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IODOFLEX◊

Cadexomer dressing with iodine

IODOFLEX

IODOFLEX IODOSORB ProductIODOFLEX◊ and IODOSORB◊ are a range of Cadexomer dressings with Iodine products, available in three presentations.

IODOFLEX removes barriers to healing by its dual action antimicrobial and desloughing properties. The broad spectrum antimicrobial action is provided by the sustained release of iodine and the desloughing action is provided by the unique cadexomer matrix.

By effectively removing the barriers of bacteria, slough and debris and excess exudate, IODOFLEX is effective for the treatment of infection in chronic exuding wounds.

Claims

  • Provides sustained antimicrobial activity1,2
  • Effective against a broad spectrum of bacteria1,3,4,5,6,7
  • Removes loose slough and debris to clean the wound bed1,3,4,8,9,10,11
  • Has high absoprtion capacity3,4,5,8,11,12 to absorb exudate1,13,14
  • Creates a moist wound environment2

Benefits

  • Clinically proven to treat infection5,8
  • Effective deslougher3,8,12,15
  • High absorbency3,4,5,8,11,12
  • Wide range of high level clinical support
  • Versatile range
  • Changes colour as iodine is released
  • Encourages wound healing2

Features 2FeaturesFeatures

  • Changes colour: to indicate when dressing change is needed
  • Simple and easy to apply and remove1,5,10
  • Biodegradable
  • Range of sizes: aids dressing selection

Ordering Information

IODOFLEX

S&N Code Description Pack Content NHS Code PIP Code
66001301 5g Dressing 5 EKB007 073-1547
66001302 10g Dressing 3 EKB008 014-9617
66001303 17g Dressing 2 EKB009 216-3269

IODOSORB

S&N Code Description Pack Content NHS Code PIP Code
66001286 2g Powder 7 EKB010 045-3696
66001298 10g Ointment 4 EKB012 036-6658
66001297 20g Ointment 2 EKB018 033-3906

References

1. Skog E. et al A randomised trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers. Br J Dermatol 1983, 109(1): 77-83
2. Drohlshagen C. & Schaffer D. Use of absorbent antimicrobial and viscous hydrogel to manage ulcers secondary to peripheral vascular disease. Poster presented at the Symposium on Advanced Wound Care, Anahiem, 1999
3. Troeng T. et al In Cadexomer iodine, Fox J.A., Fischer H. (eds) 1983, p.43-50
4. Lindsay G. et al A study in general practice of the efficacy of cadexomer iodine in venous leg ulcers treated on alternate days. Acta Theraputica 1986, 12, p.141-148
5. Johnson A. A combative healer with no ill effect. Iodosorb in the treatment of infected wounds. Professional Nurse 1991, p.60-64
6. Salman H. and Leakey A. A report to Smith & Nephew Medical Ltd. The in-vitro activity of silver Sulphadiazine and cadexomer iodine against recent clinical isolates of methicillin-resistant Staphylococcus aureus (ITALICS), methicillin-resistant coagulase-negative staphylococci and Pseudomonas aeruginosa (ITALICS). Report number 194-03-01, March 2001.
7. Mertz P.M. et al Can Antimicrobials be effective without impairing wound healing? The evaluation of a cadexomer iodine ointment. Wounds 1994, 6(6): p.184-193
8. Sundbery J. and Meller R. A retrospective review of the use of cadexomer iodine in the treatment of chronic wounds. Wounds 1997, 9(3): p.68-86
9. Holloway G.A. et al Multicenter trial of cadexomer iodine to treat venous stasis ulcer. West J Med 1989 (Jul), 151, p.35-38
10. Moberg S. et al A randomised trial of cadexomer iodine in decubitus ulcers. J Am Geriatrics Soc. 1983, 31, p.462-465
11. Drousou A. et al Antiseptics on Wounds: An area of controversy. Wounds 2003, 15(5):p.149-166
12. Ormiston M.C. et al A randomised comparison of cadexomer iodine and a standard treatment in out-patients with chronic leg ulcers. In Cadexomer iodine, Fox J.A., Fischer H. (eds) 1983, p.63-69
13. Floyer C. and Wilkinson J.D. Treatment of venous leg ulcers with cadexomer iodine with particular reference to iodine sensitivity. Acta Chir Scand 1998, suppl 544, p.60-61
14. Moody M. The use of cadexomer iodine (IODOSORB) in the treatment of stage three pressure ulcers. Poster at ETRS Bordeaux, 1999
15. Hansson C. The effects of cadexomer iodine paste in the treatment of venous leg ulcers compared with hydrocolloid dressing and paraffin gauze dressing. Int J Dermatology 1998, 37: p.390-396

Product in use

"The effect of Cadexomer Iodine on pain and its ease of application and removal gave high acceptance by patients and nurses" 1

IODOFLEX IODOSORB ProductConsidering 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 2:

  • 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.

Features 2Features

Application

IODOFLEX◊ Dressing application

IODOSORB◊ Ointment application

IODOSORB◊ Powder application

Warnings

  • There is a potential risk of interaction with lithium, resulting in an increased possibility of hypothyroidism
  • Do not use IODOFLEX or IODOSORB concomitantly with mercurial antiseptics and taurolidine

Precautions

  • 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

Contraindications

  • 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

References

1. Skog E. et al A randomised trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers Br J Dermatol 1983; 109(1): 77-83
2. 15. Collier, M. Recognition and management of wound infections. Worldwidewounds, January 2005

Technology

CadexomerCadexomer 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.

FAQs

 

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, but the product should normally be changed 2-3 times per week.

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.

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

No.

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 in fact been shown to accelerate healing in some studies1.

References

1. Drosou A, Falabella A, Kirsner RS. Antiseptics on Wounds: An Area of Controversy. Wounds 2003 15(5): 149-66

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Smith & Nephew is providing information in this site for general educational use only, and does not intend for this to be construed as medical advice or used as a substitute for the advice of your physician. For questions or concerns about a previous or upcoming surgery, Smith & Nephew recommends that you contact your healthcare professional.