Community Wound Care Formulary by Clinical Presentation See the - PDF document

Community Wound Care Formulary by Clinical Presentation See the Tissue Viability guidebook for advice on these presentations Limb Cellulitis Dry Cellulitis Epimax or equivalent that is on the CCG emollients formulary Wet cellulitis Saturated enough to require Atrauman daily dressings Zetuvit plus K-soft K- lite Wet cellulitis Saturated enough for 3 days Adaptic touch dressing change Zetuvit E / or plus / or Kerramax Care k-soft K-lite Discussion: If open wound also then use antimicrobial Urgotul SSD as primary contact layer If so very wet also consider Kerramax Care as a primary dressing. To be used in conjunction with appropriate antibiotic regime. Compression should be used throughout treatment and pain assessment essential. Bandage toe to knee. If repeated cellulitis, patient to have full assessment to decrease risk. Leaky Legs Non-compression option Legs saturated from below Wash legs in Epimax Zetuvit Plus or Kerramax Care as a primary knees requiring intensive If concerned for microbial dressing. daily dressings management load then consider Dermol K soft Lotion for 2 weeks max ( CCG K-lite. formulary) Compression option Legs saturated from below Wash legs in Epimax Kerramax Care as a primary or if concerned knees requiring intensive If concerned for microbial for sticking add dressings management. load then consider Dermol N-A ultra beneath. Perform Doppler assessment lotion 2 weeks max ( CCG K soft to shape and protect, formulary) Actico short stretch bandage 8cm at foot then 10cm ankle to knee, 12cm knee to thigh ( if required) Shaping necessary. Toe bandaging. Use for Apply following training only Mollelast Approved: January 2018 by York and Scarborough Medicines Commissioning Committee Review: January 2020

leaking toes with chronic from Activa Healthcare or oedema, not if diabetic. TVNS Microfine Toe caps. Caution Ready to Wear washable XS,S,M,L,XL with diabetes and ill-fitting compression toe caps (20- £26.92 causing pressure damage. 36mmHG) for toe and www.hadhealth.com/forms Measure foot width to forefoot oedema. prescribe, Cellona shoes (Activa XS,S,,M,L,XL On FP10 Healthcare)to accommodate bandages Ensure there is a primary diagnosis e.g. dependency oedema, lymphoedema, venous eczema, cardiac failure and care plans will be dependent on this. Leg Ulcers Venous leg ulcer with ABPI Superficial wounds – mix Wash legs in Epimax 0.8-1.3 slough and granulation If concerned for microbial load then See leg ulcer pathway consider Dermol Lotion for 2 weeks max ( CCG formulary) N-A ultra or Adaptic Touch Kerramax Care to absorb, Actico if oedema Actico 2C if no oedema Or K-two range Prescribe according to ankle circumference Venous leg ulcer with ABPI Sloughy wounds and deeper Gelling fibre to debride and absorb ( 0.8-1.3 ulceration. Aquacel, Kytocel) TVN referral if complicated. Or Iodoflex if biofilm Kerramax Care to absorb and compression as above Venous leg ulcers that are Measure and prescribe as per Consider a foam dressing under the suitable for Hosiery kits ( company info e.g. Activa leg hosiery kit ( adhesive or non-adhesive) 40mmHG) so smaller ulcer kit, Actilymph leg ulcer E,g Urgotul Absorb Border, manageable leg ulcers kit Aquacel Foams Altipress (Urgo) Mediven ulcer kit Mixed aetiology leg ulcers Sloughy wounds and deeper Aquacel to debride and absorb ABPI 0.5-0.8 ulceration Kerramax Care and K-two reduced. (vascular referral) Arterial leg ulcers Usually sloughy, unlikely to If painful then Urgotul or N/A (vascular referral) debride despite optimal Zetuvit Plus dressings K-soft K-lite (no compression) If dry necrosis then Povitulle. Approved: January 2018 by York and Scarborough Medicines Commissioning Committee Review: January 2020

