Wound Management Formulary and

Clinical Pathways 2017

Written by The Tissue Viability Team GCS.

Formulary complied by Tissue Viability Team and agreed by the CCG.

Gloucestershire Countywide Primary Care Wound Management Formulary
Contents Page
4 Introduction
5 Important & Further Information
6-7 Debridement Pathway
8-9 Exudate Pathway
10 Fungating Wound Pathway
11 Leg Ulcer Pathway
12-13 Over Granulation Pathway
14 Pressure Ulcer Grading Pathway
15-16 Skin Tear Pathway
17 Preventing Wound Infection Pathway
18 Wound Pain Evaluation
19 Wound formulary – Barrier Creams
20 Wound formulary – Contact Layers
21 Wound formulary – Basic Adhesive Dressings
22 Wound formulary – Hydrocolloid Dressings
23 Wound formulary – Gelling Fibre Dressings
24 Wound formulary – Foam Dressings with Silicone Adhesive
25 Wound formulary – Non-Adhesive Foam Dressings
26 Wound formulary – Super Absorbent Dressings
27 Wound formulary – Hydrogel Dressings / Charcoal Dressings
28 Wound formulary – Burns Dressings
29-34 Wound formulary – Antimicrobial Dressings
35 Wound formulary – Debridement Pads / Adhesive Tapes / Dressing Packs
36 Wound formulary – Swabs / Lightweight Conforming Bandages
37 Wound formulary – Elasticated Tubular Bandages

2
38 Wound formulary – Compression Bandaging
39 Wound formulary – Layer / Multi-layer Compression Bandaging
40 Wound formulary – Therapeutic Off-loading Footwear / Medicated Bandages
41 Wound formulary – Adhesive Remover / Saline / Topical Corticosteroids
42 Wound formulary – Pressure Reducing Pads
43 Wound formulary – Protease Modulating Matrix Dressings / Acrylic Dressings
44 Wound formulary – Wound Fillers / Regenerating Matrix Therapy
45 Wound formulary – Topical Pain Management / Non Adhesive Foams
46 Wound formulary – Compression Bandaging
47 Wound formulary – Topical Negative Pressure
48 Wound formulary – Larvae
49 Wound formulary – Podiatry & MIU
50-51 Appendix 1 – Exception Reporting Forms
52 Notes

3
Reviewed Nov 2016
Printed Jan 2017
Next routine review Jan 2018

INTRODUCTION

This formulary is a revised edition for 2017. It is based on the previous formulary, which was developed by The County Wide Tissue
Viability Steering Group comprising of representatives from Gloucestershire Care Services (GCS) and Gloucester Hospitals NHS
Foundation Trust.

This formulary has been reviewed by NHS Gloucestershire Medicines Management Team, with the support of GCS Lead Tissue
Viability Nurse, and other nurses with an interest in dressings within the county.

Our aims are towards:

• Promoting evidence based practice by providing a framework within which it is safe to practice.
• Promoting continuity of care.
• Promoting rational prescribing.
• Supporting the practical application of nurse prescribing.
• Encouraging safe, effective and appropriate use of dressings.
• Cost effectiveness.

These formulary choices are based on performance and stability of both the item and the manufacturing / supplying company, as
well as consideration of price.

Please order the exact amount of dressings required, and not necessarily the listed pack size. Supplier details and contact
numbers can also be obtained from the BNF. Multi Compression bandaging should be ordered following your current protocol.

4
Other Trust and external policies and procedures that are relevant to this Formulary include:
• NHS Gloucestershire Care Services’ POPAM (Policy on ordering, Prescribing and Administering Medicines)
• Nursing Procedures – The Royal Marsden Manual of Clinical nursing Procedure 8th edition.

A Nurse Order form is available to use when requesting FP10 supply.

If a non-formulary product is used, a Non-Formulary Exception Reporting Form (available as Appendix 1) must be completed and
returned to: The Lead Tissue Viability Nurse, Gloucestershire Care Services, Edward Jenner Court, Pioneer Avenue, Gloucester
Business Park, Brockworth, Gloucester, GL3 4AW.

Where non-formulary products are identified repeatedly, we can consider revising the formulary. Your feedback is important.
Always follow manufacturer’s guidelines when applying products.

This formulary contains clinical pathways designed to guide you in your clinical decisions and to ensure quality in healthcare and
the standardisation of care processes.

It is fundamental that dressings with active pharmacies are not mixed, i.e. iodine and
honey.

This will alter the pharmacy and the practitioner will not know the exact pharmacy they
are putting on the wound bed.

5
 DEBRIDEMENT PATHWAY
Wound bed The removal of non-viable tissue from the wound bed until healthy tissue exposed
preparation using is an essential part of chronic wound healing. Follow suggested pathway to inform Types of Non Viable Tissue.
TIMES- debridement method:
.
T May be yellow, grey, blue, brown
Tissue- type? or black. Have a slimy consistency
viable
Assess the wound using TIMES Assess the patient holistically including or form a hard eschar.
Underlying cause? site, past medical history, medication and
measurements nutritional status Forms of non viable tissue are:
Infection necrotic, slough, fibrous and
compromised tissue .
Moisture
Tissue type present
Edges DEBRIDE if not
If No?
contraindicated Non-viable? Slough When not to debride
Skin necrosis or haematoma
If patient has any of the following: Mummified
digits, diabetic toes (some areas such as exposed
How? tendons may need to be kept moist) or necrotic
palliative wounds. Any foot necrosis including
Autolytic (Using dressings), Mechanical heels and digits: assess circulation first
If debridement is required
(Debrisoft), Larval, Sharp (competent
promptly for example to
practitioner ) Surgical ( surgeon )
prepare wound for VAC
therapy refer to TV team for Consult with TV if further advice needed:
specialist advice Consider Inadine dressings to manage dry
Non-specialist necrosis
debridement methods as
per formulary
Formulary dressings to aid autolytic debridement:

