate present.
Clinisorb
10 cm2
10 x 20 15 x 25
184 245 395
Gauze swabs To cleanse wounds in addition or as an alternative to dressing pack
Gauze swabs
7.5x7.5
(Sterile) 8ply
10x10 8ply
(Non-sterile)
39
Pack (5)
79
(100)
Absorbent Perforated
Low absorption capacity and only suitable for lightly exudating superficial wounds.
Low adherence dressings with adhesive border. Shower proof.
Softpore
6 x 7 10 x10 10 x 15 10 x 20 10 x 25 10 x 30 10 x 35
6 13 20 35 40 49 58
Physical Debridement pad
Removes wound debris, necrotic material, slough and exudate and even long standing hyperkeratotic tissue from surrounding skin.
DebriSoft
A maximum of 2 dressings must be ordered.
10 cm
2
627
Adhesive Tapes
Permeable, hypoallergenic synthetic tape
More cost effective to order as 10m role. Permaeable non-woven synthetic tape
Chemifix
Clinipore
2.5cm x 10m 5cm x 10m
10cm x 10m
1.25cmx5m 2.5cmx10m
5cmx5m
100 140 210
35 73 99
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Soft Silicone & Wound Contact Layer
For use on superficial or acute traumatic wounds where dressing adherence is a risk. For fragile skin. A
secondary absorbent dressing is required (changed as necessary).
Primary wound contact layer.
Non-adherent polyester mesh,
1mm pore size and impregnation
of neutral triglycerides, prevents
penetration of granulation tissue
Into dressing. Petrolatum free,
effective up to 7 days.
Primary wound contact layer
For most cost effective use -
where appropriate - leave
dressings in situ and change
outer secondary dressing only.
This range of products can be
insitu for 7-14 days – always
check with manufacturer
guidelines in the first instance.
Always Use Clinical Judgement.
Able to irrigate through dressing if
required.
To be used where adherence of products to a wound is likely.
These dressings are NOT to be
used if wound is heavily
bleeding. Consider an alginate
or UrgoClean as an alternative.
Change outer dressing in between times.
Atrauman
N-A Ultra
Mepitel One
Urgotul
5x5
7.5x10 10x20 20x30
9.5 x9.5 9.5 x 19
6 x 7 9 x 10
13 x 15 24 x 27.5
5 x 5
10 x10 10 x40
15 x15 15 x 20 20 x 30
26 27 61
169
33 63
159 319 645 1738
152 303 1020 645 859 1381
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Vapour-Permeable or Semi-Permeable Adhesive Film Dressing
Use on superficial, shallow wounds such as cuts, abrasions, scalds, donor sites, postoperative wounds, sores and ulcers. Self-adhesive & waterproof to allow bathing.
Film dressings to be used only
as a primary dressing on lightly
exudating wounds.
Contra-Indications Do not use on infected wounds, deep cavity wounds, third degree burns or wounds with moderate to heavy levels of exudate. The exudate may become trapped beneath the film causing skin maceration and inflammation.
C-View
Mepitel Film
6 x 7 10 x 12 12 x12 15 x 20
6.5 x 7 10 x 12 10.5x 25 15.5 x 20
38 102 109 236
49
131 255 324
Absorbent Dressings
For moderate to highly exuding
wounds. May be used as
primary or secondary dressing.
Superabsorbent dressings
Can be used under
compression
Zetuvit E
Flivasorb
Flivasorb adhesive
KerraMaxCare
Eclypse Foot Eclypse Boot Eclypse Boot
10 x10
10 x 20 20 x 20 20 x 40
10 x10
10 x 20
20 x 20 20 x 30
12 x12 15 x15
10x10 10x22 20x22 20x30
33 x 48
60 x70
55 x47
21 24 38
107
88
105 186 235
127 167 295 337
790 1378 990
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Absorbent Management of moderate to highly exuding wounds For awkward to dress areas Atraumatic non-adherent primary dressing for low to highly exuding wounds. Can be used under compression Superabsorbent leg/foot wrap dressings. Do not use on arterial bleeds or heavily bleeding wounds Management of moderately to highly exuding wounds, with adhesive border
Sorbion Sachet Extra
Sorbion Sachet Multi Star
Sorbion Sana Gentle
Sorbion Sachet Border
5x5 7.5 x 7.5 10 x10
10 x 20 cm 20 x 20 20 x 30
8x8 14x14
8.5 x8.5
12 x12
12 x 22
22 x22
22 x32
15 x 15cm
25 x 15cm
145 178 225 373 700 999
299 489
199 249 449 799
1099
449 699
Hydrocolloid (Semi-Permeable)
Facilitate rehydration & autolytic debridement of dry, sloughy, or necrotic wounds. Suitable also for promoting granulation.
