Wound management products

Prescribing Notes:

• Can be used as a skin protector against body fluids, e.g. in peri-wound areas to protect from wound exudate, around stoma sites and in continence care.
• Once product is dry, adhesive dressings can be placed directly over the product, e.g. can stick dressings over cream or film.
• Barrier cream is suitable for unbroken skin. Barrier film is suitable for broken skin or where is there is higher exudate/moisture levels.
• Cavilon advanced is used for prevention and management of Moisture Associated Skin Damage (MASD). A high endurance skin protectant for covering and protecting intact or damaged skin. It forms a durable, thin elastomeric transparent film. The film adheres to dry, moist or wet skin surfaces and remains intact despite continuous or repeated exposure to moisture and/or corrosive irritants. It is for single use only.
• Cavilon advanced is for specialist use only - use in secondary care adult gastroenterology or adult critical care settings on the advice of a Tissue Viability or Bladder and Bowel Specialist Nurse.

Prescribing Notes:

• Please refer to the National Association of Tissue Viability Nurses Scotland (NATVNS) wound cleansing guidelines.
• Prontosan is a wound cleansing solution best used for soaking chronic and/or infected wounds. It should not be used routinely. 350ml bottles last 8 weeks once opened, 40ml pods are for single use.

Prescribing Notes:

• Hydrogel dressings have a high water content. They aid rehydration of hard eschar and promote autolysis in necrotic and sloughy wounds.
• Amorphous Hydrogel gels are suitable for cavities and are effective at desloughing and debriding wounds.
• Hydrogel dressings/sheets are useful for flat wounds and should be applied as per manufacturer’s instructions.
• Hydrogel dressings should be changed every 1 to 3 days. They are applied directly to the wound and covered with an appropriate secondary dressing depending on level of exudate to keep moist and in situ.
• A protective barrier, e.g. a hydrocolloid dressing, or skin protector, may prevent maceration and excoriation of the peri-wound area, which can occur due to leakage of gel and/or exudate.
• Activheal can be used with larvae but needs thoroughly cleansed prior to application.
• ActiformCool is a primary dressing to assist in autolytic debridement by hydrating necrotic and sloughy tissue and also absorbing exudate. Suitable for painful wounds. Suitable for neonates.
• Prontosan Wound Gel X is a hydrogel with surfactant, it can be used in heavily colonised wounds to reduce the bacterial load. It is a single patient product, not single use. It can be used for up to 8 weeks from date of opening.

Prescribing Notes:

Recommendations for vapour-permeable films and membranes are currently specific to each Health Board and can be accessed from these links:

• NHS Borders
• NHS Fife
• NHS Lothian

Prescribing Notes:

• A simple secondary dressing is required. It should be reviewed and changed as required.
• Jelonet is for specialist use in burns and plastics only. Should not be used in cavity wounds.
• Lomatuell Pro has a soft adherent contact layer, which creates a gel on contact with wound exudate.
• Paraffin gauze dressing, e.g. Jelonet should only be used in accordance with thermal injuries guidelines. Refer to the NHS Lothian Thermal (Burns) Injury Guidelines (intranet).
• Mepitel One dressing has one low adherent contact side. It can be used in awkward areas and where it can be left in situ for up to 14 days while a secondary dressing is changed.
• Mepitel must be used under black foam when using negative pressure wound therapy, e.g. VAC.

Prescribing Notes:

• Alginates have haemostatic properties.
• Alginate dressings may be used on moderate to heavily exuding wounds. They should be changed every 2 to 7 days according to the manufacturer’s instructions or daily if used on infected wounds.
• Alginate dressings absorb serous fluid or exudate to form a gel which conforms to the shape of the wound.
• A secondary dressing should be used with alginate dressings.
• Alginate dressings are contra-indicated in dry, necrotic or lightly exuding wounds.
• Alginate dressings should not be used in sinuses.

Prescribing Notes:

• Primary dressing for medium to highly exuding wounds and wounds that require autolytic debridement.
• Absorbent dressing which converts to a soft gel, on contact with wound exudate and retains integrity during handling.
• Retains fluid within its structure and therefore reduces the risk of maceration to surrounding skin.
• Requires a secondary dressing.
• Cavities: loosely pack the ribbon leaving at least 2.5cm outside the wound for easy retrieval. The number of ribbons inserted should be counted and recorded. Refer to Cavities Wound Dressings Record.
• Sinus and fistula wounds should not be packed with Aquacel but it may be used to keep the aperture of these wounds patent.

