Catheter & Accessories Formulary 2018 - Reference guide for the Prescribing & PECOS ordering of all Indwelling Catheters & Drainage Bags & ...
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Catheter & Accessories Formulary
2018
Reference guide for the Prescribing & PECOS ordering of all Indwelling
Catheters & Drainage Bags & Accessories
For Review: January 2021
Reviewed: January 2018NHS Fife Catheter & Accessories Formulary 2018
CONTENTS
INDEX PAGE
Introduction 3
Prescribing Quantities & Tips 4
SECTION ONE – PRESCRIBING INFORMATION
Indwelling Catheters and Urinary Sheaths 5
Leg Bags 6
Overnight/2litre bags 7
Fixation Device 7
Bag Holder 7
Catheter Valve 8
Catheter Maintenance Solutions 8
Anaesthetic Gel 8
Nephrostomy Drainage Bags 8
Appendix 1 – Exception Form 13
SECTION TWO - PECOS ONLINE ORDERING
Introduction 9
Indwelling Catheters 10
Leg Bags 11
Drainage Bags 11
Urinary Sheaths 11
Fixation Device 12
Bag Holder 12
Catheter Valve 12
Catheter Maintenance Solutions 12
Anaesthetic Gel 12
Nephrostomy Drainage Bags 12
Helpful hint 13
Appendix 1 – Exception Form 14
The information contained within this booklet is intended for use by healthcare professionals within NHS
Fife. At the time of going to print all prices were taken from the Dec 2017 Scottish Drug Tariff & the PECOS
online ordering catalogue.
2NHS Fife Catheter & Accessories Formulary 2018
INTRODUCTION
Continence Formulary
This formulary is a joint guide for all healthcare professionals that prescribe/request
prescriptions or order through PECOS for patients that require products for bladder
dysfunction.
This booklet has been designed as a quick reference guide for first line choices which should
be used for all new patients and for current patients when a re-assessment of their needs is
completed.
The formulary will be reviewed on a regular basis and at this point any amendments or
additions will be considered. Wherever possible there is a continuity of product use between
primary and secondary care which has been achieved by joint working on this formulary.
If you are unable to prescribe or order a FIRST CHOICE PRODUCT the ‘EXCEPTION FORM’
should be completed with reasons for use of non-formulary products (Appendix 1) or
alternatively contact the Continence Advisor / Senior Prescribing Support Nurse (SPSN) Team
for details of a second choice product.
This reference guide has been split into 2 sections:-
Section One – For healthcare staff prescribing or requesting a prescription.
Section Two – For healthcare staff ordering through PECOS using the Non Prescription
Ordering (NPO) system.
This formulary is authorised by Pauline Millar Continence Advisor for NHS Fife, with
contribution from the Senior Prescribing Support Nursing Team, Mary Thomson & Karen
Whatton.
If you need further information please contact:
Continence Service:
01592 869924
Mary Thomson & Karen Whatton: Fife UHB.Fifeprescribingsupportnurse@nhs.net
01592 643355 ext: 22068
3NHS Fife Catheter & Accessories Formulary 2018
PRESCRIBING QUANTITIES ADVICE
This chart is for guidance purposes only
AVERAGE 56 day cycle/2 monthly PRESCRIBING QUANTITIES
PRODUCT QUANTITY
Leg bags 8 1 x 10 box
Non sterile single use overnight bags 56 6 x 10 packs
Catheter valves 8 2 x 5 packs
Urinary sheaths 28 1 x 30 pack
AVERAGE ANNUAL PRESCRIBING QUANTITY
PRODUCT QUANTITY
Long term catheter 6
Bag Holder/Sleeves ( washable & reusable ) 2 x 4 packs
G Strap Adult 2 x 5 packs
PRESCRIBING TIPS
1. LONG TERM INDWELLING CATHETERS - 2 catheters should be ordered on the first
prescription - so that a spare catheter can be kept in the house/care home. Re-order 1
at a time thereafter.
2. SILVER COATED CATHETERS- Should only be prescribed on the advice of the Continence
Advisor.
DO NOT PRESCRIBE – These are very expensive items and not necessary
Bard Bio-Cath Comprehensive Care Foley Tray Bard Bardex IC Tray
Bard Lubrisil Comprehensive Care Foley Tray Cath-It Insertion/Removal Kit
Clinisupplies Prosys Cath Trays VESCPO1 and VESCPO2
ORDER THROUGH PECOS:
192762 Catheterisation Pack Each £0.57
4NHS Fife Catheter & Accessories Formulary 2018
INDWELLING CATHETERS
PRESCRIBING TIP - When prescribing catheter, add size required to end of code
E.g. CODE = DP3201, Size = 12ch, Prescribing Code = DP320112.
