Skin Care and Ostomy Formulary Product List4 · 2013-07-17 · 9478 Odor Eliminator Hollister 2 oz/each . Other Items Central Number Generic Product Trade Name/Manufacture Dispensed

Skin Care and Ostomy Product List

Skin Care Central Number Generic Product Trade Name/Manufacture Dispensed

6273 Wound Cleanser Restore, Hollister 8 oz spray bottle/each

2754 Soothe & Cool Body Wash/Shampoo Medline 4 oz bottle/each

89580 Shampoo Cap Medline Each

1995 Remedy Dimethacone Protectant Medline Remedy 4 oz bottle/each

9500 Remedy Skin Repair Cream Medline Remedy 2 oz/bottle each

6338 Remedy Calazime Zinc Oxide Barrier Medline Remedy 4 oz tube/each

Skin Care Central Number Generic Product Trade Name/Manufacture Dispensed

14427 Antifungal Cream Miconazole 2% Medline 4 oz bottle/each

14421 Antifungal Powder Miconazole 2% Medline 3 oz bottle/each

22726 Protective Barrier Spray (no-sting) Sureprep, Medline 28 ml bottle/each

10017 Baby Powder Johnson & Johnson 4 oz bottle/each

6583 Baby Wash (No Tears) Johnson & Johnson 4 oz bottle/each

14019 Vaseline/Petrolatum Jelly Curad 2oz/each

14017 Triple Antibiotic Ointment Curad 144 packets/box

Other Items Central Number Generic Product Trade Name/Manufacture Dispensed

9509 Adhesive Remover Wipes Hollister 50/box

10019 Protective Barrier Wipes Hollister 50/box

2544 Oral Care Kit Q-Care, Sage 6 kits/24 hr pack

6524 Oral swabs Toothettes, Sage 20/bag

36986 Witch Hazel Hemorrhoidal Pads Tucks 40 pads/container

9368

1” x 5 yd zinc oxide “pink” waterproof tape Hy -Tape Roll/each

6042 ½” x 5 yd zinc oxide “pink” waterproof tape Hy-Tape Roll/each

22814 2” Medipore Tape 3M 12 rolls/box

9478 Odor Eliminator Hollister 2 oz/each

Other Items Central Number Generic Product Trade Name/Manufacture Dispensed

6582 Heel Protectors Build-A-Boot, Primo Each

6549 Alignment Body Wedge DeRoyal Each

6474

Chair Cushion MediChoice Each

14736 Bariatric Chair Cushion MediChoice Each

8634 Egg Crate Pad for Bed

Sunshine Medical Each

Foam Dressings Central Number Generic Product Trade Name/manufacture Dispensed

1230 2 ½ “ x 3 ½” tracheostomy dressing Lyofoam Each

6617 3 ½” x 3” fenestrated foam dressing COPA Kendall Each

12795

4” x 4” Silver Foam Dressing (no border) Restore, Hollister Each

12799 6” x 6” Foam Dressing (no border) Restore, Hollister Each

Transparent Thin Films Central Number Generic Product Trade Name/Manufacture Dispensed

22563 1 ¾” x 1 ¾ “ Tegaderm, 3M Each

22564 2 3/8” x 2 ¾” Tegaderm, 3M Each

22565 4” x 4 ¾” Tegaderm, 3M Each

20752 4” x 10” Tegaderm, 3M Each

8178 4” x 4 ½” oval HP extra adhesive Tegaderm, 3M Each



659 1 ½” x 1 ½” Bioclusive, Johnson & Johnson

Each

Hydrocolloids (Moisture Retention) Central Number Generic Product Trade Name/Manufacture Dispensed

6591 4” x 4” extra thin Duoderm, Convatec Each

6590 6” x 8” CGF (Control Gel Formula) Duoderm, Convatec Each

Hydrogels (Wound Hydration) Central Number Generic Product Trade Name/Manufacture Dispensed

1233 Solid Hydrogel 6” x 8” Vigilon, Bard Package

21048 Hydrogel Restore, Hollister 3oz Tube

Calcium Alginate (Exudate Management) Central Number Generic Product Trade Name/Manufacture Dispensed

10248 4” x 4.75” Calcium Alginate Restore Calcium Alginate, Hollister

Each

12087 1” x 12” Rope Restore Calcium Alginate rope, Hollister

Each

Silver

22800 4” x 4.75” Calcium Alginate with Silver Restore Calcium Alginate, Silver, Hollister

