Archive for the ‘Wound and Skin Management’ Category

Telemedicine, Wound Care and . . . Dracula?

Friday, May 6th, 2016

Find out how telemedicine continues to change wound care (and what you can learn from your favorite cartoon characters).

Telemedicine, Wound Care and ... Dracula

 

What do Dracula, Wile E. Coyote and telemedicine have in common? It’s an intriguing question for sure, and you’ll be able to find out the answer at the Wild on Wounds (WOW) National Conference, to be held Aug. 31 – Sept. 3 in Las Vegas.

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Pressure Injuries? (Don’t) Say It Ain’t So!

Tuesday, April 19th, 2016

Mounting pressure to call pressure injuries (aka pressure ulcers) something else has caused a stir – and clinicians in wound care are feeling the heat. Find out why.

Pressury Injuries - Don't Say It Ain't So

One of the most basic principles of healing a wound is to determine the cause – and then remove it. It sounds so simple, doesn’t it? But this is easier said than done, as many wounds have similar characteristics, and we don’t always have all the facts at our disposal in order to pinpoint the cause.

Unfortunately, this process has become further – and unnecessarily – complicated, thanks to increasing pressure (no pun intended) on wound clinicians to name a pressure injury something else. See? We told you it was complicated. Here’s what you need to know.

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Pressure Injury (Ulcer) Staging: More Real-World Answers

Friday, April 15th, 2016

More real-world wound care questions and answers relating to pressure injury staging, including slough, debridement and skin breakdown.

More Real-World Pressure Injuries

 

Can’t get enough of pressure injury staging? Neither can we. That’s why we’re excited to present even more questions and answers about this topic, based on what wound clinicians experience out in the field (versus what we might learn from textbooks or in a classroom).

In our first such post – packed with some awesome pressure injury staging questions from the field – we discussed slough, levels of destruction and debridement. Here, you’ll find out more about pressure injury staging as it relates to abrasions, surgical flaps, skin breakdown due to clothing, and more. So here they are – five more tips for staging pressure injuries, based on real questions from clinicians.

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Moisture Associated Skin Damage: Know Your Type

Friday, March 4th, 2016

Know how to correctly identify these four common types of Moisture Associated Skin Damage (MASD) for best wound care practices.

MASD Categories

 

It might sound reasonable to assume that Moisture Associated Skin Damage (MASD) is the result of, well … moisture. The fact is that it takes more than just moisture to cause MASD, which is the inflammation and erosion of the skin that’s caused by prolonged exposure to various sources of moisture, including, urine, stool, perspiration, wound exudate, mucous, or saliva.  Skin does not break down in water alone.  However, when moisture on the skin is combined with friction, chemical irritants or bacterial/microbial factors, that’s when the real damage occurs.

For effective wound care, clinicians must be able to properly assess MASD from the onset – even if at first the diagnosis isn’t obvious. It all begins with good clue gathering, and knowing the characteristics of each of the four common types.

Identifying MASD

Because moisture on the skin increases skin permeability (which alters pH and cools the tissue), it compromises the barrier function of the skin’s protective acid mantle. This, in turn, makes the skin more susceptible to friction and shearing forces.

Correct MASD identification is critical for treatment, and should begin as soon as initial signs appear. The first step is to conduct a complete skin assessment. Don’t ever assume that you know what’s going on at first glance. Follow the general rule of thumb for any wound expert, and keep looking! Take your time, be methodical, and note the location, texture, moisture level, maceration, denuding and changes in skin color.

Know your type

Incontinence-Associated Dermatitis (IAD)

One of the most common forms of MASD is incontinence-associated dermatitis (IAD), which is the inflammation of the skin from extended exposure to urine or stool.  You may also know it as perineal dermatitis, irritant dermatitis or diaper rash (in children). The highest-risk patients are those that have both fecal and urinary incontinence.

As mentioned earlier, moisture requires an additional irritant in order to produce MASD. Urine contains ammonia, which increases the skin’s pH and destroys the protective acid mantle.  Adding to the problem, frequent skin cleansing in response to urinary or fecal incontinence can increase the risk of breakdown. Even incontinent briefs can contribute to IAD by causing perspiration in the affected area. Although the briefs pull the actual fluids away, the microclimate remains moist and warm.