NB. These catheters are also suitable for Suprapubic use.
FIRST CHOICE
LONG TERM CATHETER - UP to 12 WEEKS - HYDROGEL
TYPE RUSCH - AquaFlate SympaCath (Teleflex Medical)
DESCRIPTION Hydrogel Coated Latex SIZE/CH 12- 18
LENGTH Standard Female
CODE DH3101 DH2101
QUANTITY Each COST £6.22
COMMENTS Includes syringe pre-filled with sterile water & empty 10ml syringe for balloon deflation
FIRST CHOICE
LONG TERM CATHETER - UP to 12 WEEKS - SILICONE
TYPE RUSCH - AquaFlate Brilliant (Teleflex Medical)
DESCRIPTION Silicone SIZE/CH 12- 18
LENGTH Standard Female
CODE DA3101 DA2101
QUANTITY Each COST £6.11
COMMENTS Includes syringe pre-filled with sterile water & empty 10ml syringe for balloon deflation
FIRST CHOICE
SHORT /MEDIUM TERM CATHETER - UP to 28 DAYS
TYPE RUSCH - AquaFlate PTFE (Teleflex Medical)
DESCRIPTION PTFE Coated Latex SIZE/CH 12- 18
LENGTH Standard Female
CODE DP3101 DP2101
QUANTITY Each COST £2.17
COMMENTS Includes syringe pre-filled with sterile water & empty 10ml syringe for balloon deflation
SHEATHS
FIRST CHOICE
SILICONE PENILE SHEATHS – SELF ADHERING
TYPE MACGREGOR HEALTHCARE LTD, QUFORA
SIZE 24mm 28mm 31mm 35mm 40mm
CODE (standard length) 20111101 20111201 20111301 20111401 20111501
CODE (short length) 20111103 20111203 20111303 20111403 20111503
QUANTITY 30 30 30 30 30
COST 38.38 38.38 38.38 38.38 38.38
COMMENTS Sheaths should be changed daily. Use Qufora leg bags and overnight bags
5NHS Fife Catheter & Accessories Formulary 2018
LEG BAGS Included in pack are gloves and elasticated straps. Bags should be changed every 7 days
FIRST CHOICE
LEG BAGS - 350mls
TYPE UNOMEDICAL CARELINE
TAP T TAP
TUBE LENGTH Short Long
CODE 45-01 SVCG 45-02 LVCG
QUANTITY 10 10
COST £25.69 £25.69
LEG BAGS - 500mls
TYPE UNOMEDICAL CARELINE
TAP T TAP LEVER TAP
TUBE LENGTH Short Long Short Long
CODE 45-05 SVCG 45-06 LVCG 46-05 SVCG 46-06 LVCG
QUANTITY 10 10 10 10
COST £25.48 £25.48 £25.48 £25.48
LEG BAGS - 750mls
TYPE UNOMEDICAL CARELINE
TAP T TAP LEVER TAP
TUBE LENGTH Short Long Short Long
CODE 45-09 SVCG 45-10 LVCG 46-09 SVCG 46-10 LVCG
QUANTITY 10 10 10 10
COST £25.48 £25.48 £26.93 £26.93
COMMENTS
LEG BAGS FOR SHEATHS
FIRST CHOICE -
TYPE MACGREGOR HEALTHCARE QUFORA STERILE
TUBE LENGTH Short Long
CODE 12161804 12161504
QUANTITY 10 10
COST £22.40 £22.40
6NHS Fife Catheter & Accessories Formulary 2018
DRAINAGE BAGS
FIRST CHOICE
SINGLE USE 2litre OVERNIGHT DRAINAGE BAG
TYPE UNOMEDICAL CARELINE with NON RETURN VALVE-NRV (E2)
CODE 45-40 LBC
QUANTITY 10 per pack COST £2.47
COMMENTS 1 Bag change per night
FIRST CHOICE
STERILE 2litre DRAINAGE BAG - DRAINABLE
TYPE UNOMEDICAL CARELINE T-TAP with NRV (E4)
CODE 45-20-IDC
QUANTITY 10 per pack COST £11.92
COMMENTS Bag change every 7 days
DRAINAGE BAGS FOR SHEATHS
FIRST CHOICE
TYPE MACGREGOR HEALTHCARE QUFORA Non sterile/Non Drainable
CODE 13800101
QUANTITY 10 per pack COST £2.05
COMMENTS 1 Bag change per night
FIXATION DEVICE
FIRST CHOICE
FIXATION /RETION DEVICE
TYPE COLOPLAST CATHETER RETAINING SIMPLA G STRAP ADULT
CODE 383001
QUANTITY 5 per pack COST £14.44
COMMENTS Can be washed and reused
BAG HOLDER/SLEEVE
FIRST CHOICE
LEG BAG HOLDERS – REUSABLE/WASHABLE
TYPE PROSYS
SIZE Small/24-40cms Medium/36-50cms Large/40-65cms
CODE PLS3881 PLS3904 PLS3928
QUANTITY 4 per pack 4 per pack 4 per pack