Hydrocolloids are not recommended to be used on diabetic foot ulcers.
For no or low exudate Useful for traumatic wounds, superficial burns, skin abrasions or removal of foreign bodies Free from animal products
Comfeel Plus
Transparent (shower proof)
5 x7
5 x15 5x25
10 x10 9 x14 9 x29 15 x15 15 x20
66 155 253 125 239 339 327 332
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
These types of dressings are not suitable for infected wounds. Dressing should seal round the borders of the wound.
For low exuding wounds. Absorbent hydrocolloid dressing with added alginate for absorption. Shaped for difficult to dress areas
Comfeel Plus Ulcer (Shower proof)
Comfeel Plus Contour
20 x20
4 x6 10 x10 15 x15 20 x20 18 x20 (sacral)
6 x8 9 x11
334
94 240 515 741 560
218 378
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Alginate
Shallow/Sloughy Wounds
Highly absorbent. Forms a gel on contact with wound exudate. A secondary dressing is required. Squares can be cut or torn into strips and loosely packed into the cavity of
deeper wounds. (Can be used on
bleeding wounds).
For Cavity Wounds Ribbon or rope for small, deep, open, wet wounds and sinuses. Use flat dressing for larger open wounds.
Sorbsan Flat
Urgosorb
Sorbsan Ribbon with probe
Sorbsan Packing
Urgosorb Rope
5 x5 10 x10 10 x 20
5 x5
10 x10 10 x 20
40cm
30cm
30cm
81 171 320
87
208 382
204
347
270
Hydrogel
An appropriate secondary dressing is required and should be chosen carefully.
Not suitable for infected or heavily-exuding wounds.
For low exuding / dry “flat” wounds.
Consider use when wounds are painful. Use for debridement to soften and rehydrate tissue Not to be used for deep cavity wounds
Aquaform Hydrogel
ActiFormCool
To hydrate dry tissue the dressing top liner should be left in place to occlude the wound.
For exudating wounds both
8g
15g
5 x 6.5 10 x10
10 x 15
166 202
178 261 375
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
and sinuses.
Must be checked daily or on alternate days initially. There may be odour associated with use of this product.
liners should be removed to improve moisture/vapour transmission.
May be kept in place up to
7days. Change when it
becomes discoloured or
opaque
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Foam
Can be used as primary or secondary dressings depending on wound type, site, size, depth, tissue type,
exudate levels. In hyper-granulating tissue, which may arise from use of occlusive dressings such as
hydrocolloids, changing to a more permeable product such as foam dressings may be beneficial.
These dressings may be kept in place for up to 7 days.
For patients with sensitive skin.
Choose dressing type appropriate to level of exudate & position of wound.
For patients with sensitive and/or fragile skin
Biatain Silicone
BiotainSilicone Lite
Biatain non adhesive
Urgotul Absorb Border
7.5 x7.5 cm 10 x10cm
12.5x12.5cm 15x15cm
17.5x17.5cm
7.5x7.5cm 10x10cm 12.5x12.5
5 x7 10 x10 10 x20 15 x15 20 x20
8x8 10 x 10 13 x 13 15 x 20
20x20
Sacrum
6 x 8.5 10 x10
140 206 252 374 497
128 232 383 427 635
135 195 239 389
425
180 215
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Mepilex Lite
Mepilex
.
(Consult TVN )
Mepilex Border
Mepilex Border
Sacrum
15 x15
10 x 11 11 x 20 15 x 16 20 x21
20 x50
7 x 7.5 10 x 12.5 10 x 20 10 x 30
15 x 17.5 17 x20
15 x15 18 x18 23 x23
417
266 439 482 728
2825
138 272 369 555 469 607
334 485 791
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Foam – Shaped
Shaped Foam Dressings: - May be used for awkward areas such as heel, knee or elbow, low to high exuding wounds. May be kept in place for up to 7 days
Tegaderm Foam Adhesive
Tegaderm foam adhesive heel
6.9x9.6 mini
wrap 6.9x7.6 mini
oval 10x11
14.3 x15.6 19x22.2 oval
13.9x13.9 14.3x14.3
166
142
233 412 676
410 344
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Hydrofiber
Ensure dressing extends at least 2 cm beyond the wound margin by selecting an appropriate size
In-patient use For medium to high exuding wounds. Should be covered with an appropriate secondary dressing.
