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Exudate Management with Dressings

In local wound management, dressings are the main option for managing exudate. Following an integrated exudate assessment, the clinician will decide whether there is a need to change or maintain the current dressing regimen.

Strategy for achieving the desired moist wound environment

AIM STRATEGY
Increase moisture
  • Choose dressing type to add or conserve moisture
  • Use thinner version of current dressing
  • Decrease dressing frequency change
Maintain wound moisture
  • Continue with current dressing
Reduce wound moisture
  • Use thicker (more absorbent) version of current dressing
  • Change dressing type to greater fluid handling capability
  • Use or add higher absorbency secondary dressing
  • Increase frequency of dressing change

There are a vast number of different absorbent dressings, mainly because one of the most difficult tasks in wound management is the containment of exudate (Beldon, 2010). A number of dressing types are suitable for exudate management. These various products handle fluid in different ways. Some simply absorb the fluid at the point of contact with the wound, while others spread it laterally (wicking), making full use of the dressing’s total size.

There are those that rely both on absorbency and evaporation, measured by moisture vapour transmission rate (MVTR), as well as dressings that absorb vertically with a reduced lateral wicking action. Some gel-forming dressings also trap exudate components and microorganisms (WUWHS, 2019).

The main categories of dressing to choose from for exudate management are alginates, Hydrofiber, gelling fibres, super absorbents and foams.

There are several ideals for a dressing when looking at exudate management that should be considered:

  • Available in a range of shapes and sizes across care settings
  • Easy to apply
  • Require a secondary dressing
  • Comfortable/reduces pain/does not cause pain on application
  • Conformable
  • Prevents leakage and strikethrough
  • Absorbs odour
  • Stays intact and remains in place during wear
  • Suitable for extended wear (based on clinical need)
  • Suitable fluid-handling capacity relative to the wound exudate level
  • Retains fluid-handling capacity under compression therapy or when used with an offloading device
  • Atraumatic and retains integrity on removal
  • Unlikely to cause sensitisation or to provoke an allergic reaction
  • Cosmetically acceptable and available in a range of colours to match the patient’s request
  • Does not impede physical activity
  • Patient can shower with the dressing in situ
  • Incorporates sensors/alerts to feedback on dressing performance, need for change and wound condition
  • Inactivates factors that enhance inflammation (Matrix metalloproteases MMPs)
  • Cost-effective – considering factors such as the unit cost of dressing versus time taken to change, the potential impact on healing by use of cheaper dressings, how to make the case to procurement

(WUWHS, 2019)

Assess Exudate Colour

Clear/straw coloured

  • Considered normal
  • Lymphatic/urinary fistula

Cloudy/milky/cream

  • A response to inflammation
  • Possible infection

Red/pink

  • Postoperative
  • Traumatic dressing removal
  • Possible infection

Green/yellow

  • Bacterial infection
  • Pseudomonas aeruginosa

Yellow/brown

  • Infection/ possible infection
  • Liquefaction of necrotic/ sloughy tissue
  • Possible infection
Thin and watery Assess Exudate Viscosity Thick and sometimes sticky

Low Protein content

  • Chronic oedema
  • Venous or cardiac disease
  • Malnutrition
  • Urinary, lymphatic or joint fistula

Assess exudate odour

  • Remove necrotic tissue if clinically indicated
  • Reduce bioburden and manage underlying infection
  • Review frequency of dressing change
  • Some dressings may produce a charecteristic odour

High protein content

  • Infection and/or inflammatory process
  • Necrotic material
  • Enteric fistula

Dry

  • No visible moisture
  • Not an ideal wound healing environment
  • May be ideal for ischaemic wounds (consider vascular referral)
  • Consider hydrating eschar
  • Consider potential dressing adherence
  • Surrounding skin may be scaly, atrophic and hyper-keratotic

Moist

  • An ideal wound healing environment
  • Dressing may be lightly marked
  • Wound bed could appear glossy
  • Reduced dressing change frequency
  • Surrounding skin may be intact and hydrated

Wet

  • Dressing may be extensively marked
  • Potential fragmented areas of maceration
  • Consider appropriate periwound protection
  • Select dressing with appropriate fluid handling properties

Saturated

  • Free fluid is visible
  • Primary dressing is wet and strike through may occur
  • If exudate escapes and/or frequent dressing changes are required, use high fluid handling capacity dressing
  • Risk of macerated/ denuded periwound skin
  • Use appropriate periwound protection

Leaking

  • Free fluid is visible
  • Dressings are saturated with exudate leaking from primary and secondary dressings
  • High risk of extensive periwound maceration
  • Superabsorbant products are necessary
  • Use appropriate periwound protection/NPWT
Dressing options
  • Film
  • Hydrogel
  • Hydrocolloid
  • Adhesive foam
  • Non-adhesive foam
  • Contact material
  • Clear absorbant acrylic
  • Adhesive foam
  • Non-adhesive foam
  • Alginate/ gelling fibre
  • Clear absorbent acrylic
  • Skin protectant: barrier film/ cream
  • Adhesive foam
  • Alginate/ gelling fibre
  • Super absorbant dressing
  • Skin protectant: barrier film/ cream
  • Super absorbant dressing
  • NPWT
  • Skin protectant: barrier film/ cream

Any alteration in exudate levels and characteristics may indicate a change in wound status and as such wound management should be reassessed as necessary. Adapted from Wounds UK, 2013; WUWHS, 2019