Cornwall & Isles of Scilly Joint Dressings Order Form 2015/16

Complete for each wound. Date:……………………….

Patient’ Name:
DOB: / Nursing Home & Telephone No:
Surgery Name:
Wound site/area to be dressed: / Approximate size of wound:
Level of exudates (Please tick):
Light Moderate Heavy / Please state frequency of dressing change:
Pressure Sore / Surgical / Necrotic / Epithelialising
Ulcer / Bruise/haematoma / Sloughy / Cavity
Diabetic Ulcer / Laceration/Skin Flap / Granulating / Other
PRODUCT / DRESSING / SIZES (circle
required size) / APPROX COST PER SINGLE / Maximum order / QUANTITY
Necrotic / Hydrocolloid / ActivHeal Hydrocolloid / 5 x 7.5cm
10 x 10cm
15 x 15cm / £0.78
£1.58
£3.43 / 4
5-10
5-10 / 0
0
0
ActivHeal Hydrocolloid Foam / 5 x 7.5 m
10 x 10cm / £0.97
£1.55 / 5-10
5-10 / 0
0
Comfeel Plus Transparent / 10 x 10cm
15 x 15cm
20 x 20cm / £1.26
£3.30
£3.37 / 5-10
5-10
5-10 / 0
0
0
Comfeel Plus / 10 x 10cm
15 x 15cm
20 x 20cm / £2.42
£5.19
£7.47 / 5-10
5-10
5-10 / 0
0
0
Hydrogel / ActivHeal Hydrogel / 15g / £1.41 / 10-20 / 0
Hydrogel dressing / Intrasite Conformable / 10 x 10cm
(Equiv to 7.5g)
10 x 20cm
(equiv to 15g) / £1.80
£2.42 / 10-20
10-20 / 0
0
Hydrogel sheet / ActiFormCool / 5 x 6.5cm
10 x 10cm / £1.79
£2.63 / 5-10
5-10 / 0
0
Odour / Charcoal Dressing
(Non-absorbant) / Clinisorb / 10.5 x 10.5cm / £1.75 / 10-20 / 0
Anabact gel / 30g / £7.89 / 2 tubes / 0
Infected/
Colonised / Antimicrobial Primary Silver
Dressing / Urgotul SSD / 10 x 12cm
15 x 20cm / £3.13
£8.85 / 5
5 / 0
0
Alginate/Manuka Honey / Algivon Plus / RCHT use only
Honey dressing / Activon Tulle / 5 x 5cm
10 x 10cm / £1.80
£2.97 / 7 / 0
0
Activon Tube / 25g / £2.05 / 7 / 0
Antibacterial / Flamazine (Silver Sulfadiazine 1% cream) / 50g / £3.85 / 1 tube / 0
Cadaxomer Iodine / Iodoflex / 5g
10g / £4.06
£8.12 / 5
3 / 0
0
Iodine Tulle / Povitulle / 5 x 5cm
9.5 x 9.5cm / £0.28
£0.42 / 25
25 / 0
0
Sloughy / Alginate flat sheet / Sorbsan Flat / 5 x 5cm
10 x 10cm / £0.81
£1.71 / 10-20
10-20 / 0
0
Alginate Pad / Sorbsan Plus / 7.5 x 10cm
10 x 20cm / £1.76
£3.96 / 5-10
5-10 / 0
0
Protease Modulating Matrix / Aquacel Extra (lasts 3-7 days depending on exudate) / 5 x 5cm
10 x 10cm
15 x 15cm / £0.99
£2.36
£4.44 / 10
10
5-10 / 0
0
0
Urgoclean Pad / 6 x 6cm
10 x 10cm
20 x 15cm / £0.95
£2.11
£3.96 / 1-2
1-2
1-2 / 0
0
0
Rapid Capillary Dressing / Vacutex / 10 x 10cm
10 x 15cm / £1.66
£2.23 / 5-10
5-10 / 0
0
Cavity / Sorbsan Ribbon / 40cm / £2.04 / 5-10 / 0
Biotherapy / Larvae - Maggots / Tissue Viability Team advice only
Granulating / Foam (Adhesive)
Foam (Adhesive) / ActivHeal Foam Adhesive / 10 x 10cm
12.5 x 12.5cm
15 x 15cm / £1.63
£1.68
£2.15 / 5-10
5-10
5-10 / 0
0
0
Advazorb Border / 7.5 x 7.5cm
10 x 10cm
12.5 x 12.5cm / £1.19
£2.10
£2.58 / 5-10
5-10
5-10 / 0
0
0
Advazorb Border Lite / 7.5 x 7.5cm