Two week challenge KerraLite Cool, ActivHeal Hydrogel. Diabetic foot wounds
should be referred to
Use your selected dressing for two Antimicrobial cover: Activon Honey / Algivon
diabetic podiatry -
weeks. If no progress use alternative Flaminal Hydro / Forte consider high risk of
product.
infection.
Consider Debrisoft for superficial slough management
If debridement is delayed after four weeks and removal of hyperkeratosis
refer to tissue viability
Why debride?
Chronic wounds often contain necrotic or sloughy tissue, which can harbor bacteria and act as a barrier to
healing. The availability of nutrients and oxygen and presence of ischemic tissue make this an ideal environment
in which both aerobic and anaerobic bacteria can multiply (White and Cutting, 2008), increasing the risk of
malodour and infection. Debridement of sloughy/necrotic tissue is one of the cornerstones of good wound practice
and vital when reducing the bacterial burden within the wound (Vowden and Vowden 1999a; Vowden and Vowden
1999b).

When is referral necessary?

If any doubt exists as to the diagnosis or treatment pathway referral should be made to specialist services, tissue
viabilty, diabetic podiatry, vascular specialists.

References:

Vowden,K. Vowden,P. Debridement made easy Wounds UK 2011:7(4)

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 For leg ulcer management please
follow Leg ulcer policy- Ensure
Doppler assessment is undertaken to EXUDATE PATHWAY
assess for compression bandaging

This pathway can be used as a guidance tool to manage exudate levels within your community setting

Look at the colour of the exudate - What could it be telling you?

Straw coloured or clear- Bleeding or blood stained may Brown- if wound sloughy or
Green or yellow- possible
considered normal indicate trauma or infection/ necrotic this shows the
Infection follow infection
colonisation-follow infection breakdown of that tissue
pathway
pathway

DRY
MOIST MODERATE / WET SATURATED / LEAKING

Unless wound management plan

is to keep wounds dry (e.g.
ischaemia) - Consider:
• KerraLite Cool Border
• ActivHeal Hydrogel
• Hydrocolloid
• Flaminal Hydro
1 x weekly dressing changes
No maceration and lightly marked
dressing. Consider:
• KerraCel
2-3 x weekly changes 4-7 x weekly changes
Maceration present,
Dressing may have moderate
strikethrough and possible
strikethrough, possible peri- wound
leaking from dressing. Consider:
maceration. Consider:
• KerraMax Care
• KerraFoam Gentle Border
• Biatain Silicone
• KerraCel

Use Cavilon Barrier cream, spray or stick to protect If exudate levels are still unmanageable refer to tissue
8
the peri-wound skin. Consider emollients to viability team who may consider topical negative
rehydrate. pressure therapy or other alternatives.
Supporting information

Exudate supports healing by providing a moist wound environment. The main role of exudate is in facilitating the
diffusion of vital healing factors such as immune defence by removing bacteria and the migration of cells across
the wound bed. It also promotes cell proliferation, provides nutrients for cell metabolism and aids autolysis of
necrotic or damaged tissue (Romanelli, et al 2010).

Although a moist wound environment is necessary for optimal wound healing, over- or under-production of
exudate may adversely affect healing. Factors such as bacterial colonisation can contribute to excess exudate
production; therefore it is important when assessing a wound that a holistic approach is taken to explore why
exudate levels are high so appropriate treatment can be commenced.

High exudate levels can cause peri-wound maceration therefore it is important to use skin barrier products to
protect your patient. Also consider the impact of exudate on a patients day to day life, such as soiled clothing
and odour control, this may lead to social isolation and therefore it is vital that we manage exudate as efficiently
as possible (Beldon 2016).

References

Beldon P. (2016). How to recognise, assess and control wound exudate. JCN wound care. 30 (2), 32-38.

Davies, P. (2012). Exudate assessment and management. Wound Care. S (1), 18-24.

M Romanelli, K Vowden, D Weir. Exudate Management Made Easy. Wounds International 2010; 1(2):

Available from http://www.woundsinternational.comVowden K, Vowden P. Understanding exudate management

and the role of exudate in the healing process. Br JCommunity Nurse 2003; 8(11 Suppl): 4-13.

9
 FUNGATING WOUND PATHWAY
Fungating wounds are complex and therefore management should be individualised for each patient.
The below pathway is categorised with different issues that can occur with this wound type giving suggestions to support care.

Bleeding hMalodour Check if patient is

Pain and discomfort Consider alginate dressing- Use charcoal dressings to under care of specialist
Assess pain levels using In severe cases kaltostat absorb odour - Clinisorb. palliative care or
wound pain assessment. alginate, topical adrenalin Topical metronidazole may oncology services-
or tranexamic acid may be also be indicated in severe Follow advised
Consider breakthrough required. cases. Consider alternative management plan from
analgesia and give prior to antimicrobial dressings. specialist area and
dressing changes. liaise with them prior
to changing wound
If still unmanageable topical care regime
morphine may be considered -
-Refer to GCS managing Necrosis and slough
Fungating Wound Guidelines Consider ActivHeal
for further information. Hydrogel to aid in
debridement of non- Itching
viable tissue Apply KerraLite Cool. If pathway followed
Use honey dressings with and wound
caution as they may Oral antihistamines management advice
cause bleeding. Menthol in aqueous still indicated refer
Consider Polymem to tissue viability
dressing. team for specialist
advice
Exudate
High absorbent
Infection
dressings may be
Refer to GCS preventing
indicated to manage
infection pathway. Consider if
exudate- Follow
antimicrobial dressing
exudate Pathway.
required.

