Contents:

Catheter, Stoma &

Skincare

Formulary Version 11

December 2018

Catheter products

Stoma accessories

Skin care products

Community nurses/district nurses: Items not listed in this formulary are non-formulary. If needed for a particular patient, an exception

reporting form should be completed (available on SCH website).

Catheters

Initial catheterisation: the catheters listed in this formulary can be ordered by community

nurses through NHS Supply Chain for initial use only.

Long term catheter use: a prescription should be requested from GP practice.

Stoma and skin care products

Stoma products: request a prescription from GP practice.

Skin care products: (excluding stoma skin care products) patients to be advised to purchase

skin care products

GP practice staff

Wherever possible formulary items should be prescribed. If a non-formulary item is required,

an exception reporting form should be completed (available on WSCCG & IESCCG website)

Prescribing Indicator

First Line

Second Line

Special Consideration

Catheter Products

Intermittent Catheters

1. Single-use Intermittent Catheters (single use)

Intermittent catheterisation allows patients to empty their bladder when the normal functioning of the

bladder is impaired. A single use catheter is inserted into the bladder by the patient to drain the bladder and

is then removed. The frequency of use will depend on the patients’ clinical need and in normal

circumstances may be up to 5 times daily for bladder emptying.

*In certain circumstances some patients may require more frequent bladder emptying, including those with

neurological and spinal conditions. This cohort of patients, following assessment by a qualified nurse in this

field, may require bladder draining every 3 hours or up to 10 catheters per day*

Appliance Product

details

Gauge/ CH

size

Cost per pack

(pack size) Comments

Usual

quantity to

order

First Line

Teleflex Flocath Quick

Male

40cm 8-18

£36.95 (30)

Integral saline solution

Protective sleeve for

touch free application

Approx. use in

normal

circumstances

4-5 catheters per

day / 4-5 packs per

month

Female

20cm 8-14

Teleflex Liquick Base

Male 10-16

£85.24 (60)

Higher Quantity Pack

For patients requiring a

more flexible

catheter

Approx. use

4-5 catheters per

day / 2-3 packs per

month

Female 6-14

Paediatric 8-10

Second Line

Coloplast Speedicath

Male

8-16 £45.54 (30)

Quantities may be higher

for patients with

neurological /

spinal conditions Approx. use

4-5 catheters per

day /

4-5 packs per

month

Female

Wellspect Healthcare

LoFric Primo

Male 10-18 £46.80 (30)

For patient self-

catheterisation Female

15cm/20cm 10-14 £48.12 (30)

Paediatric 6-10 £48.12 (30)

Compact Option

Speedicath Compact

Male 12-18 £54.99 Compact size for rapid

use when mobile/out of

home OR poor dexterity

Pre Lubricated

May be a 2nd

product at lower

quantities on

repeat Female 8-14 £47.10

Pathway considerations for Intermittent catheterisation

Patients may be assessed and commenced on intermittent catheterisation from the following settings:

Acute: Ipswich Hospital / West Suffolk Hospital

- Urology Clinic

- Urogynaecology Clinic

Community: Suffolk GP Federation

- Bladder and Bowel Community Service

When considering patient appliance overuse or changes in patient clinical need, patients should be assessed by

their GP and if required referred back to the service which commenced the treatment.

Relevant contacts:

Suffolk GP Federation Bladder and Bowel Service: 0300 123 2425

Ipswich Hospital central number: 01473 712233

West Suffolk Hospital central number: 01284 713000

Indwelling Catheters and Accessories

Appliance Product

details

Gauge/ CH

size

Cost per pack

(pack size) Comments

Usual

quantity to

order

2. Long-term indwelling catheters (use for up to 12 weeks)

First Line

Rüsch Sympacath AquaFlate

Hydrogel Coated Latex

with prefilled syringe

Male

12-18 £6.27 (1) 1st Line

*Contains LATEX*

1 catheter every

4-12 weeks

In normal

circumstances 1

catheter can last

12 weeks

Suprapubic

catheters or

complex

conditions may

require more

frequent changes

Female

L.I.N.C All-Silicone catheter

with prefilled syringe and

Lidocaine Gel

Male 12-18

£5.57 (1)