So how do you know if it’s IAD? Here are typical characteristics:

  • Found over fatty tissue of the buttocks, perineum, inner thigh and groin (though they can occur over bony prominences).
  • Distributed in a consolidated or patchy formation.
  • Covers diffuse areas, shaped like a mirror image in the skin fold or linear area in the anal cleft.
  • Is superficial or partial thickness in depth. Note: if there’s tissue destruction into the subcutaneous tissue or deeper, it must be staged as a pressure ulcer (for more information, see the WCEI blog “Will the Real Pressure Ulcer Please Stand Up?”)
  • Presents with non-uniform redness in the wound bed, maceration in the surrounding skin and peri-anal redness. No necrosis.
  • Has diffuse and irregular wound margins.

Intertriginous Dermatitis (ITD)

Intertriginous dermatitis, also called intertrigo, is an inflammatory condition of opposing skin surfaces caused by moisture.  You’ll find it in skin folds, such as under the breasts, in the axillary (armpit) area, or inguinal (groin) region. It’s particularly common in obese patients.

Moisture can become trapped in the skin fold, where there is a lack of air circulation.  The excess moisture causes the dead cells in the uppermost layer of the skin (the stratum corneum) to become saturated and then puff up. The result is rough textures (which means they won’t glide very well), and the result is skin-on-skin friction.

Characteristics of ITD:

  • Found in the skin folds.
  • Distributed in a linear, mirror image on each side of the fold
  • Always partial thickness.
  • Presents as mild erythema (redness) that can quickly progress to erosion, oozing, maceration or crusting.
  • Surrounding skin is often macerated and prone to bacterial and fungal infections such as candidiasis.
  • Can be painful, itchy and may produce odor.

It’s important to realize that a patient can suffer from both IAD and ITD at the same time, coexisting side-by-side.

Periwound Moisture-Associated Dermatitis

Periwound moisture-associated dermatitis occurs when the skin adjacent to a chronic wound becomes exposed to exudate or toxins from bacteria in the wound bed, causing inflammation and erosion. This is a result of too much exudate that hasn’t been properly managed. Left untreated, the periwound will eventually break down and the wound will enlarge.

Infected wounds are especially prone to periwound moisture-associated dermatitis because they produce more exudate.  The condition is more common in the elderly and immunocompromised, but our clinical practices can contribute as well. This can be due to a number of risk factors, including improper dressing selection, infrequent dressing changes, and aggressive tape removal.

Peristomal Moisture-Associated Dermatitis

The final common type of MASD is peristomal moisture-associated dermatitis.  This form of inflammation and skin erosion occurs only in ostomy patients.  It begins at the stoma/skin junction, and can extend outward as much as 4 inches in any direction.  As many as 50% of patients with a stoma experience this condition, which can be extremely detrimental to their quality of life.

Peristomal moisture-assisted dermatitis can happen around any stoma, including tracheostomies, gastrostomies, urostomies, and colostomies.  However, ileostomy patients – those with stomas at the small intestine – have the highest risk since the effluent (output from the stoma) is watery and caustic.  When the pouching system leaks due to improper sizing, an uneven peristomal plane or incorrect wear time, the effluent causes skin irritation and potential breakdown.

Pay close attention to the area around the stoma, keeping a close eye out for potential problems, including well-defined erythema, edema, and loss of the epidermis. You may also see papules, vesicles, itching, crusting and oozing. As with other forms of MASD, it’s important to address the problem early.

Do you know your MASD types?

What types of MASD have you encountered the most in your facility, and have you ever had trouble identifying them? Do you have any tips for MASD identification, and has early identification made a difference in patient outcome? Please tell us about your experiences by leaving your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Wound Assessment: Skin of Many Colors

Thursday, February 25th, 2016

Understanding the structural differences between light and dark skin is crucial for clinicians, and this free Wild on Wounds webinar will help – plus you’ll get awesome tips for assessing skin of color.

- Cropped

 

Chances are that when you studied skin assessment in US textbooks, most of the case studies or featured photos involved patients with lighter skin tones – common to people of European decent.  Historically (and unfortunately), there’s been a lack of research, guidelines and consistency in treating skin of color.

