Efficient exudate management improves healthcare efficiency by reducing healing time, reducing maceration and damage to periwound skin, minimises the risk of infection, reduces healthcare costs and improves the patient’s quality of life.

If a patient’s exudate levels are not managed effectively, then the following may occur:

  • Leakage and soiling
  • Periwound skin changes, maceration, denudation (skin stripping or erosion) contact dermatitis
  • Delayed healing
  • Odour
  • Discomfort and pain
  • Infection
  • Protein loss and fluid and electrolyte imbalance
  • Need for frequent dressing changes
  • Psychosocial problems - exudate-associated leakage, soiling, odour, pain and the requirement for frequent dressing changes may distress patients and carers and result in social isolation

Highly exuding wounds can affect people of all ages with a variety of conditions, often causing distress and anxiety. As well as the human cost, managing these challenging wounds also represents significant costs for the NHS (Wounds UK, 2013).

A common myth is that all that is needed to manage exudate effectively is extra padding on the wound (WUWHS, 2019; Wounds UK, 2013).

While moisture is necessary for healing, an overly wet environment may damage the wound bed as well as the surrounding skin (Cutting & White, 2002; Romanelli et al., 2010). Damage may also occur due to increased frequency of dressing changes when adhesive products are being removed too often, causing epidermal stripping (Fletcher, 2003).

The first factor to consider is the reduction of anything that may be contributing to increased fluid levels. For example, the use of diuretics to treat heart failure or elevation of limbs to reduce dependant oedema may help to reduce exudate. Once these factors have been addressed, local management of the exudate with dressing products or therapies may be considered.

A myriad of wound types and circumstances are implicated in the production of high volumes of exudate. For instance, large wounds, deep wounds, fistulae, wounds with a sinus, infected wounds (Dealey, 2000; Gardener, 2012).

Factors that may affect exudate production and management

  • Inflammatory phase
  • Static or delayed healing
  • Autolytic debridement
  • Local infection/ inflammation/trauma
  • Foreign body
  • Oedema
  • Sinus and/or fistula
  • Cardiac, renal and hepatic failure
  • Infection/inflammation
  • Medication (NSAID, steroids)
  • Obesity/malnutrition
  • Lymphoedema
  • Wound position
  • Concordance
  • Inappropriate dressing choice

Adapted from Wounds UK, 2013.