A wound with heavy or purulent drainage is a localized defect or excavation of the skin or underlying soft tissue that produces large amounts of serous, sanguineous, serosanguineous or purulent discharge. Purulent wound drainage is thick with a yellow, green or brown color, with a pungent, strong, foul, fecal or musty odor. Purulent drainage is a sign of an unhealthy wound and demands treatment.
Symptoms of Purulent Drainage
With most wounds, a small amount of thin, pale colored exudate is normal. As all wounds are contaminated, with or without necrotic tissue, they will have an odor. Bacteria of different varieties have varying odors, colors and consistencies, and dead tissue in a wound introduces additional bacteria to the affected area. An increase in amount or consistency of exudate along with a change in color signals a cause for concern, as well as changes in odor.
Figure 1: Strikethrough of wound exudateFigure 2: Exudate management, leg ulcer with heavy drainageFigure 3: Removal of wound dressing ineffective in managing exudate
Exudate or wound drainage is the result of dilation of the blood vessels during the early inflammatory stage of healing possibly caused by the presence of certain bacteria. In an attempt to heal the wound, the body is creating and maintaining an optimal moist wound environment. Exudate is a derivative of serum with a high protein content and various additives which assist with healing; exudate consists of dead cells and liquefied necrotic debris, active white blood cells, growth factors, and natural enzymes that stimulate autolysis and healing, at least when present in an acute wound.
All wounds should experience some form of exudation, but some may drain more than others due to any number of factors, including location of wound, pressure, hydrostatic pressures, temperature, infection, wound size, dressings used and type of wound. Patients with diabetes, neuropathy or vascular disease are at a higher risk for chronic wounds and increased wound drainage.
The make-up of exudate from chronic wounds differs from that of acute wounds and can promote further inflammation and impede growth and healing.
An assessment of exudate volume and appearance can tell a clinician a great deal about a wound's healing progress. This assessment of the wound can include monitoring the number of dressing changes required a day and a visual inspection of the removed dressing. Some clinical continuity can be maintained through the use of an assessment tool such as an exudate continuum.
Treatment of Wounds with Heavy or Purulent Drainage
A balance must be struck in treatment between containing heavy drainage and preventing maceration and maintaining a moist wound environment. Responses should vary based on the need of the patient, the type and location of the wound and what stage of the healing process the wound is in. There are a variety of dressings available to allow for a correct pairing of dressing and wound needs. In wounds with venous insufficiency, compression and elevation may be helpful in assisting with blood return and suppressing exudate. Some heavy drainage may have an underlying cause which can be treated such as an infection. Some deeper or tunneling wounds with exudate may be suitable for negative pressure therapy.
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Image Source: Medetec (www.medetec.co.uk). Used with permission.