IODOFLEX*

This information is intended for Healthcare Professionals only.

"The effect of Cadexomer Iodine on pain and its ease of application and removal gave high acceptance by patients and nurses" ¹⁷

Considering an appropriate topical antimicrobial treatment

The importance of wound infections, in both economic and human terms, should not be underestimated. Practitioners need to know how to recognise and manage the signs and consequences of clinically infected wounds. The key principles for the management of a patient with a wound infection can be summarised as follows ¹⁵:

• Treat the patient holistically
• Recognise the signs of inflammation/increased bacterial burden/clinical infection
• Be able to take 'reliable' wound swabs
• Be able to interpret culture reports
• Treat the infection - causative organism(s)
• Consider antibiotic sensitivities
• Consider which wound management products are suitable and appropriate*
• Minimise the risk of cross-infection
• Reduce the risk of any complications
• Educate the patient and his/her family and carers

*Topical antimicrobials are used to reduce bio-burden; therefore, the choice has to be related to the identity of the causative organisms, assessed either through bacterial culture or clinical judgement. The choice of topical agent should also include an awareness of their potential to induce sensitisation.

Application

IODOFLEX Dressing application

IODOSORB* Ointment application

• The contents of the sachet/tube should be used on one patient only
• Do not use IODOFLEX or IODOSORB in the vicinity of the eyes, ears, nose or mouth
• The product is for external use only
• IODOFLEX or IODOSORB may cause transient smarting especially in the first hour after treatment. This is a sign that the product is beginning to clean the wound. Occasionally, IODOFLEX or IODOSORB may cause the skin around the wound edges to swell or redden. This will usually pass.
• Contact with the skin around the wound edges/intact skin should be minimised
• It is possible for an adherent crust to form if the IODOFLEX or IODOSORB is allowed to dry out
• A single application of IODOFLEX or IODOSORB should not exceed 50g and not more than 150g in one week
• The duration of treatment should not exceed 3 months and allow a one week break before re-starting treatment to enable excretion of iodine

• Do not use on dry necrotic tissue or on patients with a know sensitivity to any of its ingredients
• Do not use on children, pregnant or lactating women or people with thyroid disorders or renal impairment

This information is intended for Healthcare Professionals only.

Cadexomer with Iodine: Intelligent Interactive Iodine

Cadexomer with Iodine is a uniquely formulated starch matrix formed into spherical, highly absorbent microbeads containing 0.9% elemental iodine.

The Cadexomer is a 3D cross-linked polysaccharide starch matrix. The 0.9% iodine is physically bound to the cadexomer matrix and is only released when it is required.

Cadexomer with Iodine: The Mode of Action

Wound fluid and exudate are absorbed into the cadexomer beads of the product, allowing the iodine to be released slowly. Please refer to the animation below.

When Cadexomer with Iodine is applied to the wound surface, exudate, pus and debris are absorbed into the cadexomer beads. The beads will swell resulting in the formation of a demonstrable gel.

The presence of exudate and the consequent swelling of the beads results in the cross-linked bonds of the cadexomer matrix breaking and the iodine being released into the surrounding wound environment. When the iodine is released, the amount of iodine released will be to a level such that the concentration of iodine in the dressing and the wound environment reach an equilibrium. The equilibrium will remain and no further iodine will be released until the balance is disturbed.

Once the iodine in the surrounding wound environment has been depleted, more will be released from the product until the equilibrium is reached again and will remain until disturbed. This process will continue until all the 0.9% iodine within the product has been exhausted. The conversion of iodine is also associated with a colour change from orangey brown to white. Therefore once all the iodine has been converted and utilised, the IODOFLEX will appear white in colour. At this point it is time to make a dressing change.

