Wound exudate and how to properly assess and manage it has been a long standing clinical challenge in wound care. Assessing the exudate color, odor, volume, viscosity, and if it is causing maceration of the periwound skin are all important to note when creating a care plan for the patient. If there is not proper management of the exudate, then the high protease levels and low growth factor levels will negatively impact wound healing time.

Types of Wound Exudate

There are four types of wound drainage: serous, sanguineous, serosanguinous, and purulent. Serous drainage is clear, thin, and watery. The production of serous drainage is a typical response from the body during the normal inflammatory healing stage. Yet, if there is a large amount of serous drainage, it can be the result of a high bioburden count. Sanguineous drainage is only normal in occurrence during the inflammatory stage of healing where a small amount of this blood may leak from a full- or partial-thickness wound. If it is seen outside of the inflammatory phase, sanguineous drainage can be a result of trauma to the wound. Serosanguinous drainage is the most common type of exudate that is seen in wounds. It is thin, pink, and watery in presentation. Purulent drainage is milky, typically thicker in consistency, and can be gray, green, or yellow in appearance. If the fluid becomes very thick, this can be a sign of infection.

Considerations in Managing Exudate

Exudate is a byproduct of vasodilation during the inflammatory stage and in chronic wounds the drainage changes and contains proteolytic enzymes. Effective management of the exudate depends on the characteristics of the wound such as amount of exudate, location, and exudate composition. Chronic wounds often have bacteria, like pseudomonas or staphylococci, which inhibit new cell growth. In this case, cultures to combat the bacteria can be beneficial so that an accurate care plan can be initiated. This may include topical antimicrobials, topical antibiotics, antifungals, or oral/IV medications. Other considerations are the cost and frequency of dressing changes. When a patient is changing gauze four times a day due to exudate, it would be more beneficial for the patient and financial bottom line to use a foam dressing.

Changing the dressing less allows the wound bed to be left undisturbed, which allows for the migration of new cells. When wound beds are left undisturbed in an optimal moist environment, they are able to heal at a faster rate. Changing dressings only when needed also causes fewer traumas to the periwound which can be due to adhesives or maceration damage. Negative pressure wound therapy, compression, and foam dressings can be helpful in managing exudate. Overall, it should be noted that the dressing selection should be based on the individual patient and wound characteristics. If the wound is not in the normail inflammatory phase of healing, the clinician must investigate what is the root cause and how to manage the drainage.

Sources

Mulder GD. Quantifying wound fluids for the clinician and researcher. Ostomy Wound Manage 1994; 40(8): 66-9. Nix DP. Patient assessment and evaluation of healing. In Bryant RA, Nix DP, eds. Acute and Chronic Wounds: Current Management Concepts. St. Louis, MO: Mosby; 2007.

Smeets R, Ulrich D, Unglaub F, Wöltje M, Pallua N (2008) Effect of oxidised regenerated cellulose/collagen matrix on proteases in wound exudate of patients with chronic venous ulceration. Int Wound J 5(2): 195-203.

Stotts NA, Wipke-Tevis DD, Hopf HW. Cofactors in impaired wound healing. In Krasner DL, Rodeheaver GT, Sibbald RG, eds. Chronic Wound Care: A Clinical Source Book for Healthcare Professionals. Malvern, PA: HMP Communications; 2007:215-20.

Vowden K, Vowden P. The role of exudate in the healing process: understanding exudate management. In: White RJ, editor. Trends in Wound Care Volume III. London: Quay Books, 2004.

About the Author

Lindsay (Prussman) Andronaco is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. Andronaco is the 2011 recipient of the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse' and has been recognized in Case In Point Magazine as being one of the "Top People in Healthcare" for her "passionate leadership and an overall holistic approach to medicine."