2nd choice or

patients with latex

allergy

*Includes lidocaine gel

with pack* Female 12-16

Second Line

Rüsch Brillant AquaFlate

All-Silicone catheter

With prefilled syringe

Male 12-18

£6.11 (1)

2nd line choice or

patients with latex

allergy Female 12-16

Paediatric use only

Bard Biocath Hydrogel

Coated

Paediatric

5ml 8-10 £8.54 (1) Paediatric only

*Contains LATEX*

3. Catheter maintenance solutions

Sodium chloride 0.9%

OptiFlo S Bard 50ml £3.42 Used to unblock a

catheter

Usually not on

repeat unless

requiring regular

bladder wash outs Uro-Tainer NaCl 0.9% Braun 50ml £3.45

Solution G

OptiFlo G (Suby G) Bard 50ml £3.54

(50ml sachet) For patients prone to

encrustation.

Used as regular

maintenance to prevent

blockage

Usually not on

repeat unless

requiring regular

bladder wash outs Uro-Tainer Twin

(Suby G) Braun

2x30ml

sachets

£4.85

(2 x 30ml sachets)

4. Catheter lubricating gel

Cathejel Lidocain

Female 8.5g £1.10 For catheter insertion

Contains Lidocaine

*Not required for

LINC catheters that

include Lidocaine gel

PRN for use at

each

catheterisation Male 12.5g £1.15

5. Catheter valves (change every 7 days)

Care Flo catheter valve L.I.N.C

Lever tap

£7.59 (5) Alternative to leg bag

*Assessment of bladder

function is necessary

before using this

product*

4 valves per Month

Qufora Catheter Valve Qufora £8.50 (5)

Incontinence Sheaths and Accessories

Appliance Product details Gauge/ CH

size

Cost per pack

(pack size) Comments Usual

6. Incontinence Sheaths (External Catheter)

First Line

Prosys Flofit

Self Adhesive Silicone

Sheath

Standard 24mm

28mm

31mm

35mm

40mm

£46.20 (30)

Use 1 sheath per 24 hours

*Ensure patient is correctly

measured prior to use*

Approx. use – 1

sheath per day /

1 pack per

month

Pop-on

Wide Band

Second Line

Jade Ultra Flex Extra Clear

Sheath

Small

25mm

29mm

32mm

36mm

41mm

£47.16 (30)

Medium

Intermediate

Large

Extra large

7. Sheath Accessories

Barrier Film Wipes

Coloplast Conveen Prep

Wipes 1st Line

Contains Alcohol

Sheath prep

wipes Box of 54 £10.81

1 wipe used at each sheath

change

Approx. every 24 hours

High Quantity Pack

2 boxes every 3

months Smith & Nephew

Secura Barrier Film Wipes

(Alcohol-free)

Barrier film

Wipes Box of 50 £23.68

Adhesive Remover

Great Bear

GB Soft Skin No Sting

Medical Adhesive

Remover Spray

Aerosol Spray 50ml £9.32

To aid sheath removal

when required

1 can of spray

per month

Great Bear

GB Soft Skin No Sting

Medical Adhesive

Remover Wipes

Wipes Pack of 30 £15.11 1 box of wipes

per month

Drainage Bags and Accessories

Appliance Product details Gauge/ CH

size

Cost per pack

(pack size) Comments

Usual quantity

to order

8. Leg Drainage Bags

First Line

Qufora Leg Bags

Use for 7-10 days

Choice of lever tap or T

tap

500ml

750ml

Direct inlet

5cm

£22.40(10)

To maintain a closed

system overnight leave

the leg bag connected

and connect a night bag

to the leg bag.

All Qufora leg bags can

be drained at 90-180

degrees, which is an

advantage for people

with poor manual hand

dexterity.