This lack of diversity in educational resources is not only a disservice to clinicians and patients, it can be downright dangerous. For example, without exposure to proper techniques, you might not recognize a Stage I pressure ulcer in a darker-skinned patient, because non-blanchable erythema (redness) is harder to see.

As our patient population grows increasingly diverse, it is absolutely essential that bedside clinicians understand how skin differs among people of various ethnic and racial backgrounds, and what that means in wound assessment.

Learning starts here

Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS, WCEI Co-founder/ Clinical Instructor

Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS, WCEI Co-founder/ Clinical Instructor

The truth of the matter is that most of us have learned whatever we can about treating skin of color from our own experiences in the field. This is why WCEI Co-founder and Clinical Instructor

Nancy Morgan addressed this topic in her Wild on Wounds (WOW) 2015 National Conference presentation, “How to: Skin of Color.”

Now offered as an on-demand webinar, Morgan discusses the specific characteristics of skin of color, and how clinical conditions present differently in highly pigmented (versus lighter) skin. You can hear her entire presentation – and view it for free – with a special coupon code (listed below).

What makes skin darker?

Skin color is the result of melanin – a brown pigment. The purpose of melanin is to protect the skin by absorbing harmful ultraviolet (UV) radiation from the sun.  As we encounter UV rays, special cells called melanocytes produce additional melanin.

You may be surprised to learn that there’s no difference in the number of melanocytes between skin types. The palest and the darkest person will, on average, have the same number of these cells in their skin. However, the production and concentration of melanin in the epidermis (top layer of skin) is double in darker skin.

Does skin tone matter?

There are many skin tone classification scales used in the field, created mostly by and for dermatologists.  As Morgan states in her presentation, these scales aren’t helpful when it comes to wound care. “We have to do a very thorough visual inspection of the skin, and we have to talk to the patient about his or her baseline skin color.”

More webinar highlights

Besides exploring the basics of skin color and tone, you’ll find out more from Morgan’s webinar, including:

  • Skin conditions more common in darker skin, such as hyperpigmentation, keloid scarring, and xerosis.
  • Useful tips for performing a holistic assessment of a patient with dark skin.
  • Why some clinical conditions – such as sDTI, erythema or cyanosis – can be much more difficult to pick up in skin of color.
  • How other conditions, such as hemosiderin staining, may appear very different than they would in a patient with lighter skin.

Get your free webinarFree Webinar - Skin of Color

Are you ready to learn more about this topic and better address the wound care needs of your patients with dark skin?  Click here and use the code BLOG to access this 60-minute recording, which qualifies for an education credit.

More thoughts?

We’d love to know about your clinical experiences with skin of color: did you receive any official training regarding this topic, or have you mostly learned from your own personal experiences? Is your facility proactive in making sure clinicians are knowledgeable in how skin tone and color effect proper wound assessment? Tell us about your observations and experiences by leaving your comments below.

Wild on Wounds℠ (WOW) is the national wound conference designed for healthcare professionals that are interested in enhancing their knowledge in skin and wound management. Clinicians come from all over the US to see, touch and participate in our hands-on workshops. They also learn about all the new and advanced wound care treatments and technologies to better help care for their patients.  For more information visit www.woundseminar.com

Is it Really a Bruise? Get The Bigger Picture on Skin Lesions

Thursday, February 18th, 2016

In the world of wound care, clinicians define skin lesions precisely. So what might look like a bruise at first glance could really be a suspected deep tissue injury, purpura . . . or something else. Do you know the difference?

Bruise sDTI or Purpura?

If a picture is worth a thousand words, then in the world of wound care, the same can be said about the appearance of a lesion – where the blood has escaped the vessels and entered the skin. By paying close attention to the color and texture, you can determine if it is more than a simple bruise.

Knowing what to look for – and getting the bigger picture – helps us conduct better assessments. What appears at first glance to be a standard bruise could actually be anything from purpura or petechiae, to an ecchymosis or hematoma. Or wait . . . is it a suspected deep tissue injury (sDTI)?

These terms are often used interchangeably, but within wound care, clinicians define them more precisely.  Confused? Don’t worry, we’re here to help!

