Journal of Community Nursing - page 66

66 JCN
2013,Vol 27, No 4
WOUND CARE
E
xudate, an essential component
of the normal wound-healing
process, helps create a moist
wound environment. Exudate
contains growth factors, nutrients,
cytokines, matrix metallaproteinases
(MMPs) and white cells, all of which
help to stimulate healing (World
Union of Wound Healing Societies
[WUWHS], 2007). Moisture aids
autolytic debridement and is pivotal
in the process of epithelialisation,
permitting movement of cells across
the wound surface.
Exudate production in wounds
that are progressing to healing
reduces over time. However, in
non-healing or chronic wounds,
excess volumes of exudate tend
to continue, with a corresponding
change in its constituents, resulting
in negative clinical outcomes (Dealey
et al, 2006; Adderley, 2010). For
example, an imbalance of MMPs
(enzymes that play a key role during
the inflammatory phase of wound
Superabsorbent dressings — have
we reached maximum capacity?
healing in degrading devitalised
proteins in the extracellular matrix)
may result in non-selective protein
breakdown activity, which can impact
on the inflammatory phase of wound
healing and delay the healing process
(Trengrove et al, 2008). Trengrove et
al (2008) have also suggested that
chronic wound exudate should be
regarded as a wounding agent in its
own right.
As said, although exudate plays
a central role in healing, it can cause
problems. At worst, it can result in
malodour, pain, maceration and
unsightly soiled dressings, which
can have a negative impact on an
individual’s quality of life, triggering
feelings of self-loathing, disgust and
low self-esteem (Jones et al, 2008).
Exudate can increase to
unacceptable volumes in chronic
and/or large surface area wounds,
under certain systemic or localised
circumstances, such as:
Sustained inflammatory response
Infection
Lymphoedema/oedema
Venous disease
Medication (i.e. diuretics)
Heart failure
Malignancy.
Excess exudate can compromise
the healing process, as the wound bed
and periwound skin are damaged by
its caustic cocktail of elements (Bishop,
2003; Okan et al, 2007).The wound bed
can become saturated and moisture
may leak onto the periwound skin,
causing soggy or macerated skin (
Figure
1
), as well as excoriation (Dowsett,
2008) (
Figure 2
). An increase in exudate
volume can also be indicative of
infection (Cutting andWhite, 2005),
which may further impede healing.
Poor exudate management may
have serious consequences (particularly
in vulnerable individuals whose
health may already be compromised),
including:
Discomfort or pain
Leakage and malodour — a
cause of concern and distress for
patients (Jones et al, 2008)
Risk of infection as a result
of strikethrough
Enlarged wounds as the
surrounding skin breaks down
(Benbow and Stevens, 2010)
Protein loss/fluid and electrolyte
imbalance (Johnstone, 2007)
Need for increased
dressing changes.
Poorly managed exudate can also
lead to undue anxiety and distress,
not only for patients, but also for
their carers who have to deal with
saturated clothing and bed linen
(Palfreyman, 2008).
DRESSING SELECTION
Dressings remain the most accessible
option for managing wound exudate.
It is imperative, therefore, that
clinicians dealing with wounds on a
regular basis understand the way in
which dressing materials function and
June Jones, JJ TVE,Tissue Viability Education,
Southport, Merseyside; Jo Barraud,Tamaris
Communications, Hitchin, Hertfordshire
Exudate management is one of the key challenges for clinicians who
have to deal with wounds. The World Union of Wound Healing
Societies (WUWHS, 2007) highlighted the importance of appropriate
dressing selection for exudate control and removal of excess exudate.
Correct dressing selection ensures that the wound bed remains moist
without becoming saturated, which in turn prevents damage and
pain to the surrounding skin and reduces the risk of infection from
strikethrough. This article examines the role of exudate in wound
healing, and the inherent challenges in its management, both for
patients and carers. The role of superabsorbent dressings is discussed
and the findings of an evaluation of clinicians’ requirements and
expectations of superabsorbent dressings are presented.
KEYWORDS:
Exudate
Superabsorbent dressings
Moist wound healing
June Jones, Jo Barraud
1...,56,57,58,59,60,61,62,63,64,65 67,68,69,70,71,72,73,74,75,76,...116