All long tube leg bags

have spare connectors,

but cutting tubing for

adjustment is not

recommended

Approx. 1 box

every 2-3

month

Short tube

10 cm

Long Tube

30cm

LINC Medical Systems

LINC Flo Leg Bag

Use for 5-7 days

350ml

T tap only

Direct £20.72 (10)

Each box comes with 10

pairs of leg bag straps

To maintain a closed

system overnight leave the

leg bag connected and

connect a night bag to the

leg bag

Approx. 1 box

every 2-3 months

10cm tube

500ml

Lever tap /

T-tap

Direct

£22.27 - £22.31 (10) 10cm tube

30cm tube

750ml

T-tap only

Direct

£22.28 (10) 10cm tube

30cm tube

Second Line

Teleflex

Rusch Leg Bag

Use for 5-7 days

*Choice of lever tap or slide

tap*

350ml 10cm tube

£21.90 (10) Each bag comes with 2 leg

bag straps

To maintain a closed

system overnight leave the

leg bag connected and

connect a night bag to the

leg bag

Approx. 1 box

every other

month

30cm tube

500ml 10cm tube

£23.94 (10) 30cm tube

750ml 10cm tube

£23.94 (10) 30cm tube

9. Belly bag® (use for up to 28 days)

Teleflex Rusch Belly Bag

B1000

*Patient must have functioning

bladder musculature to use

product*

1 litre Twist tap £10.78 (1)

For patients where a leg

bag cannot be

Connected

*Not suitable for external

catheters or nephrostomy

tubing*

1-2 bags per

month

Appliance Product details Gauge/ CH

size

Cost per pack

(pack size) Comments

Usual quantity

to order

10. Disposable Single Use Night Drainage Bags

First Line

Qufora

Non-sterile

Single use bags 2 litre

90cm tube £2.05 (10)

First choice single use

tear perforated edge to

empty

*may not be appropriate for

patients with poor

dexterity*

1 bag per night

3 boxes per

month Linc-Flo

Non-sterile

Single use bags

100cm tube £2.13 (10) First choice single use

Twist off tap

Second Line

Teleflex

Non-sterile

Single use bags with slide

tap outlet

2 Litre 120cm kink

resistant tube

£9.55 (30)

*higher quantity*

Single use bag with slide

tap outlet

Includes 1 x bed hanger per

pack

1box

every month

11. Reusable Night Drainage Bags

First Line

Qufora drainage bag with

tap outlet

Use for 7-10 days 2 litre

lever tap /

T-tap

with 120cm

inlet tube £9.57(10) Change every 7-10 days.

1 box every

2-3 months

*If patient using

bags more

frequently –

consider daily

single use bags

as alternative*

Linc-Flo drainage bag with

tap outlet

Use for 5-7 days

120cm anti-

kink tube £9.52 (10) Change every 5-7 days

Second Line – Reusable Drainage Bag

Teleflex

Rusch night drainage bag

2 Litre

lever /

slide tap

120cm kink

resistant tube £10.78 (10)

Change every 5-7 days

Each bag has integral bed

hanger

1 box every

2-3 months

12. Accessories

Leg bag holders

Clinisupplies Prosys sleeves

Small 24-40cm

£7.61 (4)

Washable

PRN use

Approx. every

4-6 months

Medium 36-50cm

Large 40-65cm

Clinisupplies Prosys

Leg bag straps P10LS £12.88 (10)

G-strap

Clinisupplies Prosys Retainer

Strap

Adult £12.27 (5)

Washable

PRN use

Approx. every

4-6 months Abdominal £13.54 (5)

Stoma Accessories

Product Quantity Price Comments Usual quantity to order

1. Barrier films (used with each bag/flange change)

3m Health Care Cavilon No

Sting Barrier Film Pump Spray 28ml £5.79 Used on skin that is broken,

sore or weepy to promote

healing.