Bruise

A bruise (also known as a contusion), is a leakage of blood from the vessels into tissues, and is always the result of blunt force trauma.  Keep in mind that “blunt force” doesn’t necessarily mean your patient has been in a fist fight or hit with a baseball bat. The bruise can be the result of something as simple as bumping into furniture.

So is it a bruise? Here’s how to tell:

  • Bruises typically resolve within two weeks.
  • They are initially a dark maroon or reddish color (because the blood is oxygenated).
  • As the bruise ages, it progresses through the colors of a ripening banana – from green to yellow and then brown – before fading away. Note: these colors will be less obvious with darker skin, so as you make your assessment, compare the site with a symmetrical area, if possible.
  • The skin is always intact.
  • The damage can be superficial, it can be deep, or it can be a combination of the two.
  • The tissues may be painful and swollen, and there may be a localized temperature increase due to the inflammation.

Hematoma

A subdermal hematoma is a collection of blood in the skin, often clotted, bulging or mass-like.  It may be in just the epidermis and dermis, or down into the subcutaneous tissue.   A hematoma is not the same as a bruise, though you may find a hematoma within a bruise. The most common cause of a hematoma is injury or trauma to the blood vessels.

Purpura/Petechiae/Ecchymosis

Purpura consists of red or purple lesions that are similar to bruises, in that they are blood added to the skin tissues.  However, purpura spots are not the result of blunt force trauma. Instead, they are caused by either an inflammatory skin disease or a vascular problem. In addition:

  • Purpura spots don’t blanch when pressed.
  • There is usually no kind of pain associated with purpura.
  • Purpura may be palpable (that is, you can feel a rash-like texture with your fingers) or unpalpable.
  • Unpalpable purpura comes in different types, including petechiae, which are flat purpura spots under 3 mm. These pinpoint-sized spots may be quite difficult to identify in darker skin.
  • Flat purpura spots that are larger than 5 mm are called ecchymosis. These spots tend to be irregular in shape (ranging from a dark maroon to a purple), and can be seen on the skin or in the mucus membranes.

It’s important to note that ecchymosis and bruising are not the same thing, though you may hear some clinicians use these terms interchangeably. Again, ecchymosis is a kind of purpura, and is not caused by blunt force.

Suspected Deep Tissue Injury

Suspected Deep Tissue Injuries (sDTIs) also share some qualities with bruises in that they are non-blanchable, intact, and appear in similar colors – purple or maroon. Alternately, they may be a blood-filled blister.

But here’s the key difference: sDTIs are due to damage from pressure or shear, and not blunt force.  Therefore, you’re more likely to find them over a bony prominence and in patients with a history of immobility. The most common site for an sDTI is the heel.

When you touch the tissue of sDTIs with your fingertips, it could be painful, firm, mushy, boggy, and warmer or cooler compared to adjacent tissue.  It’s important to use palpation on all dark-skinned patients on high-risk areas, because visual assessment cannot be trusted. Swift identification of sDTIs is important because unlike bruises, which will resolve on their own, sDTIs can deteriorate rapidly, exposing additional layers of tissue despite treatment or offloading.

Do you know the difference?

Now that you’ve learned about the differences between bruises, sTDIs and other similar skin conditions, what do you think? Have you been able to distinguish the true identity of patient lesions in the past, or has it been difficult to properly assess them? Has your facility emphasized the need to distinguish between these types of lesions? And which type do you find the most difficult to identify? We’d love to hear more about your experiences – please leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Essential Steps for Skin Tear Prevention

Thursday, February 11th, 2016

Skin tears are a common condition for the patients we care for, which is why it’s so important for clinicians to know who is at risk, and what can be done to minimize them. 

Skin Tear Prevention

Painful. Disfiguring. Traumatic. Skin tears are all of these things, plus they can lead to further complications and serious infections. Unfortunately, they also happen to be a very common condition for the patients we care for. In fact, an estimated 1.5 million skin tears occur each year – and that’s just among institutionalized adults.

In addition to causing pain and discomfort, skin tears can be difficult to treat, and are a direct reflection of the quality of care delivered at our facilities. This is why it is imperative for clinicians to know who is at risk for skin tears, and what we can do to prevent them from happening.