Prescribing Notes:

• There should be an overlap of at least 2cm from the margin of the wound to ensure adhesion and to seal wound borders.
• Hydrocolloid dressings absorb exudate and swell to form a gel, which forms a moist environment under the dressing.
• Hydrocolloid dressings are used for wounds that are superficial and have low exudate. They aid rehydration and autolytic debridement of dry, sloughy or necrotic wounds.
• Hydrocolloid dressings should be changed every 3 to 7 days according to the manufacturer’s instructions. Dressings should be changed: when dressing becomes saturated with exudate, when ‘strike through’ occurs or daily in case of infected wounds. If a dressing change is needed before 3 days due to exudate, then consider a more absorbent dressing.
• Hydrocolloids can emit a characteristic odour when removed from the wound. This is a normal occurrence, but the odour should disappear once the wound is cleansed.

Prescribing Notes:

UrgoClean

• In contact with exudate, the fibres of the dressing swell and bind to the sloughy residue to aid autolytic debridement. A contact layer prevents adherence to the wound bed.
• A secondary dressing is required to retain the dressing in the wound and absorb exudates.

Maggot Therapy

• Maggot therapy should only be undertaken by individuals with previous practical expertise and knowledge of wound management.
• Maggots are adversely affected by hydrogels containing propylene glycol as a preservative. Purilon gel is therefore preferred if a hydrogel is to be applied prior to their use.
• Maggot therapy may be prescribed in primary or secondary care for infected or necrotic wounds including leg ulcers, pressure ulcers, infected surgical wounds, and necrotic diabetic foot ulcers. They are not recommended for use in wounds that might connect with the body cavity or important internal structures or organs, or near exposed major blood vessels.
• Maggots are placed in the wound and held in place for up to 4 days depending on formulation. The outer padding should be changed according to exudate levels, which may be daily.
• There may be a change in odour, colour and volume of exudate during maggot therapy, which may be mistaken as signs of infection. If wound pain increases during treatment and is not controlled with analgesics, the maggots should be removed earlier than usual.
• Informed consent should be obtained prior to maggot therapy, and a patient information leaflet provided.
• Used maggots are classified as clinical waste and should be disposed of appropriately.
• In hospital, maggots can be obtained via pharmacy. Community pharmacists should contact BioMonde, Wales (0845 2301810; orders@biomonde.com).

Prescribing Notes:

• Foam dressings are very absorbent and can be used for light to heavily exuding wounds. Step up or down as exudates levels change.
• Wounds with a high exudate should use a super absorbent dressing rather than a foam dressing.
• Foam dressings have low adherence, are conformable and can be used as primary or secondary dressings.
• The exudate is absorbed into the foam and the dressings should be changed every 1 to 7 days according to the manufacturer’s instructions.
• Tape or an appropriate bandage can be used if the product does not have an adhesive border. The foam dressing should not be fully covered with occlusive film, but film can be used as a border.
• Foam dressings are contra-indicated in very dry, sloughy or necrotic wounds as a primary dressing.
• Tegaderm Form is a highly absorbent polyurethane foam dressing for moderate to heavily exuding wounds with semipermeable film backing layer. 3M logos indicate upper surface of dressing. Available in a variety of sizes and styles. Suitable for use under compression.

Prescribing Notes:

• Foam dressings are very absorbent and can be used for light to heavily exuding wounds. Step up or down as exudates levels change.
• Wounds with a high exudate should use a super absorbent dressing rather than a foam dressing.
• Foam dressings have low adherence, are conformable and can be used as primary or secondary dressings.
• The exudate is absorbed into the foam and the dressings should be changed every 1 to 7 days according to the manufacturer’s instructions.
• Tape or an appropriate bandage can be used if the product does not have an adhesive border. The foam dressing should not be fully covered with occlusive film, but film can be used as a border.
• Foam dressings are contra-indicated in very dry, sloughy or necrotic wounds as a primary dressing.
• Soft silicone foams might be considered for patients with delicate or fragile skin, painful wounds and/or wounds that are difficult to dress e.g. foot ulcers.
• Tegaderm Foam adhesive is a highly absorbent polyurethane foam dressing for low to highly exuding wounds, with a semipermeable film backing layer and adhesive border. Comprises four layers for high fluid absorption. Adapts to changing fluid levels in the wound to create a moist environment that promotes healing.

Prescribing Notes:

• Standard Foams to be used for healthy non-fragile skin.
• Soft Silicone Foams to be used where skin stripping is evident or likely to occur with standard foams. More information can be found in the European Wound Management Association position statement on Pain at wound dressing changes.
• Soft Silicone Foams should be considered when pain is experienced on dressing removal even when pain assessment has been undertaken and appropriate interventions have been implemented, e.g. analgesia, comfortable environment, position, distraction techniques, etc.
• Kliniderm Lite is less absorbent than Kliniderm and is suitable for low exudates/epithelialising wounds. It may be useful in areas that require a dressing with more conformability.