Aquacel Foam dressings
May be used as a secondary dressing for Aquacel range if exudate level very high Ensure central pad is at least 2cm larger than the wound size.
Aquacel Useful for wet & sloughy
wounds. Can be layered if required in high exudate levels
Aquacel Foam Adhesive
Aquacel Foam Non-Adhesive
Ribbon
2 x 45cm 1 x 45cm
8 x8
10 x10 12.5 12.5 17.5 x17.5
21 x21 25 x30
5 x5 10 x10
15 x15 20 x 20 15 x20
239 179
137 235 307 520 761 985
131 248 417 680 570
Antimicrobial
Antimicrobial dressings may be used for critically colonised or clinically infected wounds to reduce bacterial load. Dressing selection should be dependent on tissue type, level / viscosity of exudate, size, type, position and depth of wound.
Alginate
Flaminal is a hydroactive colloid dressing with alginates. Flaminal contains a biological (enzymatic) anti-microbial system. Cover the entire wound-bed with product and apply a suitable non-occlusive secondary dressing.
15g covers approx 40cm2
During Flaminal® Forte treatment, whitish, sticky alginate flakes may appear in the wound. This indicates that the wound is too dry for Flaminal® Forte treatment. In such case, use Flaminal Hydro. Nozzles are also available Both may be left in place as long as gel structure remains unaltered. (1-4 days, depending on the amount of exudate).
Flaminal Hydro
Can be recapped for single patient use.
Flaminal Forte
Can be recapped for single patient use.
15g tube
15g tube
752
752
810
810
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
PHMB
PHMB (Polyhexamethylene biguanide) has a broad spectrum activity against bacteria, viruses and fungi. An alternative to other antimicrobial products.
Absorbent, polyurethane foam dressing impregnated with broad-spectrum anti-microbial (PHMB 0.5%) Antimicrobial barrier is effective for up to 7 days.
Kendall AMD Foam
Dressing
Kendall AMD Foam Dressing Adhesive
5 x5
10 x10 15 x15 20 x20
8.8 x 7.5
8.9 x8.9 14 x14 19 x19
4.4 x 8.3 8.9 x 14cm
250 471 892
1307 423
308 637
1225 247 485
275 554 984
1434 397
328 702
1350 252 492
Pre-cut antimicrobial dressing for IV/drain/tracheostomy sites impregnated with PHMB
Excilon AMD
5x5
009
Apply Suprasorb X with PHMB to the wound bed and cover with appropriate secondary dressing. Designed to regulate moisture levels in the wound. Can be left in place for 5-7days
Suprasorb X with PHMB
5 x5 9 x9
14 x20 2 x 21 rope
246 491
1161 695
DACC (dialkylcarbamoyl chloride) Hydrophobic, anti-microbial dressing to absorb exudate and bind bacteria. All chronic or acute wounds that are critically colonised or infected Contraindications:- Do not use in combination with ointments and creams as the binding effect is impaired
Cutimed Sorbact
Dressing Pad
Cutimed Sorbact Swab
7 x9
10 x10
10 x20
4 x6
7 x9
336 525 818 157 262
Honey Dressings
For necrotic, lightly exuding, sloughy, malodorous, infected wounds. Honey is an anti-microbial agent that promotes autolytic
Algivon Plus
(Manuka Honey & Alginate)
5 x5
10 x10
196 336
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
debridement Impregnated with 100% Medical grade Manuka Honey Discomfort may be experienced due to osmotic action of honey. If this persists then review treatment. Caution:- ensure patient does not have a sensitivity or allergy to honey, bee stings or bee products Ensure diabetic patients have blood glucose monitoring
Algivon Plus Ribbon
(Manuka Honey & Alginate)
Activon Tube
2.5 x20
25g
336
202
Topical Antibacterials
Metronidazole 0.75% Gel For wounds infected with anaerobic bacteria. Controls odour from fungating tumours. Prescription only
Anabact Topical Gel (Metronidazole gel)
15g 30g
447 789
Silver
For infected wounds. Active vs. MRSA. Treatment should be limited to 1 months use. Review after 2 weeks, only continue if progress has been made. Apply all silver dressings directly to wound surface. Do not use on third-degree burns or with patients with known sensitivity to silver or alginates.