Complex compression Washable compression wrap TVN referral Garments e.g. Farrowwrap, around devices. Expensive Self-care /partnership care. Readywraps . Microfine toe but a great option for self- caps. care. Healed leg ulcers Educate patients on hosiery See below for all the companies for maintenance for hosiery. Class 1 or 2 usually sufficient. Shoes Cellona shoes if needed. Venous eczema Wet Venous eczema Compression will also Betamethasone Valerate 0.1% cream (until resolve the eczema but wash resolved approx. 2 weeks) applied daily, legs and apply steroid Epimax emollient, N-A Ultra, Kerramax creams and emollients to Care and compression as per Doppler promote skin function. reading/ankle circumference. Also consider Viscopaste but full assessment needed Dry Eczema Review compression status Betamethasone Valerate 0.1% cream or ointment for approx. 2 weeks until resolved. Encourage regular emollient application. Haematomas Intact haematoma Look at clotting status, refer Leave open and observe bruising is to orthopaedic or plastics if dispersing or for break in skin. May need suitable for surgical emollient. debridement. Broken and leaking Check clotting status, refer Medihoney Antibacterial Wound gel to haematoma to TVN, or orthopaedic or debride or Kerralite Cool Border or non- plastics if suitable for surgical border to debride . Absorb and protect debridement. Consider ABPI with Zetuvit E or Plus and K-soft , K-lite once debrided in view of bandaging. compression. Skin Tears See pathway on guidebook. Low exudate levels Urgotul Absorb Border No skin loss or partial flap skin loss Atrauman ( 2 days only , acute only) or DO NOT apply any tape, Medium exudate levels Urgotul, Zetuvit E / K soft and K-lite adhesive strips, hydrocolloid, Approved: January 2018 by York and Scarborough Medicines Commissioning Committee Review: January 2020

Iodine dressings, films or Or Urgotul Absorb Border/ Mepilex Border island dressing directly onto fragile skin. Use barrier films or spray (Derma S) under adhesive, if this cannot be avoided If venous disease present, treat as venous leg ulcer. Simple Wounds where healing is predicted Low level exudate, 7 day wear time Cosmopore E dry dressing uncomplicated wounds. or May not suit very fragile thin Showerproof Hydrofilm Plus (island dressing) skin. Surgical wounds Healing by primary intention Stitched or stapled Hydrofilm Plus Dehisced Superficial Urgotul Absorb Border / Mepilex Border Rule out infection, consider Aquacel ribbon with Urgotul Absorb surgical review. Must involve Deep wound / cavity Border or TNP. TVN. Cutimed sorbact Ribbon Infected Cavity Pressure Ulcers Category 1 No dressings needed, Consider the use of Kerrapro over bony observe prominences. Category 2 Superficial Hydrocoll or Urgotul Absorb Border Category 3 and 4 Superficial Hydrocoll or Urgotul Absorb Border Aquacel Ribbon (AG if infected)or Kytocel, Cavity or Flaminal Hydro, Topical Negative Pressure (TVN referral)Urgotul Absorb Border sacrum or Granuflex Border sacrum Unstageable For active debridement Medihoney antimicrobial gel or Kerralite Cool Border / non or Flaminal Hydro / Forte Larvae therapy Hydrocoll Black Heels If dry No dressing needed, measure, observe and Approved: January 2018 by York and Scarborough Medicines Commissioning Committee Review: January 2020

elevate only. Do not apply foam dressings. As per podiatry recommends. Use Povitulle If broken skin and Biatain non-adhesive,K-soft, K-lite. Refer for soft cast also Moisture Lesions Occasional urinary Intact, vulnerable with or Ensure shaped pads are in use with incontinence and faecal without blanching redness adequate care package. Cleanse each pad incontinence managed with change with PH balanced cleanser e.g. regular pad changes Epimax onto a cleansing cloth. This could also be the patient’s own (PH balanced preferable). Apply derma S barrier cream if red skin from moisture. Urinary and faecal Blanching redness with Cleanse with Epimax or other emollient ( incontinence with formed sporadic rash maybe broken from formulary) stool requiring regular pad or not Derma- S barrier film applicators or spray, changes every three pad changes/ cleanses or daily . Urinary and faecal Blanching redness with Derma- Pro Foam and spray incontinence incontinence with liquid sporadic rash and broken cleanser. stool requiring frequent skin/ lesions Apply Derma Pro skin protectant ointment pad changes onto the wound or broken skin ( this is higher protection than the films)Do not use dressings. Fungating Wounds Refer to TVN for individual This is a prescription only Anabact gel prescribing ideas. medicine, see BNF for (Metronidazole 0.75%) For malodour – kills the prescribing details and anaerobes contraindicators. Other option gel for killing Flaminal forte gel for moderate to heavily the anaerobes exuding levels Flaminal Hydro – for low to moderate exuding levels Charcoal dressings have Charcoal options Clinisorb mixed effectiveness Primary dressings Non-adherent wound Adaptic Touch contact layer Urgotul Alginates for haemostatic Be mindful these may stick Kytocel use and maybe more harmful to remove. Approved: January 2018 by York and Scarborough Medicines Commissioning Committee Review: January 2020