For selected patients only

(diabetics, palliative patients

and difficult stomas)

1 box/bottle per month StoCare Protect Barrier Film

Wipes 30 £12.95

Salts Barrier Film Wipes 2nd Line 30 £16.04

2. Skin fillers

Hollister Adapt Paste 60g £4.00

Used as a sealant for creases

and crevices 1-3 per month Dansac Soft Paste 50g £3.74

Oakmed Paste 2nd Line 56g £7.69

3. Sore Skin Accessories

Orabase paste S103 30g £2.16 Used to heal around stoma Not for regular use

Coloplast Brava Powder 25g £2.45

For wet skin, short term use

1-3 per month

Higher quantity tubes may

last longer

Convatec Orahesive Powder 25g £2.50

OstoMart OstoSEAL

Protective Powder 50g £4.92

Ilex Skin Protectant 2nd Line 57g £8.26

4. Discharge solidifying agents

Bullen Absorbian Sachets 30

sachets £46.31

Absorbs effluent Mainly for

ileostomies 1 per month

Opus Deogel 200ml £8.05

Opus Deogel Sachets

2nd Line

50

sachets £30.87

Respond Ostosorb 150

sachets £41.81 *Higher Quantity Option*

5. Flange extenders

Salts Flange Extender with

Aloe 30

£13.41

Extends adhesion of bag.

Especially if patient has a

hernia

1-2 boxes per month Coloplast Brava Elastic Tape 20 £13.29

Dansac X-tra Strips 30

£19.05

Ostomart Astoa 30

£19.28

Product Quantity Price Comments Usual quantity to order

6. Mouldable washers

Salts Barrier Rings Thin /

with Aloe

30 £51.32 /

£50.90

Used on problem

stomas An adhesive

sealant to fill

creases/crevices around

stoma

1-3 box per month

Higher amount of packs may

be required when prescribing

lower quantity packs

Salts Barrier Rings Standard /

with Aloe 30 £52.13 /

£51.71

Hollister Adapt Barrier Rings 48mm

10 £18.19

Pelican Cohesive Slims Small 2nd Line

30 £58.07

Pelican Cohesive Seals Small 2nd Line

30 £59.20

Dansac TRE Seal 30mm 2nd Line

30 £68.72

7. Adhesive Removers (Sprays/Wipes) (used with each bag/flange change)

StoCare Remove Adhesive

Remover Spray 50ml £5.90

Used each time

stoma bag is changed

Sprays are more cost

effective than wipes

1-3 cans per month

(depending on frequency

of bag changes)

Opus Lift Plus 360 /

with Citrus 360 50ml £5.99

Dansac Easy Spray

Adhesive Remover Spray 2nd Line

50ml

£6.62

Respond Ostomart OstoPEEL

Adhesive Remover Spray

2nd Line

50ml £6.67

StoCare Remove Non-sting

Adhesive Remover Wipes 30 wipes £8.60

Salts Adhesive Remover

Wipes 2nd Line 30 wipes £8.72

8) Belts and Support

Coloplast Brava Belt (standard –

XL size) 1 belt

£6.86-96

Use to secure and support

ostomy pouches in position

Maximum quantity 3 per year Oakmed Adjustable Ostomy Belt

100cm £7.75

Restrictions

Stoma support garments and clothing - Level 3 Following specialist recommendation only (Level 1

and 2 garments are OTC items)

Deodourants, cleansers and soaps are not clinically necessary and prescribing of these products will not

be supported in Suffolk.

Please refer to CCG Website for ‘Ostomy Accessories List - Prescribing Indictor’ for further prescribing

guidance

Contacts:

Ipswich & East: Suffolk GP Federation Community Stoma Nurses:

Debbie Cooper, Sarah Skingley 01473 242168

West Suffolk Community Stoma Nurse: Bernadette Ambrose 07739 321369 Ipswich

Hospital Trust Stoma Nurses Sharon Stopher, Sally Power 01473 703301 West

Suffolk Hospital Stoma Nurses Katie Lloyd, Ann Hubble 01284 712697

Skincare

(OTC) = Item is available for patients to purchase over the counter

Product

1. Soap Substitute

Emulsifying ointment (OTC)

Epimax®(OTC)

Zero AQS cream (OTC)

Dermol 500 Lotion (OTC) Only if infection present or frequent complication

2. Emollients (Leave on preparations)

Where required in Primary Care for patients with chronic skin conditions

e.g. psoriasis or eczema, prescribe larger tubs i.e. 450/500G only. Where use is intermittent, smaller packs are required

or simply dry skin - these are available to purchase.