Silver Alginate
For critically colonised or clinically infected wounds
Alginates have haemostatic properties so can be used on bleeding wounds. Can be left in place for up to 7 days
Urgosorb Silver
Urgosorb Silver Rope
5 x5
5 x 5 10 x10 10 x 20
2.5 x 30cm
157
149 356 671
358
159 369 695
359
Silver Non-adherent
For infected superficial wounds that need a non-adherent dressing.
Urgotul SSD (not to be used on a bleeding wound)
Can be left in place for up to 7 days
11 cm2
16 x 21cm
310 878
426 878
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Anti-microbial foam dressings Indicated for medium to heavy wounds
Biatain Ag
non adhesive
5 x7
10 x10
324 788
Antiseptic
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
For chronic, medium exudating or infected or sloughy wounds.
-Maximum single application ≤ 50g.
-Weekly max. not to exceed 150g.
-Any single course of treatment not to exceed 3 months.
Caution in patients with severe renal impairment or history of thyroid disorders (See BNF for full details). Contra-indications: lithium therapy, thyroid disorders, pregnancy & breast-feeding (See BNF for details).
Iodoflex pad
Apply to wound surface, remove gauze backing and cover; renew when saturated (usually 2–3 times weekly, daily for heavily exuding wounds)
Iodosorb ointment
5g 10g 17g
10g 20g
401 801
1269
437 874
583 972 1538
Inadine
Used as a primary wound contact layer for the prophylaxis & treatment of infections in superficial burns & skin loss injuries. In diabetic wounds up to 4 layers can be applied.
Inadine
5x5
9.5x9.5
33 49
42 62
Protease Modulator
Soft-adherent, hydro desloughing, absorbent dressing with TLC (Technology Lipido-Colloid) For use on chronic/static wounds following holistic assessment. Wound contact layer. Minimum duration 4-5 weeks. Do not use on infected wounds
UrgoClean
UrgoStart
UrgoStart Contact
6 x6 10 x10 15 x20 (Rope) 2.5 x40 5 x40
6 x6 10 x10
15 x 20cm
5 x7 11 x11 16 x21
94 209 393
235 311
430 595
1070
290 412 984
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Specialist Dressings
These dressings should only be used after recommendation from a Consultant / Specialist in wound care
Foams
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
This foam contains a mild non-toxic cleansing agent activated by moisture. Moistens wound bed so reducing trauma and wound pain.
Polymem ( non-adhesive )
8 cm2
10 cm2
13 cm2
17 x 19
157 244 407 601
170 287 450
832
Paraffin gauze dressing BP
For low exuding wounds and fragile healed tissue. Only to be used on recommendation of a Consultant/Specialist in wound care
Jelonet
10 x10
40
34
Flamazine
Short term use only
Silver Sulphadiazine 1% Cr.
For the prophylaxis and treatment of infection in burn wounds Caution in use over large areas.
1) For burns, apply daily or more frequently if higher levels of exudate;
Apply with sterile applicator. (50g tube may be used for up to 7 days) Use for 4 weeks max
Flamazine
50g
385
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Renasys Go Negative Pressure Wound Therapy (Specialist Dressings Continued)
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Renasys Go with Soft Port Dressing Kits
Pumps available from equipment library Harrogate
District Hospital Ensure TVN Team informed, Pumps must be returned to
equipment library as soon as discontinued
Contraindications /cautions:-Consideration should be taken for patients on anti-coagulant therapy actively bleeding wounds, difficult wound haemostasis, malignancy (except in palliative care), exposed arteries, veins, organs or nerves, untreated osteomyelitis, unexplored fistulae, anastomic sites, extensive necrotic tissue or non- concordant patients
Renasys-G Small
Gauze Kit Renasys-G Medium
Gauze Kit Renasys G Large
Gauze Kit Renasys-F Small Foam
Kit Renasys-F Medium
Foam Kit Renasys-F Large Foam
Kit
Renasys Go Canisters
Small
Medium
Large
Small
Medium
Large
300ml
750ml
1913
2399
3044
2245
2608
3094
1943
2673
Larval Therapy Biosurgical treatment for the debridement of chronic wounds such as diabetic foot ulcers, venous/mixed aetiology ulcers, pressure ulcers, and dehised surgical wounds. Contraindications should not be used on wounds that have a tendency to bleed or are close to a major blood vessel. Should not be used on patients on anti-coagulants where the relevant marker is not within clinical range. Should be used with caution on wounds over/adjacent to exposed organs or leading to a body cavity and then only under close supervision.
