What is exudate wound

Exudate is made of cells, proteins, and solid materials. Exudate may ooze from cuts or from areas of infection or inflammation. An alteration of the local inflammatory factors that precipitate a fluid accumulation represents an exudative effusion. Transudate is a clear fluid with low protein concentration and a limited number of white blood cells.

An imbalance between the hydrostatic and oncotic pressure within the capillaries causes a transudate effusion. To be an exudate, the effusion must have at least one of the following 2 :.

There is no ideal biochemical marker that allows complete discrimination between transudates and exudates 3. Cell Count high Lymphocytes: As in lymphoma, malignancy not otherwise specified, tuberculosis TBfungal, or post-operative. Serous exudate — a clear, amber, thin and watery plasma. Sanguineous exudate — a fresh bleeding, seen in deep partial- and full-thickness wounds. A small amount is normal during the inflammatory stage.

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Purulent exudate — a thick and opaque exudate that is tan, yellow, green or brown in color. It also depends on the location and size of the wound. Some dressings are easier to use and remove than others. Modern dressings are relatively hypoallergenic and non-adherent but sensitisation may occur to iodine, antibiotics, rubber, adhesives and preservatives. Tape cannot be applied if the skin is treated with emollient or topical steroid creams. Cost and availability must also be considered.

The aim is to rehydrate the dry scab so that it will separate off. Options are: Wet dressings using saline or hypochlorite Eusol. Hydrogel covered by perforated plastic film absorbent dressing Melolin or Telfa or vapour permeable film. Hydrocolloid dressing. These need debriding to remove the abnormal matrix of fibrin, exudate, inflammatory cells and bacteria. This can be done by surgical debridement or by an agent that soaks up debris and forms a moist gel.

Options are:.Exudate is fluid which leaks out of damaged tissues. It can be the result of traumainflammationor an underlying disease process which compromises the tissue. A classic example of exudate is pusfound in some types of wounds as they heal. Depending on the quantity and quality of the fluid, exudate can help or hinder healing, and sometimes characteristics of expressed fluids reveal information about the progress of the healing.

Microscopic examination can reveal more about what is inside the fluid, which can help a doctor make decisions about treatment recommendations.

Water is one of the major constituents of exudate, which should come as no surprise, since it makes up a large part of the body. The fluid also contains proteins from blood and tissue cells, and can include bacteria, lymphand other materials as well. Some exudate weeps slowly out of damaged tissues, accumulating gradually over time, while in other cases, the fluid may seep very rapidly, building up in and around a wound.

While it may be unsightly, fluid which weeps from damaged cells can be a good thing. It often carries infectious and dead material out of the body so that they cannot continue to contribute to inflammatory processes, providing a method of flushing the body. It can also keep a wound moist, which can contribute to healing with some types of wounds, and create a filmy barrier which protects a wound from the outside. If wounds become too dry, sometimes the healing process is disrupted, and the area can be at risk of infection from microbes which take advantage of cracks in dried skin.

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People often notice small amounts of exudate on bandages when they change them. The slow seepage indicates that healing is taking place under the bandage, but that inflammation is still occurring.

If the exudate has a strong odor, is copious, or acquires a strange color, it may be a sign that infection has set in and more medical attention is needed to address the wound. Exudate can also happen inside the body. Pleural effusionin which the space around the lungs becomes filled with fluid, can be caused by exudate. Likewise, leaking fluids can lead to edema.

In these cases, the body cannot express the leaking fluid as quickly as it is generated, and it creates medical complications. Treatment for buildups of fluid vary, depending on where in the body they are, the cause of the buildup, and the patient's general health.

Ever since she began contributing to the site several years ago, Mary has embraced the exciting challenge of being a wiseGEEK researcher and writer. Mary has a liberal arts degree from Goddard College and spends her free time reading, cooking, and exploring the great outdoors. Please enter the following code:. Login: Forgot password?Moisture balance in the wound bed is essential to wound healing. The body produces exudate as a response to tissue injury, and the amount of exudate is dependent upon the pressure gradient within the tissue itself.

Wounds in which exudate is excessive may become macerated, which can lead to further tissue damage and set the stage for infection. This can occur in wounds that are infected, or in wounds that are stalled in the inflammatory phase of healing.