Prescribing Notes:

• Standard Foams to be used for healthy non-fragile skin.
• Soft Silicone Foams to be used where skin stripping is evident or likely to occur with standard foams. More information can be found in the European Wound Management Association position statement on Pain at wound dressing changes.
• Soft Silicone Foams should be considered when pain is experienced on dressing removal even when pain assessment has been undertaken and appropriate interventions have been implemented, e.g. analgesia, comfortable environment, position, distraction techniques, etc.
• Kliniderm Lite is less absorbent than Kliniderm and is suitable for low exudates/epithelialising wounds. It may be useful in areas that require a dressing with more conformability.
• Biatain Silicone 3D fit technology contours to the wound bed (up to 2cm deep-in a concave shape). Therefore, wound fillers are not to be used with this product.

Prescribing Notes:

• PolyMem can be used as a primary or secondary dressing. It contains a wound cleanser, a moisturiser, and is a superabsorbent dressing. Can be used to relieve pain and reduce inflammation.

Prescribing Notes:

• Mepilex border post op (primary and secondary dressing) should be used and not disturbed for 48 hours post-op, as per NICE guidelines.

Prescribing Notes:

• Wounds with a high exudate should use a superabsorbent dressing rather than a foam dressing.
• KerraMax Care can be used as primary or secondary dressing and can be layered to increase the absorbency (the increase in weight of the dressings once used should be taken into consideration).
• All super absorbency dressings can be used under compression systems but maximum absorbency will be reduced. Clinicians need to be aware that sub-bandage pressures will increase as super-absorbent dressing absorbs exudates under the compression system.

Prescribing Notes:

• Wounds with a high exudate should use a superabsorbent dressing rather than a foam dressing.
• KerraMax Care can be used as primary or secondary dressing and can be layered to increase the absorbency (the increase in weight of the dressings once used should be taken into consideration).
• All super absorbency dressings can be used under compression systems but maximum absorbency will be reduced. Clinicians need to be aware that sub-bandage pressures will increase as super-absorbent dressing absorbs exudates under the compression system.

Prescribing Notes:

• Activated charcoal absorbent dressings are used for discharging, purulent and contaminated wounds complicated by bacterial infection and offensive odour.
• The dressing should be changed according to the manufacturer’s instructions e.g. when odour is no longer being controlled.
• Charcoal dressings should be used in the intact state, and not cut to shape prior to application.

Prescribing Notes:

• Can be considered for use when a wound is clean and granulating but has failed to progress to healing using recommended wound management products for a reasonable length of time. It is suitable for the treatment of all chronic wounds, such as diabetic foot ulcers, venous leg ulcers, or pressure ulcers in this situation.
• It modulates and rebalances the environment of chronic wounds through binding and inactivating proteases as well as protecting endogenous growth factors.
• Its components are resorbed and degraded by the body.
• Urgostart Plus Pad is a polyabsorbent fibre pad containing soft-adherent TLC-NOSF Healing Matrix that jellifies in contact with wound exudate, reducing MMP levels and restoring balance to close wounds sooner. The polyabsorbent fibres bind, trap and retain exudate, slough and debris.

Prescribing Notes:

• A topical haemoglobin-based spray for the treatment of chronic wounds where low Hb/ O2 is a contributing factor to non-healing.
• The spray is applied every time the dressing is changed, or at least every three days. After use, the wound should be covered with a breathable wound dressing.

Prescribing Notes:

• Silicone gel products are used to reduce or prevent hypertrophic and keloid scarring. They should be prescribed after consultation with a professional with expertise in scar management.
• High risk patients are those who have previously suffered abnormal scarring or those undergoing a procedure with a high incidence of scarring such as breast or thoracic surgery, plus major burn patients.
• They should not be used on open wounds.
• Silicone sheets should be worn for a minimum of 12 hours per day but are recommended for 24 hours per day. They should be removed for washing and reapplied, check product information for details.
• Silicone gels are more appropriate for face and neck scars.
• Complex scars will need combination therapy and it is recommended to refer to a specialist for further advice.

Prescribing Notes:

• Melolin dressing is a low adherence dressing, for minor burns, abrasions or superficial wounds. It must be kept in place by tape or under a bandage. It is usually used where an adhesive border is not appropriate.
• Mepore is a breathable, absorbent, self-adhesive dressing, for wounds with low to moderate exudate levels such as cuts and abrasions.

When to advise patient to contact Practice Nurse
Moderate to high level of exudate.
Known sensitivities to adhesive.
Signs of infection.
Deteriorating wound.
Presence of necrosis or slough where debridement might be indicated.
Diabetic patients.