Each

Silver

10149 1” x 12” Calcium Alginate Rope with Silver Restore Calcium Alginate Rope, Silver, Hollister

Each

Silver Dressings

Central Number Generic Product Brand Name Size Dispensed 2806 Textile Wound Dressing

Select Silver AFM Ag 4” x 48” Each

13952 Antimicrobial Textile Dressing Interdry Ag 10” x 144” 1 Roll/Box

Gauze, Non-Elastic Rolls Central Number Generic Product Trade Name/Manufacture Dispensed

5914 ¼” x 1 yd Plain Gauze Kendall Each 5915 ½” x 1 yd Plain Gauze Kendall Each 5916 1” x 1 yd Plain Gauze Kendall Each

5917 ¼” x 5 yd

Iodoform Gauze Kendall Each

5918 ½”x 5 yd

Iodoform Gauze Kendall Each

5919 1” x 5 yg Iodoform Gauze Kendall Each

5910 4 ½” x 4 yd Kerlex, Kendall Each

5908 4” x 4” AMD Gauze Sponges Curity, Kendall Each

5902 2” x 2” AMD Gauze Sponges Curity, Kendall 50/box

21568 4” x 4” AMD Gauze Sponges Curity, Kendall 10/package

5907 4” x 4” Non-Sterile Gauze Sponges

Curity, Kendall 200/package

5906 2” x 2” Non-Sterile Gauze Sponges Curity, Kendall 200/package

10234 2” x 2” IV Sponge Excilon, Kendall Each

Non-Adherent Dressings Central Number Generic Product Trade Name/Manufacture Dispensed

14558 3” x 8” Non Adhering Adaptic, Curity, Kendall 3/package

13228

6” x 8” Contact Layer Restore, Hollister Each

12796 6” x 8” Contact Layer with Silver Restore, Hollister Each

6041 1” x 36” Petrolatum Gauze

Vaseline, Kendall Each

5920 3” x 18” Petrolatum Gauze

Vaseline, Kendall Each

6317 ½” x 72” Petrolatum Gauze

Vaseline, Kendall Each Plastic Tube

7338 5” x 9” Impregnated Gauze Xeroform, Kendall Each

5913 4” x 5” Island Dressing Telfa, Kendall Each

22217 4” x 14” Island Dressing Telfa, Kendall Each

22218 6” x 10” Island Dressing

Telfa, Kendall Each

5820 3” x 8” Telfa

Telfa, Kendall Each

12797 Viscopaste 3in x 10yds Smith & Nephew Each

Elastic Rolls

Central Number Generic Product Trade Name/Manufacture Dispensed

5903 3” x 75” Stretch Bandaide, Kendall Each 5904 4” x 75” Stretch Bandaide, Kendall Each 5905 6” x 82” Stretch Bandaide, Kendall Each

6438 3” Tan

Bandage Roll Velcro Each

6404 4” Tan Bandage Roll Velcro Each

6939 4” x 5 yd Adherent Wrap Coban, 3M Each

Tubular Netting Central Number Generic Product Trade Name/Manufacture Dispensed

7231 Size 5 Elastic Netting

Allegiance Tube

7233 Size 7 Elastic Netting

Allegiance Tube

7234 Size 9 Elastic Netting Allegiance Tube

Stretch Panties Central Number Generic Product Trade Name/Manufacture Dispensed

10262

Large Maternity Panty 2/Package

129999 XX/XXX Large Maternity Panty 2/Package

Other Dressings & Items


5921 7 1/2” x 8” ABD Composite Dressing

Kendall Each

5922 8” x 10” ABD Composite Dressing Kendall Each

22696 Burn Gauze DeRoyal 3/Package

6534 Montgomery Strap 3M Each

5929 Sanitary Pads Hospital Specialty 3/Package

Linen Savers Central Number Generic Product Trade Name Dispensed

6093 Microdon Sheeting (Burn Patients) 3M Each

5774 Teal “Extrasorb” Linen Savers Medline 5/Pack

6361 Mint Green “Chux” Linen Savers Medline 5/Pack

6360 Blue “Procedure Pad” Linen Savers Medline 300/case

Diapers Central Number Generic Product Trade Name/Manufacture Dispensed

10892 Youth (20” – 31”) Blue

Medline 16-24/Pack

6422 Medium (32” – 44”) White

6423 Large (45” – 58”) Blue

Incontinence Items Central Number Generic Product Trade Name/Manufacture Dispensed