Cost £7.55 £7.55 £7.55
COMMENTS Can be washed and reused for 3-6 months
7NHS Fife Catheter & Accessories Formulary 2018
CATHETER VALVE
FIRST CHOICE
STERILE CATHETER VALVE FOR USE WITH INDWELLING CATHETER
TYPE PROSYS
CODE PCV3942
QUANTITY 5 per pack COST £9.57
COMMENTS Valves should be changed every 7 days
CATHETER MAINTENANCE SOLUTION
FIRST CHOICE
CATHETER MAINTENANCE SOLUTION
TYPE BARD OPTIFLO
SOLUTION OPTIFLO S - 0.9% OPTIFLO G -3.23% OPTIFLO R-6%
NaCl Citric Acid Citric Acid
CODE CSS50 CSG50 CSR50
QUANTITY 50mls 50mls 50mls
each each each
COST £3.39 £3.60 £3.60
COMMENTS Only use where clinically indicated and supported by local standard operating procedures
ANAESTHETIC GEL
FIRST CHOICE
ANAESTHETIC ANTISEPTIC LUBRICANT
TYPE CLINIMED INSTILLAGEL
VOLUME 6mls 11mls
QUANTITY 10 per pack 10 per pack
COST £14.05 £15.76
COMMENTS Contains lidnocaine and lubricant, takes 5 minutes to take effect
NEPHROSTOMY DRAINAGE BAG
FIRST CHOICE
500mls STERILE DRAINAGE BAG
TYPE MANFRED SAUER UK Ltd- NephSys System
TAP TWIST LEVER
CODE NS721.3730S NS721.3730SE
SIZE 30 cm tube 30 cm tube
QUANTITY 10 per pack 10 per pack
COST £42.03 £42.43
COMMENTS Bag change every 5 - 7 days
8NHS Fife Catheter & Accessories Formulary 2018
SECTION TWO
PECOS ORDERING
This section provides healthcare staff with the codes to place their weekly order through the
PECOS ordering system.
For use by staff who are ordering stock/stores through the
Non Prescribing Ordering (NPO) system.
PLEASE NOTE:
Not all products that are available for prescribing are available through the PECOS online
ordering system. There may be a slight variation from products that are ordered through
PECOS compared to prescription.
9NHS Fife Catheter & Accessories Formulary 2018
INDWELLING CATHETERS – PECOS ORDERING
FIRST CHOICE
LONG TERM CATHETER - UP to 12 WEEKS - HYDROGEL
TYPE RUSCH - AquaFlate SympaCath
DESCRIPTION Hydrogel Coated Latex SIZE/CH 12- 18
LENGTH Standard Female
CODE/SIZE 003587 12 003549 12
003594 14 003556 14
003600 16 003563 16
003334 18
QUANTITY Each COST £1.90
COMMENTS Includes syringe pre-filled with sterile water & empty 10ml syringe for balloon
deflation
FIRST CHOICE
LONG TERM CATHETER - UP to 12 WEEKS -SILICONE
TYPE RUSCH - AquaFlate Brilliant
DESCRIPTION Silicone SIZE/CH 12- 18
LENGTH Standard Female
CODE/SIZE 078646 12 018369 12
080236 14 018376 14
018338 16 018383 16
018345 18
018352 20
QUANTITY Each COST £1.40
COMMENTS Includes syringe pre-filled with sterile water & empty 10ml syringe for balloon
deflation
FIRST CHOICE
SHORT /MEDIUM TERM CATHETER - UP to 28 DAYS
TYPE RUSCH – PTFE Coated
DESCRIPTION PTFE Coated latex SIZE/CH 12- 18
LENGTH Standard Female
CODE/SIZE 003419 12 003327 12
003518 14 003501 14
003341 16 003389 16
003525 18 031146 18
QUANTITY Each COST £0.76
COMMENTS Includes syringe pre-filled with sterile water & empty 10ml syringe for balloon
deflation
10NHS Fife Catheter & Accessories Formulary 2018
LEG BAGS – PECOS ORDERING
FIRST CHOICE
LEG BAGS - 500mls
TYPE UNOMEDICAL CARELINE
TAP LEVER TAP
TUBE LENGTH Short Long
CODE 220830 220823
QUANTITY Each Each
£0.25 £0.25
COMMENTS Bag should be changed every 7 days
FIRST CHOICE
SINGLE USE 2litre NIGHT DRAINAGE BAG
TYPE UNOMEDICAL CARELINE with NON RETURN VALVE-NRV