Exudate wound fluid typically differs in acute versus chronic wounds. In acute wounds, exudate is rich in nutrients and leukocytes, which stimulate fibroblasts and endothelial cells to replicate. In chronic wounds, however, high levels of proteases, which slow cellular proliferation, are found. In addition there is often poor growth factor activity, which leads to a lack of development of the wound matrix, which in turn means that epithelial cells cannot migrate across the wound surface to complete the wound healing process.

Wounds that are too dry require a dressing that will donate moisture, while wounds that are too moist will require a dressing that will absorb exudate and wick it away from the skin to prevent breakdown. There are many dressing available on the market; dressing selection should be based on the amount and viscosity of wound exudate. Dressings to manage wound exudate may include hydrocolloids, foams, hydrofibers, alginates, capillary action dressings and cadexomer iodine.

For wounds with heavy exudate, vacuum dressings which use an electronic pump to pull fluid from the wound bed can be used. For patients with venous stasis ulcers, compression bandages can be used to decrease fluid in the lower extremities. Skin barrier creams and films can help protect the periwound area from becoming excoriated or macerated due to excess exudate.

what is exudate wound

Wound Educators is the premier wound care education website for online wound care learning. Dowsett, C. Wounds International. Wound bed preparation revisited. Wounds International, February 3 1.

Laurie Swezey, founder and president of WoundEducators.

Exudate Management: Mode of action for Cutimed® HydroControl / BSNmedical (Essity)

I enjoy the knowledge of this organization and I hope to carry the awesome title of wound care certification this stage of my Nursing career. If you are leaning toward a course that will eliminate the need for travel and work absences, then the WoundEducators.

It will also allow you to proceed at your own pace with a high level of learning and retention.Wound exudate is produced as a normal part of the healing process. During the inflammatory response blood vessel walls dilate and become more porous allowing leakage of protein-rich fluid into the wounded area White, Managing exudate and maintaining a wound environment that is moist but not wet is a constant challenge.

what is exudate wound

In the normal process of repair, the volume of exudate gradually diminishes as a wound heals and fluid conservation may become important Thomas, However, in chronic wounds or where the process of healing is disrupted, such as when a wound becomes infected, the exudate level is maintained or may increase. Although it is generally believed that exudate plays an essential role in the healing process it is less clear when its detrimental effects begin to outweigh the benefits.

Several studies have investigated the content of exudate and it is apparent that the constituents and quantities of individual components vary among individuals and at different times during the healing process Baker and Leaper, Acute wound fluid appears to play an important part in attracting the essential cells to the wounded area.

It is rich in both leucocytes and proteases to clear debris, and growth factors to promote tissue regeneration and facilitate the migration of cells. It is also believed to have antibacterial properties Kreig and Eming, However, the make up of the exudate is not consistent and differing constituents are found even between similar acute wounds Baker and Leaper, A different balance of cell types is found in chronic wound fluid, where there appears to be an imbalance between the amount of degradative substances such as the matrix metalloproteinases MMPs and their inhibitors, tissue inhibitors of matrix metalloproteinases TIMPs.

The resulting high levels of MMPs not only actively break down protein but also have an inhibitory affect on growth factor activity Trengrove et al, ; Yager and Nwomeh, In addition to the uncertainty about the constituents of exudate there is also a lack of consensus as to what is the normal amount, with considerable differences occurring between wound types. This problem is compounded by a lack of standardised terminology with regard to exudate and the fact that many practitioners use subjective descriptions of the amount.

While practitioners may believe they understand these terms, Thomas et al showed that even highly experienced practitioners were unable to objectively estimate the amount of exudate or agree on whether the amount was low, moderate or high. A more objective measure was proposed by Mulder who suggested that the amount can be estimated based on the frequency of dressing change using a 10cm x 10cm gauze as the measure.

Although similar terminology is used absent, minimal, moderate and higheach of these descriptors is quantified see Box. These definitions are limited in that the amounts described in the paper are based on the absorptive capacity of a simple gauze dressing.

However, the principle could be adapted to a broader range of dressing types allowing for objective comparison of exudate levels within the same wound. These two simple but common examples demonstrate how fluid levels in and around the wound may change without affecting the true exudate levels. They also demonstrate why it may be difficult to use levels of exudate to predict changes in healing status, as it is not clinically possible to differentiate between exudate and fluid seepage from severe oedematous legs.

