14 JCN supplement
2014,Vol 28, No 5
EXUDATE MANAGEMENT
This added psychosocial dynamic
arises because of:
Soiled clothing
Having to wash clothes and clean
furniture more frequently (both
practical and financial effects)
Malodour
Leakage of dressings
Social isolation due to
embarrassment.
Such factors lead to a loss
of personal control and self-
esteem. Patients may even become
depressed and lose confidence in
their healthcare provider (Moffatt
et al, 2008; Ousey, 2013). Malodour,
for example, may both deter them
from socialising, a potential trigger
for depression (Davies, 2012), and/
or affect their appetite and result in
malnutrition (Adderley, 2008).
It is important that clinicians
listen and empathise with how the
patient is feeling (Grothier, 2013),
encouraging them to become
involved and engaged with their own
care so that they feel in control of
their lives and involved in reducing or
eliminating problems associated with
excess exudate (Dowsett, 2008).
Patient assessment should also
look at:
Other comorbidities, e.g.
congestive cardiac failure
Medication
Mobility
Nutritional status
Dressings used (Menon, 2014).
EXUDATE ASSESSMENT
This involves assessing the volume,
colour, consistency and presence
of odour.
Assessing the volume of exudate
is not easy in clinical practice and is
only subjective, unless dressings are
actually weighed before and after
use which is neither accurate nor
contributes to patient care (Benbow
and Stevens, 2010). Assessing the
frequency of dressing changes and
if there is any strikethrough present
are probably more appropriate ways
of measuring the volume of exudate.
The condition of the periwound
skin, whether it is macerated and/
or excoriated, is also a gauge as
to how well the current dressing
is managing the exudate being
produced (Vuolo, 2004).
The colour of exudate can vary
according to its composition (
Table 1
),
while its consistency can be thin and
watery, or thick.
If there is malodour present,
this could be a sign of infection, e.g.
Pseudomonas aeruginosa
.
EXUDATE MANAGEMENT
The findings of comprehensive patient
and wound assessment should guide
treatment choice. The WUWHS
(2007) maintain that effective exudate
management should include:
Treating any contributory/
underlying factors
Improving patient quality of life
(preventing and treating exudate-
related problems)
Providing a moist wound-
healing environment
Optimising the condition of the
wound bed.
Taking these factors into account,
as well as the patient’s wishes,
clinicians should choose the most
appropriate dressing to manage the
volume of exudate being produced,
with properties that meet the
following criteria (WUWHS, 2007;
Dowsett, 2011):
Being able to absorb and retain
wound fluid
Being acceptable to the patient
Being comfortable to wear,
without interfering with activities
of daily living
Being easy to apply and remove
Reducing pain
Reducing odour
Being clinically and cost-effective
Being available in a variety of sizes.
Clinicians should be knowledgeable
about the variety of dressings available,
their fluid-handling capacities, if
they can be worn under compression
therapy (Vowden andVowden, 2003),
wear time, sizes available, patient
comfort and if they adhere to the
wound.Thus, once the patient’s
individual needs have been identified
during the assessment process
(including their concerns), the most
appropriate dressing can be chosen
(Benbow, 2008).
If excess exudate is not adequately
controlled, this will result in delayed
healing, which increases the risk of
infection with a subsequent‘knock-on’
effect on nursing time and dressing
costs (Vowden andVowden, 2003).
Ongoing assessment is also
important, because as the wound
heals, the volume of exudate will
decrease and possibly necessitate
a change in management plan
(Dowsett, 2008; Timmons, 2008).
While there are many dressings
available that offer standard
care, with foams possibly being
the most popular, there are now
superabsorbent dressings which have
added‘extras’ to help improve the
Top tip:
Successful exudate management
goes a long way to minimising the
psychosocial effects that chronic
exuding wounds have on patients
(Jones et al, 2008).
Table 1:
Significance of exudate colour (adapted from WUWHS, 2007)
Colour
Potential cause
Clear, amber
Considered to be normal but can be associated with infection, such as
Staphylococcus aureus
Cloudy, milky or creamy
May be a sign of fibrinous exudate, as a result of inflammation, or
infection, i.e. purulent exudate with blood cells and bacteria
Pink or red
This is due to red blood cells and may be a sign of infection, underlying
bleeding or trauma
Green
May be a sign of infection, such as
Pseudomonas aeruginosa
Yellow or brown
May be the result of sloughy tissue or material from a fistula
Grey or blue
May be due to the use of silver-containing dressings