Lanolin based products e.g. E45® or Exocream® are not routinely recommended for chronic skin conditions due to

allergy risk

First Line

Epimax®(OTC) This is equivalent to Diprobase® Cream. Can be used as a soap substitute.

Low fire risk

lsomol® gel (OTC) This is equivalent to Doublebase®. Low fire risk.

Zeroderm® ointment This is equivalent to Hydromol® ointment (lanolin free) and Epaderm®

ointment. High fire risk

White soft paraffin 50% / liquid

paraffin 50% ointment (OTC) High fire risk

Second Line

Ultrabase® cream (OTC) Low fire risk 2nd line

Emollient preparations - Restricted Use

Emollin® spray

Usually only on advice from specialist where:

Sore and inflamed skin so unable to spread cream/lotion

Where access to the affected site is difficult High fire risk

Dermol® cream (OTC) Only if infection present or is a frequent complication

Zeroveen® cream (OTC)

Usually only on advice from specialist Restricted to paediatric use where

they are unable to tolerate other emollients; ACBS borderline substance•

for patients with endogenous and exogenous eczema, xeroderma,

ichthyosis and senile pruritus associated with dry skin only

3. Emollients with urea

Emollients - Restricted Use

imuDERM® (OTC) Equivalent to Balnuem® cream

Balneum® Plus cream (OTC) Usually only on advice from specialist

Eucerin Intensive lotion Usually only on advice from specialist

Calmurid® cream (OTC) Usually only on advice from specialist

Dermatonics Once Heel

Balm® cream Inpatient use only on advice from specialist

4. Emollient bath and shower preparations

Soap substitutes available OTC include:

Epimax® ZeroAQS®

Dermol 600® bath emollient may be used if

recommended by a specialist for infected atopic eczema

for 14 days

Aveeno® bath oil may be recommended by a specialist

where there is an issue with paraffin based

products

There is a lack of good evidence to support the prescribing

of these items. These should only be prescribed at the

request of secondary care in exceptional circumstances.

Patients should be encouraged to wash with soap

substitutes

Usually only on advice from specialist Restricted to

paediatric use where they are unable to tolerate other

emollients; ACBS borderline substance- for patients with

endogenous and exogenous eczema,

xeroderma, ichthyosis and senile pruritus associated

with dry skin

5. Barrier Preparations

Barrier Cream – 1st Line

Conotrane® Cream (OTC) 100g tube £0.88 Primary Care only- use 1st line

For use on intact skin.

Sudocrem (OTC) Primary Care only

Barrier Cream – 2nd Line

Medi-derma S Barrier Cream - 2nd Line 90g tube £5.95 For use where Conotrane trialled and

failed - can be used on damaged skin.

Barrier Ointment and Incontinence Cleanser – Restricted use

Medi Derma-Pro Skin Protectant

Ointment (equivalent to Proshield) 115 tube £8.50 For severe moisture excoriation

Trial for up to 2 weeks

*When skin integrity restored return to

1st line barrier cream* Medi Derma-Pro Foam & Spray

Incontinence Cleanser

(equivalent to Proshield)

250ml bottle £5.95

Barrier Films

Medi Derma Barrier film applicators

(for use on peri-wound skin)

1ml

Applicators (5) £3.70

For use on moisture damaged skin

around wounds, skin fold and creases.

Medi Derma Barrier Film Pump Spray 30ml spray £5.35

6. Pressure sore prevention and low friction products

Pressure reducing gel or foam pads are not an alternative to appropriate pressure relieving equipment, and will

still require an appropriate clinical skin and pressure relief assessment, undertaken by a clinician within this

field of expertise.

Pressure reducing gel pads are not for use over broken skin.