7688 Fecal Incontinence Pouch Hollister Each

20587 Retracted Penis Pouch Hollister Each

External Catheters Central Number Generic Product Trade Name/Manufacture Dispensed

7244 Small 25mm Condom Catheter Hollister Each 8506 Medium 29mm Condom Catheter Hollister Each 7243 Intermediate 32mm Condom Catheter Hollister Each 8507 Large 36mm Condom Catheter Hollister Each

5968 Instaflo Hollister Each

4566 Actiflo (Used for Retention Enemas) Hollister Each

295679 FMS Replacement Bags Hollister 5/Box

Antiembolism Compression Stockings

T.E.D. Anti-Embolism Compression Stockings require an MD order. The patient MUST be measured to ensure the correct size is used. To measure knee length stockings: Measure calf circumference at greatest portion to determine size then measure distance from bend of knee to bottom of heel to determine length. To

measure thigh length stockings: Measure upper thigh circumference at the buttock fold (if >36”, use knee length stockings), measure calf circumference at greatest portion, then measure distance from buttock fold to base of heel to determine length.

Knee Length Thigh Length Calf

Circumference Length Description Central

Number Thigh

CircumferenceCalf

CircumferenceLength Description Central

Number <12” <16” Small, Regular 6612 <25” <12” 29” – 33” Small, Regular 6596

12” – 15” <17” Medium, Regular 6613 12” – 15” 29” – 33” Medium, Regular 6599 >17” Medium, Long 6615 15” – 17.5” 29” – 33” Large, Regular 6604

15” – 17.5” <18” Large, Regular 6614 >33” Large, Long 6607 >18” Large, Long 6616 25” – 32” 17.5” – 21.5” 29” – 33” X Large, Regular 6283

17.5” – 20” <18” X Large, Regular 7303 >33” X Large, Long 7259 >18” X Large, Long 6276 32” – 36” 21.5” – 26” 29” – 33” XX Large, Regular 6282

20” – 23” >18” XX Large, Long 6277 >33” XX Large, Long 6284 23” – 26” <18” XXX Large, Regular 6280

Pharmacy Skin Care Products Generic Product Brand Name Classification Uses Available Sizes

Acetic Acid 0.25% topical solution N/A Topical skin product

Irrigation of bladder and indwelling catheters 1000 mL bottle

Acyclovir Ointment 5% Zovirax® Topical antiviral Treatment of herpes labialis; mucocutaneous HSV in immunocompromised patients

Ointment

Benzoin N/A Topical antibiotic/skin protectant

Skin protectant in irritations of the skin 2 oz tinture

Benzocaine 20% Dermoplast® Americaine®

Topical local anesthetic

Temporary relief of pain associated with pruritic dermatosis, pruritis, minor burns, etc

Ointment: 30 gm tube Spray: 60 mL can

Betamethasone dipropionate 0.05% Diprolene® Topical corticosteroid

Inflammatory dermatoses Gel/jelly: 15 gm tube (propylene glycol base) Lotion: 60 mL bottle (propylene glycol base) Ointment: 15 gm tube

Calamine/Zinc Oxide Wrap Gelocast Unna Boot Medicated healing gauze

Gauze coated with zinc oxide and calamine helps soothe and heal irritated or ulcerated skin; wrap also provides compression therapy

4” x 10 yd medicated healing gauze

Capsaicin 0.075% Zostrix HP Topical analgesic Temporary treatment of pain associated with muscles and joints; diabetic neuropathy

Cream: 56.6 gm tube

Collagenase Santyl® Enzyme, topical debridement

Dermal ulcers, burns—debrides necrotic tissue Ointment; 30 gm tube

Collodion Collodion Flexible Topical adhesive Adhesive to close small wounds and hold surgical dressings

Liquid

Fluorouracil Efudex® Antineoplastic agent Antimetabolite

Management of actinic or solar keratoses and superficial basal cell carcinomas

Cream: 5% cream 25 gm tube Solution: 2%, 5% 10 mL bottle

Green soap N/A Topical detergent Cleanser for skin and hair 1 pint bottle Hydrocortisone 1% Cortenema®

