42
WOUND CARE TODAY
2014,Vol 1, No 1
FOCUS ON WOUND EXUDATE
›
with the dressing itself, rather than less
frequent changes (WUWHS, 2007).
Even if the most appropriate
absorbent dressing has been selected,
it will still need to be changed at
regular intervals even if this places a
strain on nursing resources. Relying
on excessive padding as some
clinicians do, results in saturated,
heavy dressings and increases
the potential for macerated skin
(Gardner, 2012).
It is short-sighted of clinicians
to reduce the frequency of dressing
changes as — if they are prepared
to engage in an intensive period of
frequent dressing changes — they
can improve patients’ skin integrity,
and progress the wound towards
healing more rapidly.
DRESSING SELECTION
There are a plethora of wound
dressings available to clinicians,
however, it is vitally important
to select the one that is most
appropriate for the individual
patient. This means considering
the characteristics of the wound,
including:
›
Wound site
›
Shape
›
Underlying aetiology
›
Volume of exudate
being produced.
The ideal properties of a dressing
required to manage a high volume
of exudate have been described as
(Adderley, 2008; Stephen-Haynes,
2011):
›
High-absorbency: helps to reduce
dressing frequency
›
Ability to ‘lock away’ exudate:
prevents leakage between
dressing changes
›
Ability to prevent maceration/
excoriation of the periwound skin
›
Ability to be used under
compression bandaging: does not
become too ‘bulky’when saturated
with exudate
›
Ability to minimise trauma and
pain on removal
›
Comfort and acceptability
to the patient
›
Conformity to wound site
›
Cost-effectiveness.
Many different types of wound
dressings are designed to absorb
exudate, including:
›
Foams, such as Allevyn
®
(Smith and Nephew); Biatain
®
(Coloplast), Mepilex
®
(Mölnlycke
Health Care)
›
Hydrofibers, such as Aquacel
®
(ConvaTec)
›
Superabsorbent dressings,
such as Flivasorb
®
(Activa
Healthcare); Sorbion Sachet
®
(H&R Healthcare); Eclypse
®
(Advancis); KerraMax Care
®
(Crawford Healthcare).
PREVENTING PERIWOUND
SKIN DAMAGE
There are many causes of
periwound skin damage for
patients with an exuding wound,
the obvious one being maceration.
However, indirect causes might also
include:
›
Inappropriate dressing choice
leading to ‘pooling’ of exudate
against the skin and maceration
›
Trauma caused by frequent
removal of adhesive-bordered
products, usually referred to
as ‘skin stripping’, where the
adhesive repeatedly removes
the outer layers of the skin
and triggers an inflammatory
reaction, oedema and pain
(Langøen and Lawton, 2009).
Sensitivities to products such
as moisturisers, emollients and
creams that contain lanolin (also
known as ‘wool wax’ or ‘wool fat’)
or parabens (preservatives used in
pharmaceutical/cosmetic products),
especially where they are used
DANGERS OF
EXCESSIVE EXUDATE
When wound fluid is trapped against
the skin for a prolonged period of
time, the skin becomes softer and
is at risk from proteolytic enzymes
contained within exudate (BPS, 2013).
It is good practice when managing
highly exuding wounds to examine
the periwound skin for evidence of
(BPS, 2013):
›
Maceration: skin has a pale or
white,‘soggy’ appearance
›
Excoriation: breaks in the skin and
erythematous (red-coloured rash-
like) appearance; often painful
›
‘Spongy’ texture.
Any of the above elements should
alert the clinician to the fact that
the current wound regimen is not
effectively managing the exudate,
and that a review of the treatment by
both clinician and patient is required.
For example, has the clinician chosen
the correct dressing and is the patient
complying with the treatment?
MANAGEMENT OF
EXCESSIVE EXUDATE
Frequency of wound dressing change
can be vital when dealing with
wounds that are leaking large volumes
of exudate — a wound dressing may
be classed as highly absorbent, but
its fluid-handling capacity will still be
finite, and, once this is reached, the
dressing should be changed.
There is a danger that clinicians
become over-reliant on the absorbent
qualities of certain dressings, resulting
in them reducing the frequency of
dressing changes, with the dressings
becoming saturated and leaking
exudate. In some cases, clinicians
and patients may assume that the
responsibility for exudate leakage lies
Top tip:
Remember that not all exudate
is bad Ñ
a certain amount of
wound fluid is necessary for
wound healing as it is full of the
proteins, growth factors and cells
required for healing...
›
Wound facts...
The odour of exudate can be a
clue to the state of the wound. For
example, clear, healthy exudate
does not have an identifiable
odour, whereas strong-smelling
fluid may be an indication that the
wound is infected; that there is
necrotic tissue in the wound bed;
or that the wound is connected to
a sinus or fistula (WUWHS, 2007).