Patients presenting with a leg ulcer require a full holistic assessment including a Doppler to obtain a current
ABPI or TBPI to ascertain whether there is venous or arterial impairment.
ABPI 0.8 -1.3
TBPI 0.7-1.5
Full Compression
Compression bandaging to be
applied as per manufacturer’s
instructions eg. ankle size. Toe
bandaging to be applied if toes
swollen.
Compression Hosiery kit if minimal
exudate or patient wishes to self-
care with dressings. (Jobst, Medi,
Activa)
Wrap around device can be used if
wounds are not below malleolus
If wound still present re-Doppler
every 12 weeks.
Once the ulcer has healed continue with
compression wrap system or hosiery.
Re- Doppler every 6 months.
Urgo K- Two Compri2
Coban2 Actico
LEG ULCER PATHWAY
ABPI 0.7 - 0.5 ABPI <0.5 or >1.3
TBPI 0.64-0.69 TBPI <0.64 or >1.5
Reduced Compression Refer for Vascular Assessment
Reduced Compression bandaging to Urgent referral for vascular
be applied as per manufacturer’s assessment if ABPI is less than 0.5
instructions eg ankle size. or TBPI 0.64.
Wrap around device can be used Non Urgent referral to vascular if
setting at the appropriate level ABPI greater than 1.3 or TBPI
mmHg if there is no wound below greater than 1.5
the malleolus. This allows patients
to self-care with dressings. (Medi,
Jobst, Activa)
If wound still present re-Doppler
every 12 weeks.
Once the ulcer has healed continue with
Do not apply compression.
reduced compression and either use a wrap
system or hosiery. If wound present dress conservatively.
Re-Doppler every 6 months.
Urgo K-Two reduced Compri2 lite
Always protect the periwound skin with a
Coban2 Lite barrier cream
 OVER-GRANULATION PATHWAY
Over-granulation is a soft tissue that is ‘proud’ of the wound (Peduncle) and minus the granules that represent granulation tissue. It
will not progress towards healing.
Common causes of over-granulation are:
• Granuloma Pyogenicium- associated with post-op surgery
• Friction
• Internal feeding devices such as PEG
• Excess moisture
• Infection
Follow this pathway to support the management of over granulation tissue within your
community setting:

Over granulation tissue first

Improvement?
noticed- Cover Biatain no
Continue
adhesive for two weeks

Over-granulation still present?

Deterioration or no change? Refer to tissue viability (referral form
Dress with Inadine. If exudate levels available on intranet) for specialist advice, a
unmanaged follow exudate pathway. GP referral may also be indicated if
dermatology advice required.

Are there any signs of
wound
infection/colonisation?
If yes commence infection
prevention pathway, in a
lightly exuding wound
continue to dress with
Inadine for a further two
weeks.
Improvement? If resolved
consider returning to
conservative dressing. If
some over-granulation
remains consider a further 2
weeks of antimicrobial
dressings.
Deterioration or no change?
If wound dry consider
Fludroxycortide tape.
Consider the cause:

Overgranulation is defined as an excess of granulation tissue which is in excess. Overgranulation is also known
as hypergranulation, exuberant granulation tissue, or proud flesh and usually presents in wounds healing by
secondary intention. It is clinically recognised by its’ friable red, often shiny and soft appearance that is above
the level of the surrounding skin (Johnson & Lea 2007) and can be healthy or unhealthy tissue (Harris &
Rolstad 1994)

Consider differential diagnosis:

Granuloma Pyogenicium: – common cause associated with post-op surgery. Presents as small erythematous
papules, which may exude heavily and bleed. This may need a referral back to surgeon.

Other causes include: Friction eg from PEG tube, excess moisture, infection

Remember:

Healthy granulation tissue - treat with pressure or steroid

Unhealthy granulation tissue – may be extremely friable and require antibiotics due to infection.

Malignancies: May resemble over granulation tissue

References : Achieving effective outcomes in patients with over-granulation WCA UK (2011)

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 Equipment
PRESSURE ULCER GRADING
Actions to take
Diagnosis and contributing factors: • Datix
• Braden
• Areas over bony prominence
• Must
• Assess if secondary to medical equipment
• Assess equipment
• Is moisture a contributing factor- assess if moisture lesion, consider continence assessment
needs
• Has a risk assessment been undertaken previously if patient already under your care, what can be learnt
• Inform management
from this reflect and assess why pressure damage has occurred.
plan how often
repositioning is
Mirrored appearance superficial skin loss consider barrier cream required
• Appropriate wound
care
• Tissue viability
referral for grade 3/4-
form available on
intranet

Equipment

Blanching/ Non Grade 2 Grade 3 Grade 4 Ungradable Ensure when selecting

blanching pressure reliving
erythema May present as blister Full thickness skin loss Deep tissue injury Where the depth of equipment that it does
or superficial skin loss damage to which extends down pressure damage not restrict patients
Press red area to but not full thickness subcutaneous tissue to underlying cannot be seen mobility further.
skin for 5 skin loss only and not to structures including secondary to the
Ensure a good seated
underlying structures presence of non-
seconds if positon when selecting
viable tissue
unchanged this is a cushion to promote
a grade 1 pressure redistribution.
Use Kerrapro on unbroken Refer to ICES for
skin to help redistribute 14 further equipment
pressure. support
 SKIN TEAR PATHWAY
Follow this pathway to inform your assessment and management of skin tears within your community
setting Category 1a

SKIN TEAR IDENTIFIED

CONTROL CLASSIFY Category 1b

BLEEDING (MEASURE AND
Elevate limb if DOCUMENT)
possible, apply ASSESS Refer to GCS
pressure using Guidelines on
gauze management of
acute traumatic Category 2a
wounds – see
pictures
rfdsssssssssssssssssssssssssssssssssssssss CLEANSE

Cleanse with normal saline

Category 2b
Use gloved moistened Avoid fixator strips,
finger to encourage REALIGN WOUND EDGES do not stretch wound
flap to realign (If possible) edges

Category 3

DRESSING

Dress with Biatain Lite or KerraLite Cool.