10 x 10cm
12.5 x 12.5cm / £1.07
£1.89
£2.32 / 5-10
5-10
5-10 / 0
0
0
Biatain Adhesive / 10 x 10 cm
12.5 x 12.5 cm
18 x 18 cm / £1.74
£2.54
£5.13 / 5-10
5-10
5-10 / 0
0
0
PolyMem / 5 x 5 cm
10 x 13 cm / £0.52
£2.18 / 10-20
10-15 / 0
0
Granulating / Foam (Non Adhesive) / Biatain Non-Adhesive / 5 x 7cm
10 x 10cm
20 x 20cm / £1.30
£2.37
£6.47 / 5-10
5-10
5-10 / 0
0
0
Advazorb / 10 x 10cm
10 x 20cm / £1.08
£3.35 / 5-10
5-10 / 0
0
PolyMem / 8 x 8 cm
10 x 10cm / £1.59
£2.47 / 5-10
5-10 / 0
0
Atrauman / 5 x 5cm
7.5 x 10cm
10 x 20cm / £0.26
£0.28
£0.62 / 25-50
25-50
15-30 / 0
0
0
Telfa (podiatry use) / 7.5 x 5cm / £0.12 / 25-50 / 0
Silicone / Adaptic Touch / 5 x 7.6cm
7.6 x 11cm / £1.13
£2.25 / 2-5
2-5 / 0
0
Epithelisng / Adhesive Island / Hydrofilm Plus (water & bacteria proof) / 9 x 10cm
10 x 20cm / £0.27
£0.45 / 5-10
5-10 / 0
0
Semi-Permeable Adhesive / Hydrofilm / 6 x 7cm
10 x 12.5cm
10 x 15cm
15 x 20cm / £0.22
£0.42
£0.52
£0.96 / 5-10
5-10
5-10
5-10 / 0
0
0
0
Miscellaneous / Absorbent Cellulose Dressing / Zetuvit E Sterile / 10 x 10cm / £0.21 / 25-50 / 0
Zetuvit Plus / 10 x 10cm / £0.63 / 25-50 / 0
Barrier / Cavilon film (one application of stick will last 3 days) or cream / 1 ml stick (x5)
28g / £1.00
£3.98 / 5
1 / 0
0
Negative Pressure Therapy / Vacuum Assisted Closure / Tissue Viability initiation only
PICO
Atraumatic skin closure / Leukostrip on FP10
Steri-strip via EROS / 6.4 x 76mm / £0.63 / 1pk of 10 / 0
Wound Irrigation / Clinipod
Irripod / 25 x 20ml / £0.20
£0.23 / 25
25 / 0
0
Surgical tape / Scanpor / 2.5cm x 10m / £0.92 / 1 roll / 0
Finepore / 2.5cm x 9.14m / eEROS ONLY
Bleeding Wounds / Kaltostat / 5 x 5cm / £0.95 / 10-20 / 0
Keloid Scarring / Cica-Care / Tissue Viability Team advice only
Dressing pack / Nurse it (Alvita) / S/M M/L / £0.52 / 5-10 / 0
Dressit / S/M
M/L / £0.60 / 5-10 / 0
0
Sterile Gauze packs / Pack of 5 gauze swabs / 7.5 x 7.5cm / £0.41 / 5-10 / 0
Non-sterile gauze swabs / Pack of 100 gauze swabs / 10 x 10cm / £1.43 / 1 / 0
Bandages / Type 1 retention bandage / K-Band / 10cm x 4m / £0.28 / 5-10 / 0
Quantities based on ankle circumference of 18-25cm
Type 2 Light Support / Profore #2 / 10cm x 4.5m / £1.34 / 5-10 / 0
Class 3A Light comp / K-Plus / 10cm x 8.7m / £2.26 / 5-10 / 0
Class 3B mod comp / Profore #4 / 10cm x 2.5m / £3.23 / 5-10 / 0
Cohesive Short Stretch / Actico / 10cm x 6m / £3.33 / 5-10 / 0
Stockinette / Acti-Fast blue- 7.5cm
Acti-Fast yellow 10.75cm / 1m/5m
1m/5m / £0.77/£3.74
£1.20/£6.04 / 1
1 / 0
0
Elasticated tubular bandage / easiGRIP / B/C/D/E/F / £0.62 - £1.49 / 1 / 0
Paste bandage / Viscopaste / 7.5cm x 6m / £3.63 / 5-10 / 0
Padding / K-Soft / 10cm x 3.5m / £0.45 / 5-10 / 0
Padding / Profore #1 / 3.5m / £0.70 / 5-10 / 0

Joanne Richards Final version May 2015. To be reviewed May 2016