Aderma Dermal Gel Pads

10x10x0.3 cm £4.43

Gel pressure relieving strips 10x10x1.2 cm £13.30

20x20x0.3 cm £17.70

30x5x0.3 cm £6.65

Not to be used over broken skin

Gel pressure relieving pads for

vulnerable intact skin

Does not replace appropriate

pressure relieving equipment

50x2.5x0.3 cm £5.55

Heel Standard £15.49

Heel Extra Large £17.66

Sacrum/Ankle Wrap

£17.40

Kerrapro Gel Pads

50x2.5x0.3 cm £5.39

Gel pressure relieving strips 30x5x0.3 cm £6.47

10x10x1.2M cm £12.95

Not to be used over broken skin

Gel pressure relieving pads for

vulnerable intact skin

10x10x0.3 cm £4.30

Heel £15.18

Sacrum/Ankle £17.09

Dyna-Tek Foam

Positioning Products

Foot & Heel protector (pair)

£3.99 Not for use as seating

pressure relief Devon Utility Pad £3.87

Silk Garments

Product Size Price Comments

DermaSilk:

Facial Mask

Infant £16.69

Silk garments can be washed

repeatedly and reused

2 pairs of garments to be ordered at one time

(one to wear / one to wash)

Silk garments are restricted products - for the use of patients

with severe skin disorders, causing the skin to become very

fragile, for example Epidermolysis Bullosa

Child £16.69

Teen Size £21.29

Adult Size £21.29

Body Suit

0-3 months £38.81

3-6 months £38.90

6-9 months £40.01

9-12 months £41.04

12-18 months £41.12

18-24 months £42.16

24-36 months £42.24

3-4 years £43.35

Briefs 3-6 years £22.09

7-10 years £22.09

Shirt Roll Neck

3-4 years £47.93

5-6 years £51.13

7-8 years £53.26

10-12 years £55.40

Adult Small XXL £78.78

Shirt Round Neck Adult (Male) Small XXL £78.78

Adult (Female) Small XXL £78.78

Tubular Sleeves (pair) 33cm long £27.77

50cm long £34.27

Leggings (pair)

0-3 months £27.71

3-6 months £27.77

6-9 months £28.88

9-12 months £29.93

12-18 months £29.99

18-24 months £31.05

24-36 months £31.11

3-4 years £32.22

Adult (Male) Small XXL £79.71

Adult (Female) Small XXL £79.71

Gloves (pair)

Small Child £15.02

Medium Child £15.02

Small Adult £21.09

Medium Adult £21.09

Large Adult £21.09

Pyjamas (set)

3-4 years £72.28

5-6 years £76.74

7-8 years £80.07

10-12 years £83.41

Knee Length Undersocks (2 pairs) Standard Length £24.66

Longer Length £24.66

Undersocks (per 2 pairs)

Child 3-8 £18.75

Child 9-1 £18.75

Child 2-5 £18.75

Adult 5½ - 6½ £18.75

Adult 7 - 8½ £18.75

Adult 9 - 10½ £18.75

Adult 11-13 £18.75

Process for Reviewing Formulary Products

NO YES

YES NO YES NO

ATTACH TWO

COMPARATIVE

CONTROLLED

STUDIES/BEST

SUPPORTING

EVIDENCE

SEND TO TRALEE LASHLEY

Medicines Management Team, Endeavour

House, Russell Road, Ipswich IP1 2BX

OR EMAILTO

TRALEE.LASHLEY@NHS.NET

FORMS WILL BE DISCUSSED AT TISSUE

INTEGRITY & APPLIANCE GROUP

(TIAG) MEETING (HELD EVERY 3

MONTHS)

A DECISION WILL BE MADE AT TIAG

MEETING DECISIONS WILL BE AVAILABLE

ON THE SCH INTRANET

IS THE PRODUCT ON FORMULARY?

DOES THE PRODUCT NEED TO BE

ADDED?

DOES THE PRODUCT NEED TO BE

REMOVED?

COMPLETE

SECTIONS 1 & 2 OF

EXCEPTION

REPORTING

FORM

COMPLETE

SECTIONS 1 & 3 OF

EXCEPTION

REPORTING

FORM

COMPLETE THE

EXCEPTION

REPORTING

FORM SECTIONS 1

& 3

NO ACTION

REQUIRED