See supporting
Mark with arrow and date to show direction of information for
removal. additional
descriptions
 Category 1a
A skin tear where the
edges can be realigned
to the normal anatomical
position (without undue
stretching) and the skin
or flap colour is not pale,
dusky or darkened.
Category 1b
A skin tear where the
edges can be realigned
to the normal
anatomical position
(without undue
stretching) and the skin
or flap colour is pale,
dusky or darkened.
Category 2a
A skin tear where the
edges cannot be
realigned to the normal
anatomical position
and the skin or flap
Stephen-Haynes J, Carville K. Skin tears Made Easy. Wounds International 2011; 2(4): Available from
colour is not pale,
http://www.woundsinternational.com dusky or darkened.
Category 2b
Skin Tear Audit Research (STAR). Silver Chain Nursing Association and School of Nursing and Midwifery, A skin tear where the
edges cannot be
Curtin University of Technology. Revised 4/2/2010. realigned to the normal
anatomical position and
the skin or flap colour is
pale, dusky or
darkened.
Category 3
16 A skin tear where the
skin flap is completely
absent.
 PREVENTING WOUND INFECTION PATHWAY
Assess your wound using the TIMES framework
Are there any signs and symptoms of a host response? (Yes, refer patient to infected pathway)
Exudate management: is your current product selection suitable for the level and type of exudate presenting? (Refer to the exudate management pathway for guidance)
Is it a non-healing chronic wound? (If yes consider any underlying causes)
For cellulitis please follow local pathway (refer to flow diagram for celllultis)
Following assessment, decide on appropriate treatment option below

PROPHYLACTIC TREATMENT CRITICAL COLONISATION WOUND INFECTION

Do you consider your patient to be high risk Do you consider the wound to be Do you consider the wound to be infected?
of developing or a wound Infection? critically colonised?

Treatment plan Treatment plan Treatment plan

Cleanse the wound with Prontosan TM solution Cleanse the wound with Prontosan TM solution Commence an antimicrobial dressing
Commence Cutimed ® Sorbact ® to prevent increase of bacterial Commence Cutimed ® Sorbact ® to manage the increasing For patients with a host response consider swabbing the
bioburden within the wound, preventing wound infection bacterial bioburden and prevent wound infection from occurring wound and commencing antibiotics

Review Process
Review the wound every 4 weeks, this should Review Process
include the following: Review the wound after 2 weeks of treatment, include the following:
Wound management - TIMES Framework Wound management -TIMES Framework
Compression therapy regime (if appropriate) Compression therapy regime
Holistic assessment of the patient Holistic assessment of the patient

REVIEW OF TREATMENT REGIME

Is this pathway still the most suitable treatment option for your patient?
Based on the your recent clinical assessment are the signs and symptoms of increased bacterial bioburden reducing?
Is the wound now showing signs of progression? This would include the following:
Reduced wound margins? Reduced exudate levels? Signs and symptoms of increased bacterial bioburden are or have reduced?
(Refer to when to discontinue treatment or when to seek further specialist advice for next steps)

Yes - Improved Clinical Signs and Symptoms No Improvement in clinical symptoms

Is your patient still or considered to be high risk of developing further wound infections? If no improvement has been noticed and two or more
Yes - Continue treating using the prophylactic pathway regime, reviewing every 4 weeks or until healing has occurred symptoms still present refer to tissue viability team
No - Consider discontinuing the pathway and assess the wound for a more appropriate dressing selection Document a clear rationale for the new
Document a clear rationale for the new treatment plan treatment plan

Mellissa Beer - Tissue Viability Nurse, Gloucestershire Care Services NHS Trust
Sally Irving - Tissue Viability Nurse, Gloucestershire Care Services NHS Trust 17
Dawn Stevens - Clinical Nurse Manager, BSN medical Limited

160005045 - Preventing Wound Infection Pathway Amends-v3.indd 1 06/01/2017 09:56

 Patient Name: _______________________ Patient DOB: ___/___/___ Date: ___/___/___
Patient ID: __________________________ HCP: __________________________

Wound Pain Evaluation

Occurance
Pressure Ulcer
Constant Night pain Elevated/Dependent

of Pain
Malignant
Intermittant Walking Dressing change
Infection
Leg Ulcer
Wound Type

Diabetic Foot Ulcer Anticipating Aching Burning

Description of Pain
Surgical Other: Throbbing Stinging
Burns Gnawing Shooting
Derm (Pyoderma) Tender Stabbing
Trauma Cramp Numbness
Other: Other: Other:

10 Worst pain possible, If showing signs of infection, please refer to your local infection protocol
Unbearable
Hurts worst 9 Unable to do any activities Psycho-social Nociceptive Neuropathic
because of pain

• Consider referral to • Treat local factors: e.g. maceration, • Dual acting antidepressants
8 Intense, Dreadful,
Horrible GP / Pain Clinic - SNRI’s
• Refer to local • For wounds that are painful and exuding, • Anti-epileptic drugs
7 Unable to do most activities
Hurts whole lot
because of pain
protocols consider foam impregnated with • Topical drugs
Ibuprofen, e.g. Biatain Ibu.
6 Miserable, Distressing Tricyclic Antidepressants /
WHO analgesic ladder1 Anticonvulsants (gabapentin).
Unable to do some activities
Intensity

because of pain
Step 1 Non-opioid (e.g. asprin, Consider Gralise®, Horizant®,
Treatment

5
Indicated

Hurts even more

paracetamol or NSAID) +/- adjuvant Neurontin, Gabarone®
4 Nagging, Uncomfortable,
Troublesome

3 Can do most activities with rest

Step 2 Weak opioid for mild to
Hurts little more
periods moderate pain (e.g. codeine) +/- non-
opioid +/- adjuvant
2 Mild Pain, Annoying
Pain is present but does not limit
activity
1 Step 3 Strong opioid for moderate to
Hurts little bit
No pain
severe pain (e.g. morphine)
0 +/- non-opioid +/- adjuvant
Use in conjunction with appropriate dressing regime in accordance with local woundcare formulary

No hurt
Review weekly or if condition changes
Wound Care Formulary:
Barrier Creams:

Barrier cream/films are a topical formulation used to place a physical barrier between the skin and contaminants
that may irritate the skin, such as exudate, this helps to prevent skin damage caused by moisture exposure.

