12 / 20
??? JCN
2015
JCN Roadshow
H
igh levels of exudate in a patient’s wound can be
problematic for a number of reasons, including
maceration of the periwound skin, malodour
and problems with dressing choice due to absorbency.
This JCN Learning Zone sought to provide guidance
for nurses on a number of exudate-related issues that
can arise including:
Understanding what exudate is
The role of exudate in wound-healing process
How exudate is often a problem in wound care
The difference between absorption and retention
Importance of appropriate dressing selection.
Learning zone:
managing high
exudate volumes
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Exudate can contain microorganisms (this does not
necessarily mean the wound itself is infected).
Exudate is essential for moist wound healing,
providing vital growth and immune factors, supporting
cell migration across the wound bed, releasing nutrients
for cells, and promoting cell proliferation.
Wounds that can be affected by high exudate
Some wounds are particularly prone to high
exudate volumes:
WHAT IS EXUDATE?
Exudate contains water, electrolytes, nutrients,
inflammatory mediators, protein digesting enzymes,
growth factors and waste products
Exudate also contains cells such as neutrophils,
macrophages and platelets
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WHAT ARE THE CHALLENGES?
A wound that is producing high volumes of exudate can
result in some specific treatment challenges:
Malodour
Wound enlargement
Protein loss/fluid electrolyte imbalance
Local wound infection
Delayed healing
Soiled clothing and bedding.
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WHY IS EXUDATE A PROBLEM?
Chronic exudate has been described as a wounding
agent in its own right and it must be managed effectively
to create the optimal wound-healing environment. The
periwound area is also vulnerable to the excess moisture
caused by exudate and this needs to be managed to
avoid maceration.
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WHAT ROLE DOES DRESSING CHOICE PLAY?
It is important to choose a dressing that can cope with
the amount of exudate being produced by the wound.
This means choosing a dressing that can absorb exudate,
prevent leakage onto the periwound area and stay on the
wound for a sufficient length of time to be effective.
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IS THE DRESSING WORKING?
It can be hard to know if the correct dressing to manage
the amount of exudate being produced by a wound has
been chosen. However, there are some classic signs that
a dressing may not be coping:
Patient’s quality of life does not improve
The wound margins extend
Wound bed shows signs of increasing bacterial load
There is soiling outside dressing on periwound skin
Frequent dressing changes
Odour is not controlled
Wound pain continues.
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CONCLUSION
Understanding the exudate management properties of
wound dressings and the recommended wear time is
essential when caring for patients with highly exuding
wounds. This will help to prevent complications such as
skin reactions, maceration and delayed healing.
Sponsored by
12
Chronic venous leg ulcer
Burn
Fungating wound
Skin donor site
Post-op’ dehisced wound