CODE 136902
QUANTITY 10 per pack COST £1.40
COMMENTS 1 Bag change per night
DRAINAGE BAGS – PECOS ORDERING
FIRST CHOICE
STERILE 2litre DRAINAGE BAG - DRAINABLE
TYPE UNOMEDICAL CARELINE T-TAP with NRV
CODE 201266
QUANTITY 10 per pack COST £3.54
COMMENTS Bag change every 7 days
URINARY SHEATHS –PECOS ORDERING
FIRST CHOICE
SILICONE PENILE SHEATHS – SELF ADHERING
TYPE CONVEEN OPTIMA SILICONE
SIZE 21mm (shorter length) 25mm 30mm 35mm
CODE 195855 116522 116539 116546
QUANTITY 5 5 5 5
COST £2.50 £2.50 £2.50 £2.50
COMMENTS Sheaths should be changed daily
11NHS Fife Catheter & Accessories Formulary 2018
FIXATION DEVICE – PECOS ORDERING
FIRST CHOICE
FIXATION /RETION DEVICE
TYPE COLOPLAST CATHETER RETAINING G STRAP ADULT
CODE 099573
QUANTITY 5 per pack COST £12.30
COMMENTS Can be washed and reused
BAG HOLDER/SLEEVE – PECOS ORDERING
FIRST CHOICE
LEG BAG HOLDERS – REUSABLE/WASHABLE
TYPE UNOMEDICAL
SIZE Small Medium Large
CODE 126385 126378 126361
QUANTITY 4 per pack 4/per pack 4/per pack
COST £4.21 £4.40 £5.28
COMMENTS Can be washed and reused for 3-6 months
CATHETER VALVE – PECOS ORDERING
FIRST CHOICE
STERILE CATHETER VALVE FOR USE WITH INDWELLING CATHETER
TYPE UNOMEDICAL
CODE 181636
QUANTITY 5 per pack COST £2.50
COMMENTS Valves should be changed every 7 days
CATHETER MAINTENANCE SOLUTION
ANAESTHETIC LUBRICATING GEL
See Section 1 – This still requires to be ordered on prescription. (See pages 8+9)
NEPHROSTOMY DRAINGE BAG- PECOS ORDERING
FIRST CHOICE
500mls STERILE DRAINAGE BAG
TYPE MANFRED SAUER UK Ltd- NephSys System
TAP TWIST LEVER
CODE NS721.3730S NS721.3730SE
SIZE 30 cm tube 30 cm tube
QUANTITY 10 per pack 10 per pack
COST £42.43 £42.43
COMMENTS Bag change every 5 - 7 days
12NHS Fife Catheter & Accessories Formulary 2018
USEFUL HINT ON ATTACHING DRAINAGE BAG TO SILICONE CATHETER
To maintain the life of the
catheter by preventing
stretching, insert the leg bag
so there are still 2 or 3
notches visible
13Appendix 1 NHS Fife Catheter & Accessories Formulary 2018
NHS FIFE PRODUCT REQUEST AND EXCEPTION FORM
Please complete Part A for all Non Formulary Requests.
Please complete Part B for wound care and/or Part C for catheter care products.
PART A
Person Requesting:
Job Title:
Work Base:
Date of Request:
NAME OF NON- PRODUCT SIZE QUANTITY REQUIRED
FORMULARY PRODUCT
PART B - WOUND
Type of wound: Location of Wound:
Size of wound: Level of Exudate:
Duration of Wound:
Formulary products already tried: Reason formulary product not suitable:
PART C - CATHETER
Suprapubic/Urethral:
Formulary Product already tried: Reason formulary product not suitable:
For how long?
Discussed with specialist: Yes/No □TVN □Continence Advisor □Vascular □Podiatrist □Plastics □Other
Name of Specialist:
NON FORMULARY PRODUCT REVIEW DATE
Once completed please send to Senior Prescribing Support Nurse Team
Fife-UHB.Fifeprescribingsupportnurse@nhs.net or Cedar House, Whytemans Brae, Kirkcaldy
Completing this form will enable the SPSN to collate non formulary prescribing information and therefore inform
future discussions on formularies, training etc.
Copies can be obtained from: http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-
catheter-product-request-and-exception-form.aspx
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