Product Manufacturer Size Tips

Cavilon Barrier Film 3M 1ml Lasts for 72 hours
Foam Applicator 3ml

Cavilon Barrier Film 3M 28ml

Spray

Cavilon Durable Barrier 3M 2g sachet x 20 Lasts for 72 hours. If

Cream 28g skin feels oily then there
92g may be too much cream

Proshield Plus H&R Healthcare 115g Can be used with highly

Protective Cream exuding leg ulcers as
well as for incontinence
Proshield Foam & H&R Healthcare 235ml
Spray Cleanser

19
Contact Layer:

Wound contact layers comprise a single layer of non-adherent mesh-like material designed as protection
for fragile tissue on the wound bed. They are usually used in the early, proliferative stages of healing to
promote granulation and epithelialisation.

Product Manufacturer Size Tips

N A Ultra (Silicone Acelity 19cm x 9.5cm
coated) 9.5cm x 9.5cm

Atrauman (knitted Hartmann 5cm x 5cm

polyester impregnated 7.5cm x 10cm
with neutral 10cm x 20cm
triglycerides) 20cm x 30cm

ActivHeal Silicone Advanced Medical 5cm x 7.5cm Can be used under TNP
Wound contact Solutions 10cm x 10cm therapy
10cm x 20cm Can be left in place for
15cm x 15cm 14 days

20
Basic Adhesive Dressings:

Simple dressings used for dry or lightly exuding, non-infected wounds.

Product Manufacturer Size Tips

Softpore Richardson 6cm x 7cm Non-woven fabric
10cm x 10cm dressing with an
10cm x 15cm absorbent pad for
10cm x 20cm low/moderately exuding
10cm x 25cm wounds
10cm x 30cm
10cm x 35cm

Hydrofilm Hartmann 6cm x 7cm Film dressing which is

10cm x 12.5cm waterproof
10cm x 15cm
10cm x 25cm
12cm x 25cm
15cm x 20cm
20cm x 30cm

21
Hydrocolloid Dressings:

The gel formed when exudate is absorbed by a hydrocolloid maintains a moist wound–dressing
environment while preventing fluid accumulation on the wound surface. Hydrocolloids are therefore also
of value in the management of clean shallow granulating pressure ulcers.

Product Manufacturer Size Tips

Comfeel Plus Coloplast 5cm x 7cm Can be used to protect
Transparent 5cm x 15cm the periwound area
5cm x 25cm with TNP
9cm x 14 cm
9cm x 25cm
10cm x 10cm
15cm x 15cm
15cm x 20cm
20cm x 20 cm

22
Gelling Fibre Dressings:

Caboxmethyl celluose primary dressing for use on a variety of exuding wounds. Designed to lock in
exudate to protect peri-wound skin from maceration, whilst helping maintain a moist healing
environment.

Product Manufacturer Size Tips

KerraCel Crawford Healthcare 5x 5cm
10 x 10cm
15 x 15cm
2.5 x 45cm Ribbon

UrgoClean Urgo 6cm x 6cm Designed to deslough

10cm x 10cm wounds but offers poly-
15cm x 20cm absorbent fibres which
2.5cm x 40cm help to manage exudate.
5cm x 40cm This is not a true gelling
fiber dressing.

23
Foams with Silicone Adhesive:

Silicone Foams offer superior absorption with soft adhesion; they can be used on a broad range of
exuding wounds. When using foams, Silicones foams should be considered first in order to protect the
peri-wound skin.

Product Manufacturer Size Tips

KerraFoam Gentle Crawford Healthcare 7.5cm x 7.5cm
Border 10cm x 10cm
10cm x 20cm
12.5cm x 12.5cm
17cm x 17.5cm Sacrum
23cm x 26cm Sacrum
23cm x 25cm Heel

Biatain Silicone Lite Coloplast 7.5cm x 7.5cm Use on non-to-low

10cm x 10cm exuding wounds and
12.5cm x 12.5cm skin tears.
15cm x 15cm
17.5cm x 17.5cm

Biatain Silicone Coloplast 7.5cm x 7.5cm

10cm x 10cm
12.5cm x 12.5cm
15cm x 15cm
17.5cm x 17.5cm
Biatain adhesive foam Sacrum
Heel
24
Non Adhesive Foams:

For use when a foam dressing is required under a secondary dressing such as compression.

Product Manufacturer Size Tips

Biatain Non Adhesive Coloplast 5cm x 7cm Safe to use under
10cm x 10cm compression
10cm x 20cm
15cm x 15cm
20cm x 20cm

Foams with Adhesive:

For use when adhesive foam is required but silicone is not appropriate.

Product Manufacturer Size Tips

Tegaderm Foam 3M 10cm x 11cm
Adhesive (adhesive 14cm x 15cm
film) Oval 19cm x 22cm
6.9cm x 7.6cm
Mini Wrap 6.9cm x 6.9cm

25
Super Absorbent Dressings:

Superabsorbent dressings have extra fluid-handling capacity. They are designed to be used on wounds
of varying aetiologies that produce moderate to high volumes of exudate.