Anusol HC® Topical corticosteroid

Inflammatory dermatoses Cream: 30 gm tube; 1 lb jar Lotion: 4 oz bottle Ointment: 30 gm tube; 1 lb jar Rectal cream: 2.5% 30 gm tube

Hydrogen peroxide 3% N/A Topical local antibacterial

Cleanser for wounds Solution: 473 mL bottle

Hydrophilic petrolatum Aquaphor® Skin protectant Skin protectant for minor irritations and abrasions Ointment: 0.25 oz tube, 16 oz jar

Iodine Iodine TR Topical antiseptic Cleanser for wet ulcers and wounds; antiseptic for minor cuts, scrapes, and burns

Solution: 473 mL bottle

Ketoconazole topical 2% Nizoral® Topical antifungal Tinea fungal infections, seborrheic dermatitis Cream: 15 gm tube Lanolin/mineral Oil/sodium borate Nivea Oil for skin Lotion Lotion: 12 oz bottle Methyl salicylate Wintergreen Oil Topical analgesic Temporary relief of minor pain in muscles and joints Liquid: 59 mL bottle

Pharmacy Skin Care Products Generic Product Trade Name Classification Uses Available Sizes Mupirocin 2% Bactroban® Topical antibiotic Treatment of impetigo and infected traumatic lesions due

to S. aureus and S. pyrogenes Cream: 15 gm tube Ointment: 15 gm tube

Nystatin topical 100,000 units/g

MycostatinTM Topical antifungal Mucocutaneous infections (treat very moist lesions with powder)

Ointment: 15 gm tube Powder: 15 gm bottle

Oatmeal powder Aveeno® Topical skin protectant Soothing agent for minor skin irritations and abrasions, itching

Powder: 21 gm (oilated powder); 42 gm packet

Oxidized cellulose Surgicel® Surgicel® NuKnit

Hemostatic agent Temporary packing for control of capillary, venous, or small artery hemorrhage

3” x 4” and 4” x 8”

Oxychlorosene topical solution

Clorpactin® WCS-90

Topical antibiotic Localized infections Powder: 2 gm bottle for reconstitution

Permethrin Elimite® Nix®

Pediculoside; scabicidal agent

Treatment of infestation with Pediculus humanus capitis and its nits or Sarcoptes scabiei

Cream: 5% 60 gm (Elimite®) Liquid: 1% 2 oz (Nix®)

Povidone-iodine Betadine® Topical antiseptic Prevention or treatment of infections associated with minor cuts/scrapes, burns, surgery, etc

Ointment: 1/32 oz packet; 28 gm tube; 1 lb jar

Selenium sulfide 2.5%

Selsun® Topical keratoplastic agent

Control seborrheic dermatitis; treatment of itching and flaking of the scalp due to dandruff; treatment of tinea versicolor

Shampoo: 118 mL bottle

Silver sulfadiazine 1%

Silvadene® Topical antibiotic Prevention of infection in 2nd and 3rd degree burns Cream: 50 gm tube; 400 gm jar

Soap free clenser Cetaphil® Topical detergent Cleanser for skin Lotion: 473 mL bottle Mafenide acetate 8.5%

Sulfamylon® Topical antibiotic Treatment of infection in 2nd and 3rd degree burns; 2 oz tube 50 g packets for compounding topical solution

Terbinafine topical 1%

Lamisil® AT Topical antifungal Reserved for resistant fungal organisms Cream: 24 gm tube

Tolnaftate Topical 1%

Tinactin® Topical antifungal Treatment of dermatophytoses Solution: 10 mL bottle

Triamcinolone Aristocort® Kenalog®

Topical corticosteroid Inflammatory dermatoses Cream: 0.025% 80 gm tube; 0.1% 15 gm tube, 80 gm tube, 1 lb jar Lotion: 0.1% 60 mL bottle Ointment: 0.025% 80 gm tube; 0.1% 15 gm tube, 80 gm tube, 1 lb jar

Zinc Oxide/ Balsam Peru

Flanders® Buttock Ointment

Topical skin protectant Promotes wound healing in ulcers, mild skin irritations and abrasions, and diaper rash