Biobag
BB50 2.5 x 4cm
BB100 4 x5cm
BB200 5 x 6cm
BB300
6 x 12cm
BB400 10 x 10cm
195.00
220.00
245.00
270.00
295.00
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Bandages
Retentive Bandages
For retention of dressings. Their aim is to keep the dressing close to the wound without inhibiting movement or restricting blood flow.
K Lite
K Lite long
K Band
10cm x 4.5m
10cm x 5.25m
10cm x 4m
98
113
28
72
117
19
Padding
For absorption of any excess exudate, comfort for patient and increase conformability of limb for application of outer bandage. Also used in application of compression bandage to protect & shape leg.
K Soft
K Soft long
10cm x 3.5m
un-stretched
10cm x 4.5m
45
56
49
58
Tubular Bandage (Elasticated Viscose Stockinette)
For retention purposes.
For garments available, consult Tissue Viability Service
Comfi-fast
Blue line
Yellow Line
Beige
Comfi-fast garments Child sizes but able to use on adults
7.5cm x1m 7.5cm x 3m 7.5cm x 5m
10.75cm
x1m 10.75cm
x3m 10.75cm
x5m
17.5cm x1m
Various sizes
available
77 213 374
120
349
604
183
Varies With size
Compression Therapy for venous leg ulcer management
A full leg ulcer assessment must be carried out before using any compression system to assess for arterial disease. The most important aspect of venous leg ulcer management is application of compression therapy. Compression therapy is applied so that the pressure at the ankle is higher than the pressure at the knee (graduated) thereby assisting venous blood in returning to the heart at a faster & more efficient level. It reduces venous pressure. Compression therapy is applied using either bandages or hosiery. (For further information see Leg Ulcer Policy).
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Full Compression Bandages (Short Stretch Bandage)
For venous leg ulceration, oedema and lymphoedema. Applied at full stretch and 50% overlap over padding, which protects areas of high pressure & sites at high risk of pressure damage.
FOR USE ON IRREGULAR
SHAPED LEGS
FOR USE ON REGULAR
SHAPED LEGS. Supplied as
a kit comprising of a comfort
layer and Actico. Additional
padding may be needed
Actico Cohesive
Actico2C Cohesive
6cm x 6m 8cm x 6m 10cm x 6m 12cm x 6m
Ankle size 18 - 25cm 25 - 32cm
269 309 321 409
795 895
269 309 321 409
795 895
Multi-layer Compression Bandaging for mixed aetiology – Reduced compression
Reduced compression bandage system.
Recommendations for reduced compression. Some patients may present with alternative bandaging.
Please continue with treatment as advised and contact consultant/specialist for further information as appropriate.
Also available in KTwo Latex free
K-Four Reduced
Compression 18cm+
(supplied as a kit)
May be prescribed as individual components if kit not available: -
Ankle size 18-25cm
K-Soft K Lite Ko-Flex
Ankle size 25-30cm
K-Soft long K-Lite long
Ko- Flex long
K-Two Reduced Ankle size 18-25cm
Ankle size 25-30cm
18cm +
10cm x 3.5m 10cm x 4.5m 10cm x 6.0m
10 x 4.5cm 10 x 5.25cm
10cm x 7m
Ktech & Kpress
429
43 97 289
54 111
330
Multi-layer Compression Bandaging Latex free system
For 18-25cm ankle sizes. For full compression, use all four layers. For reduced compression, omit third layer.
Profore latex-free Latex Free 4-layer system
970
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Multi-layer Compression Bandaging Full compression
For venous leg ulcerations with a Doppler reading >0.8mmHg (refer to Tissue Viability Nurse for advice on reading below 0.8mmHg).
K Two Multi-layer compression
bandage kit (2 layer system)
K Four Multi-layer compression
bandage kit (4 layer system)
If an alternative to full compression bandaging is required or an alternative ankle size identified contact a specialist for advice.