Product Manufacturer Size Tips

KerraMax Care Crawford Healthcare 5cm x 5cm Safe to use under
10cm x 10cm compression
10cm x 22cm
20cm x 22cm
20cm x 30cm
20cm x 50cm
21cm x 23cm Multisite

Zetuvit E Non-Sterile Hartmann 10cm x 10cm

10cm x 20cm
20cm x 20cm
20cm x 40cm

Zetuvit E Sterile Hartmann 10cm x 10cm

10cm x 20cm
20cm x 20cm
20cm x 40cm

26
Hydrogel Dressings:

Hydrogel dressings are used in a variety of wound types and they are designed to hold moisture at the
wound surface, providing the ideal environment for wound cleansing and autolytic debridement, where
the body’s own enzymes debride dead tissue. The moisture donated by hydrogel dressings can help to
soothe the wound and reduce pain. They can also provide a barrier to microorganisms and help to
prevent infection

Product Manufacturer Size Tips

KerraLite Cool Border Crawford Healthcare 6cm x 6cm The new bordered
and Non Border 12cm x 8.5cm version prevents the
18cm x 12.5cm need for a secondary
8cm x 8cm bordered dressing
11cm x 11cm bordered
15cm x 15cm bordered
ActivHeal Hydrogel Advanced Medical 8g
Solutions 15g

Charcoal Odour Dressings:

Odour–combating dressing specifically designed to target odour in a range of wounds

Product Manufacturer Size Tips

Clinisorb Clinimed 10cm x 10cm Both sides of the
10cm x 20cm dressing are identical,
15cm x 25cm not intended to be the
primary dressing

27
Burns Dressings:

Please follow burns pathway for dressing selection. The dressings below are only for the use in burns
as per the pathway.

Product Manufacturer Size Tips

Polymem Tube Aspen 7cm x 7 cm
9cm x 9 cm
Polymem Finger & Toe Size 1, 2 or 3
Polymem 8cm x 8cm
10cm x 10cm
13cm x 13cm
17cm x 19cm
Polymem MAX 11cm x 11cm
20cm x 20cm
Polymem Roll 10cm x 61cm
20cm x 60cm

28
Antimicrobial Dressings:

An antimicrobial is an agent that kills micro-organisms or inhibits their growth. There are several types
of anitimicrobial.

DACC-Coated Antimicrobial Dressings:

The physical principle of hydrophobic interaction means that bacteria and fungi become physically and
irreversibly bound to the DACC dressing. This means that these dressings can be used prophylactically
to prevent infection.

Product Manufacturer Size Tips

Cutimed Sorbact BSN 4cm × 6cm Do not use in
(swabs) 7cm × 9cm combination with
ointments and creams
Cutimed Sorbact 5 Pad 3cm as the binding effect is
Pack (round) impaired

Cutimed Sorbact 2cm × 50cm

(ribbon)

Cutimed Sorbact 5cm × 2m

29
Silver Dressings:

Silver has antimicrobial activity against many antibiotic-resistant strains of bacteria. Silver may be
incorporated into dressings in a number of different forms, most notably as elemental silver or in the
ionic state.

Silver products should be used with caution due to their toxicity, follow the 2 week challenge.

Product Manufacturer Size Tips

Askina Calgitrol Paste BBraun 15g Supplied sterile in a
tube with
a long cannula to aid
application of the paste
into tunnels,
sinuses and awkward
wound shapes

Askina Calgitrol Thin 5cm x 5cm Silver alginate matrix

10cm x 10cm wound contact layer
15 cm x 15 cm

Askina Calitrol AG 10cm x 10cm The primary wound

15cm x 15cm contact layer is a silver
20cm x 20cm alginate that is
laminated to a foam
layer

30
Silver Sulphadiazine:

Usually found in a cream preparation (Flamazine®) an antibacterial contact layer with TLC-Ag
Technology (polyester mesh impregnated with hydrocolloid, petroleum jelly and silver sulphadiazine
particles).

Product Manufacturer Size Tips

Urgotul SSD Urgo 10cm × 12cm
15cm × 20cm

Cadexomer Iodine:

Cadexomer iodine based products absorb fluids, removing exudate, pus and debris. As they swell,
iodine is slowly released killing micro-organisms and forming a protective gel over the wound surface.

Product Manufacturer Size Tips

Iodoflex Smith and Nephew 1 x 5g units (5)
1 x 10g units (3)
1 x 17 g units (2)

31
Povidine Iodine:

Povidone Iodine dressings deposit their iodine immediately upon application, designed to manage
infection by bacterial, protozal, and fungal organisms.

Product Manufacturer Size Tips

Inadine Acelity 5cm x 5cm
9.5cm x 9.5cm

Enzyme Alginogel:

Enzyme Alginogel combine the benefits of hydrogels and alginates in one product. They also
incorporate unique broad spectrum antibacterial enzymes that are effective against a range of bacteria,
including MRSA and can be used throughout the duration of the wound not just when infection is
present.

Product Manufacturer Size Tips

Flaminal Hydro Flen Pharma 15g For low to moderately
50g exuding wounds (3.5%
alginate). Can be
recapped as self-
cleaning
Flaminal Forte 15g For moderate to heavy
50g exuding wounds (5.5%
alginate). Can be
recapped as self-
cleaning

32
Manuka Honey:

Manuka honey kills harmful bacteria, eliminates odours without masking them, and maintains the ideal
moist wound healing environment. The osmotic effect draws harmful tissue away from the wound bed
but this can cause a drawing pain.

Product Manufacturer Size Tips

Activon Tulle Advancis 5cm x 5cm For granulating or
10cm x 10cm shallow wounds,
debriding or de-
sloughing

Actilite 10cm x 10cm Designed to protect a

10cm x 20cm wound, promote
healing and allow the
passage of exudate

Activon Tube 25g Ideal for debriding

necrotic tissue, or for
topping up dressings.
Good for cavities, just
wash away with saline
solution

Algivon 5cm x 5cm Ideal for wetter wounds

10cm x 10cm as the alginate has a
capacity to absorb

33
PHMB:

Polyhexamethylene biguanide hydrochloride (PHMB) has been used for over 60 years as an
antimicrobial agent due to its broad spectrum of antimicrobial activity.

PMHB is a broad-spectrum antimicrobial and is fast and effective in killing bacteria, fungi and yeasts
that reduce bioburden in critically colonised and infected wounds. There is no known resistance,
systemic absorption or toxicity.

It selectively acts on bacteria without affecting healthy cells therefore suitable for long term use.