4 oz tube

Vitamin A and Vitamin D

A & D Ointment® Topical skin protectant Temporary relief of chapped skin, diaper rash, minor burns, abrasions, and irritations associated with ostomy skin care

Ointment: 56.7 gm tube

Ostomy Products Formulary

New Image by Hollister Two Piece Pouching System Wafers 5/Box Central Number Flange Size Description Manufacture

Number

5739 2 ¼” Flextend Wafer -extended wear wafer used for urostomy or ileostomy

15603

7690 2 ¾” FlexWear Wafer – standard wear wafer with tape boarder for a colostomy or ileostomy

14204

21683 4” FlexWear Wafer – standard wear wafer with tape boarder for a colostomy or ileostomy

14206

12798 2 ¼” Flextend Convex Wafer – extended wear cut to fit

14803

New Image by Hollister Two Piece Ostomy Pouching System Pouches 10/Box Central Number Flange Size Description Manufacture

Number

5736 2 ¼” Urostomy Pouch – ultra-clear 9” pouch length for urostomy

18423

5740 2 ¼” Drainable Pouch – ultra-clear 12” pouch length for colostomy or ileostomy

18173

5741 2 ¾” Drainable Pouch – ultra-clear 12” pouch length for colostomy or ileostomy

18174

10268 4” Drainable Pouch – ultra-clear 12” pouch length for colostomy or ileostomy

18176

Premier by Hollister One Piece Ostomy Pouching System 10/Box

Central Number Flange Size Description Manufacture Number

6589 Up to 2 ½” Drainable Pouch – transparent 12” pouch length for colostomy or ileostomy

8651

5518 Up to 2 ½” Flextend Urostomy Pouch – transparent 9” pouch

8460

Premier by Hollister Pediatric One Piece Ostomy Pouching System 10/Box Central Number Flange Size Description Manufacture

Number

7691 Up to 1 ½” Pouchkins Drainable Pouch – transparent 8 ¾” pouch length

3796

5030 Up to 1 ½” Pouchkins Urostomy Pouch – 8 ¾” pouch length

3797

5031 Up to 5/8” Newborn Pouch – 4 ½” length with drain valve for newborn or preemie colostomy or ileostomy

3778

Premier by Hollister Two Piece Ostomy Pouching System (Pediatric) Central Number Flange Size Description Manufacture

Number

21228 1 3/4”

Pouchkins SoftFlex Wafer – no starter hole for pediatric colostomy or ileostomy

3761

10271 1 3/4” Pouchkins Drainable Pouch – transparent 6 ½” length for pediatric colostomy or ileostomy

3799

Hollister Ostomy Accessories

Central Number Description Manufacture Number

9509 Adhesive Remover Wipes 7760

10019 Protective Barrier Wipes 7917

10014 Adapt Stoma Powder 7906

5754 Adapt Stoma Paste 79300

22527

Small 2” Adapt Barrier Ring 7805

22528

Large 4” Adapt Barrier Ring 7806

9478 M9 Odor Eliminator Spray 7734

5035 Urinary Adapter 7331

5036 Ostomy clip 8770

13182 Irrigation Kit (bag & cone) 7721

13181 2 ¾” Irrigation Sleeve 18154

Other Ostomy Accessories Central Number Description Manufacture Number

22726 No-Sting Protective Barrier Spray

9483 Hollister Urinary Leg Bag KIt 9349

6430 Kendall Bedside Drainage Bag 6208

9368 Hy-Tape 1” Pink Tape

6322 Suture Removal Kit (Scissors)

Tube Stabilizers

Central Number Description Manufacture Number

14413

Hollister Vertical Tube Stabilizer 9782

14412 Hollister Horizontal Tube Stabilizer 9781

Wound Managers (Fistulas)


5032 4 1/3” High Output Pouch Hollister (mfg #80110) 10/Box

3231 4” x 8” Wound Drainage Collector Hollister (mfg # 9778) 3/Box

Wound Vac Products


23665 Negative Pressure Device 500ml Canister KCI Wound Vac Canister Each

*Please Note: The Wound&Ostomy Department does NOT manage wound vacs. Wound Vacs are managed through Physical Therapy or the patient’s surgeon.*

Skin Care and Ostomy Formulary Product List4 · 2013-07-17 · 9478 Odor Eliminator Hollister 2 oz/each . Other Items Central Number Generic Product Trade Name/Manufacture Dispensed

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