"The development of slow-release antiseptic agents, such as those based on iodine, has rendered antiseptics safe, effective, and reliable in the management of difficult wounds. In my own practice, I have found these therapeutic agents particularly useful in the bacterial "de-colonization" of chronic wounds, an important step in the overall approach to wound bed preparation. As a result, patient management is greatly facilitated, whether one is simply applying standard treatments or using more advanced therapies. The bacterial burden decreases, as does wound exudate. Quite frankly, I don't know what I would do without the use of slow-release antiseptics, particularly in the outpatient setting. I do know that some of my clinician colleagues are still fearful of the word "antiseptics". This fear is rooted in old literature on the use of "straight" antiseptics, with no mechanisms for slow and smart delivery. However, in the field of medicine and in caring for patients, one needs to adapt while remaining critical, and most of all be vigilant about new opportunities that can help our patients.

Detailed below is a list of the numerous papers related to IODOFLEX.

Please select an area to view the associated clinical paper abstracts:

Slough Removal

Antibacterial Efficacy

Sustained Antibacterial Action

Exudate Management

Cost Time Saving

This information is intended for Healthcare Professionals only.

How do I remove IODOFLEX from the ulcer?

Remove the secondary dressing. If it is sticking to the IODOFLEX, soak with sterile saline or water. To remove IODOFLEX from the wound, simply flush it away with sterile saline or water. If there are any small remnants of IODOFLEX left in the wound, don't worry they will be naturally degraded without causing any delay to healing or systemic reaction.

How can I tell when the IODOFLEX needs changing?

IODOFLEX will change from a dark brown to off white which indicates that all the iodine has been released. This indicates that it is time to change the IODOFLEX. The number of dressing changes therefore depend on the levels of infection and exudate present in the wound.

Is there any risk of iodine absorption causing any problems for the patient?

Generally if you use IODOFLEX within the guidelines of the prescribing information (up to a maximum of 150g a week) it is unlikely that there will be any significant iodine absorption and therefore any systemic side effects. However, IODOFLEX should not be used in patients with severely impaired renal function or a past history of any thyroid disorder as they are more susceptible to alterations in thyroid metabolism with chronic IODOFLEX therapy. It has been observed occasionally that an adherent crust can form when IODOFLEX is not changed with sufficient frequency.

Can I use a secondary dressing to secure Iodoflex to the wound?

Yes, you can use any semi-permeable secondary dressing, or secure IODOFLEX with bandages over a non-adherent piece of padding or gauze.

Does IODOFLEX cause patient pain in what often is already a painful ulcer?

IODOFLEX desloughs by absorbing and drawing away slough and exudate from the wound surface. This is not harmful but indicates that the product is working. Sometimes patients feel a warm or smarting sensation and this may be due to the drawing effect of the slough and exudate.

Will IODOFLEX relieve ulcer pain?

Yes, it has been shown to. Often IODOFLEX will relieve pain whilst in the process of desloughing the wound and killing bacteria. In clinical trials, pain reduction has been a well observed benefit for patients.

What organisms is Iodoflex effective against?

Because IODOFLEX contains elemental iodine, it is effective against a wide range of pathogenic bacteria, fungi, yeasts which can delay wound healing. There have been no reports of acquired resistance with iodine.

For how long can I use Iodoflex on a slow healing ulcer?

IODOFLEX can be used for up to 3 months. At this stage if the ulcer still needs treatment a non-iodine containing product must be used for a minimum of one week before resuming treatment with IODOFLEX.

What is the largest amount of IODOFLEX I can use in a week?

150g of IODOFLEX can be applied per patient per week. A single application should not exceed 50g. If more is needed, refer to the warnings on the relevant data sheet and prescribing information.

Can IODOFLEX be used in patients who are sensitive to iodine?

No, this is not recommended.

Will Iodoflex delay wound healing as it contains an antiseptic?

There is a body of evidence showing that some antiseptic containing products delay wound healing. IODOFLEX has been also tested in-vivo and has been shown not to reduce fibroblast or macrophage activity ¹⁸. IODOFLEX has in fact been shown to accelerate healing in some studies ².