Exudate Resources

When caring for people with venous leg ulceration, exudate management is commonly seen as one of the main challenges for clinicians. However, unfortunately, the reason for this wound-related symptom is often not identified or fully understood and therefore the clinical interventions necessary to address the problem are not implemented (Tickle, 2016). This results in people living with wounds that are failing to heal and producing a volume of exudate that has a significant impact on their quality of life (Cunha et al, 2017). Commonly, the words ‘leaky legs’ or ‘wet legs’ are documented in patient notes as the presenting problem — this is not a clinical diagnosis; it is a symptom of an underlying condition which more than likely is venous disease. Unless this is recognised and treated correctly, those ‘leaky legs’ will continue to be a problem and potentially could have a devastating impact on the patient. It is therefore important to have a good understanding of venous disease as well as the role that exudate plays in wound healing, from initial wounding, through the stages of healing, and when (and why) it becomes a problem.

Managing moisture to achieve the optimum ‘moist’ wound healing environment is key to facilitating wound healing. Wounds which are dry or have a low volume of exudate need moisture added for hydration. Wounds that are wet with a high volume of exudate need fluid to be removed effectively by dressings with high absorbency. Moisture imbalance can have negative consequences for patients — physically, psychologically and socially.

Exudate management in chronic wounds and hard-to-heal wounds is a vital process and community nurses need to be aware of the best practice evidence as well as correct product choice. This is particularly important when attempting to provide the  optimum moist healing environment and achieve a balance of moisture in the wound bed. Another important element in chronic wounds is the promotion of autolytic debridement, which helps to ensure that healing is not complicated by any devitalised tissue, which can harbour bacteria and impede new tissue growth. This article investigates best practice in the treatment of chronic wounds, with a focus on the management of moisture in the wound bed. The author also looks at one dressing in particular, Cutimed HydroControl® (BSN medical, an SCA company), which uses an osmotic effect and a high moisture vapour transmission rate (MVTR) to ensure that excessive wound exudate is drawn away from the wound bed, while also ensuring that fresh exudate is produced to promote autolytic debridement and maintain moisture levels in dry wounds. Cutimed HydroControl is able to avoid inappropriate dressing use by facilitating the needs of both exuding and dry wounds, thereby ensuring an optimum moist wound environment

The management of exudate in acute and chronic wounds is a common issue for community nurses, with too much exudate resulting in issues with infection and the breakdown of periwound skin; while too little moisture risks the wound bed becoming too dry. Nurses need to find the most cost-effective and clinically proven treatment regimen when treating wounds that produce different levels of exudate, minimising dressing changes and patient discomfort. While it can be difficult to make a choice about which dressing to use because of the vast array on offer, it is important to match the dressing to the wound and use the most appropriate dressing for the levels of exudate being produced. Similarly, using a more responsive approach to wound management — adapting treatment as the wound changes — will result in a more cost-effective approach. Advancis Medical have a range of wound management dressings that are suitable for different wound types and can handle varying levels of exudate. This allows nurses to use a step-up, step-down approach to the management of exudate as the most cost-effective dressing regimen.

A chronic heavily exuding wound can have a devastating impact on a patient’s quality of life, often resulting in symptoms such as increased pain, depression, anxiety and stress, as well as a loss of independence and social isolation. For community nurses, wounds with high levels of exudate can incur increasing costs, both in time and resources. It is imperative to heal these wounds as quickly as possible and the community nurse should undertake a robust and holistic assessment before implementing a clear and evidence-based management plan, potentially including wound debridement and the use of an effective absorbent dressing in combination with compression therapy, where appropriate, to manage exudate. This article examines the development of chronic wounds and the problem of excess exudate production specifically, before going onto look at the benefits of one particular superabsorbent dressing (Flivasorb®; Activa Healthcare/L&R). The author uses extensive evidence as well as clinical expertise to provide an overview of the dressing, and presents a case study to demonstrate its benefits in practice.

Wound fluid, or exudate, is a normal consequence of healing but physiological circumstances within the individual or their wound can arise, which lead to excessive wound fluid production. There is a risk of maceration and excoriation of surrounding skin, which can cause distress and impact on quality of life. Therefore robust assessment and nursing intervention can successfully manage exudate and facilitate improved wound healing.

There are a number of mechanisms at play that can delay wound healing. Wounds can become stuck in a prolonged inflammatory stage resulting in high volumes of wound exudate, which contains agents that contribute to delayed healing. Exudate plays an essential role in wound healing but at excessive volumes it can also facilitate biofilm formation, which can further delay healing. Maintaining optimum levels of exudate is vital for healthy wound healing, as is the prevention or disruption of biofilm formation in the wound bed. This article also looks at Sorbion Sachet S® (BSN medical), a triedandtested uperabsorbent dressing, which is now back on the Drug Tariff, but at a lower price. This article discusses the mechanisms used in the reintroduced superabsorbent dressing and how it provides a cost-effective solution to the problem of treating highly exuding chronic wounds where clinical efficacy and budgetary concerns are both top priorities.

Moisture-associated skin damage (MASD) results from an extended period of exposure to various types of moisture, commonly urine or faeces, sweat, and wound exudate¹. It can result in extensive skin breakdown through erythema, maceration and eventually moisture lesions, with the most common presentations being incontinenceassociated dermatitis (IAD), intertriginous dermatitis, periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis¹. MASD is not caused by moisture alone — other factors including friction, hygiene products, or microorganisms are usually involved¹. MASD can be painful and effect the patient’s quality of life², potentially resulting in moisture lesions if not properly managed.

The specialty of wound care is one that has expanded exponentially in modern times with a plethora of theories and technologies, including wound bed preparation, the role of proteases, negative pressure wound therapy (NPWT), and an almost bewildering array of dressing formulations, from antimicrobials to larval-based products. However, for the clinician on the ground who may not have time to appraise all the theory — or indeed afford all of the new technologies — there is still a high premium placed on having a range of wound care dressings that can be used on a variety of wounds, are simple to use, patientfriendly, and, increasingly important in this day and age, cost-effective (Chandan et al, 2009). In a follow-up to a previous article (Morgan, 2015), this piece looks at one particular dressing (Actilite Protect®; Advancis Medical) and reviews the latest in a series of case studies that show how it can be effective in a range of wounds, in particular infected wounds, due to its innovative use of honey.

Excessive exudate production interferes with wound healing and has a detrimental effect on patients’ quality of life. Exudate management is crucial as wounds need an optimum level of moisture so that they can heal. Superabsorbent dressings can handle extreme levels of exudate, prevent leakage and reduce the frequency of dressing changes, allowing people to live a more normal life unhindered by saturated dressings that constantly need to be changed.  Community nurses will often need to treat chronic wounds and may consider using superabsorbent dressings.  The article takes a look at Zetuvit® Plus (HARTMANN), a superabsorbent dressing that is used for superficial, heavily exuding acute or chronic wounds with the author examining its potential role as a wound care option in the community.