The colour and consistency of exudate is also perceived to be important and, when coupled with quantity, may be used as an indicator of progress or deterioration in the wound.

Again several authors have proposed descriptors. For example, Mulder used the terms serous, sanguineous, serosanguineous and purulent. Sibbald et al proposed serous-serum, sanguineous-blood, purulent-infection and a combination. It is interesting to note that these authors all see consistency as a good indicator of the presence of infection. However, a large study reviewing the validity of the clinical signs and symptoms of infection in chronic wounds Gardner et al, found that purulent exudate alone was less predictive of infection than other indicators such as increased pain, friable granulation tissue, wound breakdown and foul odour.

While moisture is necessary for healing, an overly wet environment may damage the wound bed as well as the surrounding skin Cutting and White, This damage may be maceration caused by the trapping of fluid on the skinor excoriation related to the proteolytic enzymes contained within the exudate, however, in practice these frequently occur together.

What is an Exudate?

Damage may also occur due to increased frequency of dressing change, when adhesive products are being removed too often causing epidermal stripping.Knowing how to correctly make those observations and documenting accordingly is critical to a comprehensive assessment.

Ultimately, we want a wound with an optimal level of moisture to support healing and not an overly moist or dry environment. However, as wound care specialists or experts, we need to take it one step further and ask a few more questions.

A good wound care clinician does more than just make observations and note them. We also need to assess the amount of wound exudate, which requires observing the condition of the wound and the dressing.

Exudate: The Type and Amount Is Telling You Something

These are the basics to our assessment and documentation, however we need to ask the critical questions. In looking at the type, color and amount presenting in the wound, we need to determine what the wound exudate is telling us. If we note sanguineous drainage, for example, it indicates some level of damage to capillaries in the tissue.

The subsequent amount of sanguineous drainage would indicate how significant the damage was. Once we have determined the cause, we implement a treatment approach that reduces or eliminates tissue damage altogether.

Therefore, our first objective is to determine what is causing these high levels of exudate. If it is truly serous exudate, there would be a number of possibilities, such as localized staphylococcus infection, chronic inflammation due to biofilm or high levels of MMPs to name a few.

Thick, milky white to tan could be associated with autolytic debridement and the liquefaction of the necrotic tissue or lymphatic exudate.

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Whereas thick, yellow to green may indicate a high bioburden in the wound. We could elaborate on different scenarios that we may face, but the main priority is to critically analyze what is going on in the wound. This is important so you can provide care that removes the abnormal conditions and manages the normal conditions to support successful wound healing. Bill RichlenPT, WCC, DWCis a licensed physical therapist and has experience in advanced wound care consultations in long-term care, outpatient, skilled rehabilitation and home health.

He has served as a clinical instructor for physical therapy students, been the director of several large rehabilitation departments, and has been providing multi-disciplinary wound care education to nurses and therapists for over 17 years. His expertise in diverse settings enhance his role as a clinical instructor. You can follow any responses to this entry through the RSS 2. Both comments and pings are currently closed.

Main Website Blog Resources Contact. Pin 1.The drainage that seeps out of wounds can be called many things, but as wound care clinicians know, the technical term is exudate. This liquid, which is produced by the body in response to tissue damage, can tell us what we need to know about the wound.

They are:. This can be key for proper assessment, and help you choose the best wound treatment. The different exudate levels include:. Always take into account the amount of exudate when selecting the dressing. We want to promote moist wound healing, but with no adverse effects from too much moisture, such as maceration of the periwound.

When it comes to documenting exudate, do you see one type being identified more than others — like the well-known serosanguineous? And what about the amount of drainage — do you use the terms listed above, or does your clinic use percentages instead? We would love to hear how your facility typically documents exudate, and if you encounter any specific challenges or successes with identifying or treating wounds based on exudate.

Please leave your comments below. For more information see wcei. You can follow any responses to this entry through the RSS 2. Both comments and pings are currently closed. Main Website Blog Resources Contact. Warm Wound Healing? Share Pin We will use Nordic Visitor again. Nordic Visitor set up a tremendous self-drive tour for us. Arnar Thor was a pleasure to work with. Friendly, courteous and professional. Helped us change hotels mid-tour quickly and efficiently.

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what is exudate wound

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