Ankle sizes up to 18cm (Short) 18-25cm ankle sizes
Ankle sizes 25-32cm
May be prescribed as individual components if kit not available: -
Ankle size 18-25cm
K-Soft K Lite K-Plus Ko-Flex
Ankle size 25-30cm
K-Soft long K-Lite long K-Plus long Ko- Flex long
10cm x 5m
10cm x 6.5m
10cm x 6m 10cm x 7.5m
10cm x 7.3m 10cmx10.5m
Full kit 10cm x 3.5m 10cm x 4.5m 10cm x 8.7m 10cm x 6.0m
Full kit
10 x 4.5cm 10 x 5.25cm 10 x 10.25m 10cm x 7m
655
776
848
674 45 98
224 297
674 56
113 259 340
655
776
848
674 45 98 224 297
674 56 113 259 340
Compression Hosiery Kits
Compression hosiery may be used as an alternative to compression bandages if concordance or patient independence is an issue. Full assessment should be completed prior to application.
Kits contain 2 liners and 1 medical stocking
Suggested brands:
Activa Leg Ulcer Hosiery Kit ActiLymph Hosiery Kit Altipress 40 Leg ulcer Kit Altipress MTM
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Compression Hosiery
British standard hosiery help manage and prevent various venous leg conditions where limb swelling is not apparent. European class hosiery plays an important role in managing conditions with chronic oedema. It has a stiffer profile that British standard hosiery. Please use made to measure hosiery when the limb is large or irregular shaped
British Standard Class Strength Indication
Class 1 14 – 17mmHg Superficial or early varices & prevention of deep vein thrombosis while travelling
Class 2 18 – 24mmHg Medium varices. Treatment & prevention of venous leg ulcers & associated conditions
Class 3 25 – 35mmHg Gross varices; post thrombotic wound insufficiency; treatment of venous leg ulcers and prevention of recurrence
Suggested Brands : -
Activa Price varies in relation to classification, style and size
Altiform Please always allow the patient to choose their preferred style / type
RAL (European) Standard Class Strength Indication
Low compression 14 – 18mmHg Early / mild oedema, prevention of varicose veins in pregnancy
Class 1 18 – 21mmHg For early / mild chronic oedema, lymphoedema where the oedema is light to moderate with little shape distortion
Class 2 23 – 32mmHg For moderate to severe chronic oedema or lymphoedema where there may be some slight or minor shape distortion
Class 3 34 – 46mmHg For severe chronic oedema and lymphoedema, where resistant oedema features or where lymphatic damage is considerable. Use also when lower compression has failed to control return of oedema.
Suggested Brands : -
Actilymph Carolon Mediven Please refer to company information for measuring
Altiven Jobst Sigvaris & choice of style, price etc.
Types of hosiery & when to use:- Circular Knit – No to moderate oedema with NO skin creases and / or indentations Flat Knit – Moderate to severe oedema with skin changes / creases and or indentations. Below knee or thigh length – use thigh length when:-
Oedema extends to thigh
Varicosities in thigh region
Oedema around knee joint
Pain in knee due to arthritis
Choice between open and closed toe Open toe stockings may be preferred for people who:
Have arthritic or clawed toes, or fungal infection
Prefer to wear a sock over the compression stocking.
Have a long foot size compared with their calf size.
Please contact appropriate specialist for advice / support
Type, Indications &
Comments Dressing Name
Sizes
(cm)
Tariff
Cost
(p)
NHS
Supplies
Cost (p)
Liners may be used in place of compression bandages dependant on patient assessment. Each liner gives 10mmHg at the ankle. May start with one liner and build up to two.
This Guideline has been approved by: The Area Prescribing Committee – Review 2016
Suggested makes Activa-Liners, Urgo-Altipress
Compression Hosiery Applicator
Devices to aid with application of hosiery.
Easy-slide Small 2-4.5 shoe size
Medium 5-7.5 Large 8-11
Actiglide
Sockaid
1
1
1
1198
1364
1288
1364
1288
Waterproof wound dressing and bandaging protector
Waterproof cover, for limbs, to prevent dressings and bandages becoming wet during showering or bathing.
Limbo
Seal-tight
Various sizes available on prescription for both leg or arm use
1056 1050
1056 1050
Footwear
Kerraped shoes may be used when other footwear will not accommodate a bandage system. They are available in a range of sizes to accommodate most foot sizes and additional bandages.
Contact specialist for further information.
Kerraped SIZE Shoe size Foot width Foot width (base of toes) (circum)
Small 2 - 5.5 7.6 - 8.6 23.8 – 27.1
Medium 6 - 7.5 8.8 - 9.2 27.6 - 29
Large 8 - 10 9.4 -10 29.5 – 31.4
X. Large 10.5 – 13 10.1 - 10.9 31.8 – 34.2
1755 All
sizes
1755 All
sizes