Product Manufacturer Size Tips

Suprasorb X+PHMB Activa 14cm x 20 cm Its HydroBalance
2cm x 21cm rope technology means it is
5cm x 5cm able to absorb exudate
9cm x 9cm and donate fluid at the
same time
Reduces pain and has
soothing properties

Prontosan Wound BBraun 350mls Has a powerful

Irrigation Solution 40mls antimicrobial agent that
can reduce bioburden
whilst the Betaine
surfactant penetrates to
clean and remove
wound debris
and biofilm

34
Debridement Pads:

Patented monofilament fibre technology lifts, binds and removes superficial slough and debris including
biofilm quickly and easily.

Product Manufacturer Size Tips

Debrisoft Activa 10cm x 10cm pads Moisten with water or
5cm x 2cm lolly saline, do not use any
cream or emollient

Adhesive Tapes:

Product Manufacturer Size Tips

Clinipore Clinisupplies 5m x 1.25cm
5m x 2.5cm
5m x 5cm
10m x 2.5cm
Hypafix BSN 4m x 5cm
4m x 10cm
4m x 15cm

Dressing Packs:

Product Manufacturer Size Tips

Nurse It Dressing Pack Medicareplus Small Do not apply the gauze
Medium to a wound
Large
35
Swabs:

Product Manufacturer Size Tips

Soft Swabs Non-woven Premier - Sherwood 10cm x 10cm x 100
fabric swab 4ply non-
sterile

Soft Swabs Non-woven 7.5cm x 7.5cm x 5

fabric swab 4ply sterile

Light Weight Conforming Bandages:

Product Manufacturer Size Tips

Hospicecrepe Hartmann 4.5m x 5cm
239 4.5m x 7.5cm
4.5m x 10cm

K Band Bandage Urgo 5cm x 4m

7cm x 4m
10cm x 4m
15cm x 4m

Mollelast Activa 4cm x 4cm Suitable for digit

bandaging with
compression bandaging

36
Elasticated Tubular Bandages:

Product Manufacturer Size Tips

Comfifast Synergy Health 3.5cm (red) 1m
5cm (green) 1m
5cm (green) 3m
5cm (green) 5m
7.5cm (blue) 1m
7.5cm (blue) 3m
7.5cm (blue) 5m
10.75cm (yellow) 1m
10.75cm (yellow) 3m
10.75cm (yellow) 5m
17.5cm (beige) 1m

37
Compression Bandaging:

Compression bandages are usually 10cm wide unless specifically advised by vascular, lymphoedema,
tissue viability or the complex leg wound service. Not to be carried out without the completion of the
appropriate competency.

Short Stretch:

These bandages are defined as having low elasticity (or non-elastic). Short-stretch bandages deliver a
low resting pressure and a high working pressure (high SSI), producing a significant massage effect on
the calf-muscle when the patient is active.

Product Manufacturer Size Tips

JOBST Compri2 BSN 18-25cm ankle size Has a visual indication
(40mmHg) 25-32 cm ankle size to ensure correct
pressures are achieved
JOBST Compri2 lite 18-25cm ankle size Has a visual indication
(20mmHg) 25-32 cm ankle size to ensure correct
pressures are achieved
Actico Activa 5cm x 6m
(40mgHg) 6cm x 6m
8cm x 6m
10cm x 6m
12cm x 6m

38
2 Layer/Multi-layer Compression:

Traditionally multicomponent multilayer systems consisted of 4 bandages. In recent years the

introduction of the two layer systems has shown significant improvement in compliance with the same
clinical effectiveness.
Product Manufacturer Size Tips
Urgo K-Two Urgo 18-25cm ankle size Has a visual indication to
(40 mmHg) 25-32 cm ankle size ensure correct pressures
are achieved.
Urgo K-Two Lite 18-25cm ankle size
(20mmHg) 25-32 cm ankle size Two-layer system
comprising short-stretch
composite wadding, with
cohesive, elastic bandaging
applied over the top. For
Urgo K-Two Latex free kit 18-25cm ankle size treatment of severe oedema,
25-32 cm ankle size and venous leg ulcers

Coban2 3M Two-layer compression

(40 mmHg) system comprising latex-
free foam padding and
Coban2 Lite cohesive outer compression
(20mgHg) layer, with reduced resting
pressure for sensitive
patients. For venous leg
ulcer treatment

39
Compression: Therapeutic Off-Loading Footwear

To help prevent foot ulcers by off-loading up to 30% of pressure, from the most vulnerable parts of the
foot.

Product Manufacturer Size Tips

Kerraped Crawford Healthcare Small Can also be used for
Medium patients in compression
Large bandaging
Extra Large

Medicated Bandages:

Designed for the wet ulcers that are surrounded by an area of sensitive skin, zinc paste bandages
contain Ichthammol which soothes the skin and helps ulcers to heal.

Product Manufacturer Size Tips

Zinc Paste and Smith and Nephew 6m × 7.5cm
Ichthammol Bandage

40
Adhesive Remover and Saline:

Product Manufacturer Size Tips

Irripods (Sterile saline) CD Medical 20ml
(box of 25)
Peel-easy (Silicone CD Medical 50ml aerosol
based adhesive
remover)

Peel-easy (Silicone Pack of 30

based adhesive
remover) wipes

Topical Corticosteroids:

Topical corticosteroid therapy in an occlusive, transparent, self-adhesive and waterproof tape

Product Manufacturer Size Tips

Fludroxycortide tape Typharma For use on over
(Haelan Tape) granulation- the cream
can be used if the tape
is unavailable

41
Pressure Reducing Pads:

Effectively redistributes pressure, dissipating it over the pad to protect the skin from pressure ulcers,
it’s produced from silicone.

Product Manufacturer Size Tips

KerraPro Crawford Healthcare Sacrum/Ankle Use with at risk patients
Heel before the skin has
Sheet 10 x 10 x 0.3cm broken to prevent
Sheet 10 x 10 x 1.2cm pressure damage
Strips 30 x 5 x 0.3cm
Strips 50 x 2.5 x 0.3cm

42
Specialist Formulary:

Products to be used following tissue viability agreement

Protease-Modulating Matrix Dressings:

Protease-modulating dressings have been developed to reduce the levels of activity of harmful
proteases, in particular matrix metalloproteinases (MMPs), in the exudate of chronic wounds.

