Exudate management: recent updates and practical guidelines

Aim

Exudate plays a key role in wound healing. However, exudate can delay healing when in the wrong amount, in the wrong place, or of the wrong composition. Effective assessment and management of exudate is therefore key to ensuring timely wound healing without complications.

Key Points

Wound exudate is produced as a natural and essential part of the healing process. However, overproduction of wound exudate, in the wrong place or of the wrong composition, can adversely affect wound healing.

The amount of exudate produced by a wound is dependent on:

• Wound aetiology – some wound types are more prone to high or low exudate levels
• Wound healing phase – the amount of exudate produced by a wound usually diminishes as healing progressesList item
• Wound size, depth and position – larger and deeper wounds may produce higher levels of exudate, as can wounds in dependent parts of the body, e.g. the lower leg
• Comorbidities, complications and other factors – there are many other reasons for increased or decreased exudate Production

Excessive exudate production can be associated with a wide range of problems. Leakage and soiling can be particularly distressing to patients and carers, and can be burdensome because of increased needs for washing of clothing and bed linen. Leakage or strikethrough may result in odour (which is sometimes, but not always, a sign of increased wound bioburden or infection). Leakage/strikethrough may also increase the risk of infection by providing a route by which micro-organisms can enter the wound. Frequent dressing changes may be required to ensure containment of the exudate or to monitor the wound.

Frequent dressing change may also be of benefit in preventing potential infection and biofilm formation. However, frequent dressing changes may be taxing and distressing to the patient, especially if associated with pain, and can cause wound bed or periwound skin damage. Consequently, further studies investigating the potential impact and benefits of increased dressing change frequency and positive clinical outcomes are required.

Other causes of discomfort and pain in patients with an excessively exuding wound include periwound skin damage and a ‘drawing’ pain sometimes produced by dressings with a high rate of absorbency, especially when used in wounds where levels of exudate is decreasing. High levels of exudation may also result in significant protein loss and put the patient at risk of fluid/electrolyte imbalance. For example, it has been estimated that a patient with a Category/Stage IV pressure ulcer (i.e. a pressure injury with full thickness tissue loss with exposed bone, tendon or muscle), could lose 90–100g/day of protein in exudate. This is more than the recommended daily intake of protein for many adults.

Excessive exudate can have a serious psychosocial impact on patients and reduce quality of life. For example, patients’ work, social and home lives may be disrupted by dressing changes or by fear and embarrassment related to leakage or odour, which can prevent patients from leaving their homes.

This abstract has been presented on LINK Wound Healing Congress 2019

Marco Romanelli
University of Pisa, Department of Dermatology, Pisa, Italy