Product Manufacturer Size Tips

Promogran (hexagonal) Acelity 28cm²
123cm²

Promogran Prisma 28cm²

Antimicrobial 123cm²
(hexagonal)

Acrylic Dressing:

A transparent wound dressing with fluid handling capacity

Product Manufacturer Size Tips

Tegaderm Acrylic 3M 7.5cm x 10cm
Absorbent 7.5cm x 20cm
20cm x 25cm

43
Wound Fillers:

Allevyn Cavity provides hydrocellular technology in a unique 3 dimensional structure for effective
management of deep wounds.

Product Manufacturer Size Tips

Allevyn Cavity Circular Smith and Nephew 5cm
10cm
Allevyn Cavity Tubular 9cm × 2.5cm
Allevyn Cavity 12cm × 4cm
Allevyn Cavity Plus 5cm x 6cm
10cm x 10cm
15cm x 20cm

Regenerating Matrix Therapy:

ReGeneraTing Agents (RGTA) are engineered biodegradeable sugar based polymers that preserve the
cellular microenviroment needed for tissue regeneration:

Product Manufacturer Size Tips

Cacipliq20 Innocell Medical 1.5ml
5ml

44
Topical Pain Management:

See wound Pain Pathway for appropriate use

Product Manufacturer Size Tips

Biatain IBU soft hold Coloplast 15cm x 15cm A soft and flexible
10cm x 22.5cm absorbent foam
10cm x 12cm dressing containing
ibuprofen which is not
systemically absorbed
by the body

Non Adhesive Foams:

For use when a foam dressing is required under a secondary dressing such as compression.

Product Manufacturer Size Tips

Tegaderm Foams Non- 3M 10cm x 10cm For use when formulary
Adhesive 10cm x 20cm non adhesive foam is
20cm x 20 cm not sutiable

45
Compression Bandages

Only to be used for patients following consultant instructions. Always consider changing to one of the
formulary systems.

Product Manufacturer Size Tips

Profore Smith and Nephew Kits <18cm
Kits 18-25cm
Kits 25-30cm
Kits > 30cm
Lite 18-25cm
Latex free 18-25cm

46
Topical Negative Pressure (TNP)

Promotes wound healing through Topical Negative Pressure (TNP). Delivering negative pressure (a
vacuum) at the wound site through a unique, proprietary dressing which helps draw wound edges
together, removes infectious materials and actively promotes formation of the granulation tissue.

Not to be carried out without the completion of the appropriate competency.

Product Manufacturer Size Tips

VAC Therapy Acelity (KCI) This MUST be agreed
with the Tissue Viability
Team before treatment
is commenced or
patient accepted from
the Acute Trust
PICO Smith and Nephew Canister-free and
disposable
This is a step up/down
version of TNP and
MUST be agreed by the
Tissue Viability team
before treatment is
commenced or patient
accepted from the Acute
Trust

47
Larvae (Maggots) for wound debridement:

This product should not be used without consultation with the tissue viability team and completion of the
appropriate competency.

Product Manufacturer Size Tips

BioBag Biomonde 2.5cm x 4cm
4cm x 5cm
5cm x 6cm
6cm x 12cm
10cm x 10cm
Free Range Larvae Retention kit 30x30 cm
kit with 1 vial
Retention kit 30x30 cm
kit with 2 vial
Retention kit 30x30 cm
kit with 3 vial
Boot retention kit and 1
vial
Boot retention kit and 2
vial
Boot retention kit and 3
vial

48
PODIATRY ONLY:

Foams with Silicone Adhesive:

Product Manufacturer Size Tips

Cutimed Siltec B (with 7.5cm × 7.5cm Low to moderately
adhesive border) 12.5cm × 12.5cm exuding wounds
15cm × 15cm
17.5cm × 17.5cm
22.5cm x 22.5cm
Cutimed Siltec 5cm x 6cm Moderate to highly
10cm x 10cm exuding wounds.
10cm x 20cm Suitable for use on
15cm x 15cm fragile skin
20cm x 20cm
Cutimed Siltec Heel 16cm x 24cm Moderate to highly
exuding wounds.
Suitable for use on
fragile skin

MIU ONLY:

Skin Closure Dressings:

Product Manufacturer Size Tips

Leukostrip (10x3 per Smith and Nephew 6.4x76mm
pack) Strips

49
Appendix 1

Dressings Non-Formulary Exception Reporting Form

Complete this form when a non-formulary product is used. This will help monitor the appropriateness of the present formulary and influence
future decision-making.

For Paper submission- Print and circle those that apply.

For Electronic submission- select the text in the required boxes and highlight it- use the toolbar.
Type of Wound Wound bed description Wound depth Exudate
levels Aim of treatment to provide

Skin Tear/ Laceration Epithelialising Superficial Dry Protection

Warm moist
Surgical Granulating Shallow Minimal
Environment
Pressure Ulcer Sloughy Cavity Moderate Rehydration
Venous Ulcer Critically Colonised Deep cavity Heavy Desloughing
Arterial Ulcer Infected Sinus Absorption
Diabetic Ulcer Necrotic Odour control
Other Fungating Anti-microbial effect

Current products in use:

Formulary products used Duration used Reasons discontinued / not suitable
1.

2.

3.

Name of product chosen: Length of time used for

50
 Rationale for choice

Did the product achieve the aims that were highlighted in the rationale: yes/no
If no, please give reason

Name of person submitting report Date

Contact address Telephone number

Please return completed forms to the Tissue Viability Nurses using TissueViability@glos-care.nhs.uk, Gloucestershire Care Services. Edward Jenner
Court. Pioneer Avenue. Gloucester Business Park, Brockworth, GL3 4AW.

51
Notes:

52