Who is at risk?

Although skin tears can occur among all ages, the youngest and oldest patients are at the highest risk. This is due to the structure of both immature and aging skin. In addition, those who are dependent on caregivers for daily activities are particularly vulnerable, since they are regularly positioned and transferred for such things as bathing and dressing. Others who are higher at risk include:

  • Older adults who ambulate independently
  • Those who are critically ill or have multiple risk factors
  • People with a history of skin tears
  • Anyone with impaired mobility
  • Those with sensory or cognitive deficits
  • Patients with visible changes in the skin such as edema, dry skin or purpura
  • Patients on four or more regularly prescribed medications
  • Patients on specific types of medications, including analgesics, antidepressants, anticoagulants, and steroids
  • People who are agitated and combative – they are more likely to bump into objects
  • Those with cardiac, pulmonary or vascular disorders

Skin tear prevention

The truth is that skin tears are not completely preventable. Since part of our job is to support our patients’ independence and improve their quality of life, at some point or another, skins tears will occur. The good news is that, as caregivers, there are things we can do to keep them at a minimum.

Improve patient environments

A patient’s environment can be modified in simple ways that can make a big difference when it comes to skin tear prevention. For instance, you can make sure there is adequate lighting in your patient’s room or living space. Seniors, for example, typically need more light in order to see clearly and avoid accidents. Next, pad furniture corners and other objects that may cause blunt force trauma when bumped, and remove throw rugs that may buckle or slip.  In addition, ensure that the patient is not wearing rings or other jewelry that can snag the skin.

Care for skin properly

Proper skin care can can go a long way in preventing tears. Skin is better able to resist tearing when it’s well-nourished and hydrated, which means nutrition plays a key role. Therefore, consult with a dietitian about the patient’s diet, and make sure they are receiving adequate fluids.

Frequent baths can dry out the skin, which increases the likelihood of skin tears. This can be a problem when facility regulations mandate that patients must have daily or weekly full baths.  If you find that frequent bathing is contributing to dry skin, adjust the full-bath schedule to twice a week, with spot baths in between.  Also, it’s important that when administering a bath, you:

  • Use lukewarm water (not hot)
  • Use soapless, pH-balanced solutions with no rinse or emollient soap
  • Pat the skin dry – do not rub

To keep the skin hydrated following a bath, apply a moisturizing agent. The stratum corneum – or outermost layer of the skin – needs at least 10% moisture. Moisturizers should be applied while the skin is still damp (not completely dry and not soaking wet) to trap that moisture.

There are three types of moisturizers:

  • Humectants promote the retention of moisture, replacing the oils in the skin
  • Occlusives provide a layer of oil on the skin surface, slowing water loss
  • Emollients soften and spread easily on the skin.

A humectant will pull the moisture up from the dermis into the epidermis to help keep skin intact (it’ll even pull moisture out of the air in the room). But humectants need to be coupled with an occlusive product to trap the moisture. In other words, you need to add a layer of oil on the skin’s surface to slow down evaporation.

Meanwhile, we want our skin to be able to slide, right? And that’s the role of emollients. They make the stratum corneum smooth and less susceptible to friction, which can create that skin tear.

More strategies for prevention are to cover fragile skin with long sleeves, pants and knee-high socks, or products such as DermaSaver® or Posey® SkinSleeves™.  If something rubs up against the patient, the clothing or the device will move and hopefully not tear the epidermis from the dermis.

Be gentle, learn more

It goes without saying that we should be extra gentle when lifting, repositioning or transferring patients. By taking your time and softening your touch when caring for those at higher risk of skin tears, the frequency of such occurrences can be decreased.

Educating ourselves and our patients is also an important part of preventing skin tears. We need to understand the risk factors, keep the skin as nourished and moisturized as possible, avoid dangerous edges and surfaces in the environment, and treat patients gently.Skin Tear Webinar Coupon Code

For even more details on the prevention, staging and treatment of skin tears, view this free one-hour webinar recorded at the 2015 Wild On Wounds (WOW) National Conference. For access, click here and use the code SKINTEARS.

What do you think?

Were you already aware of who is most at risk for skin tears, and does this affect how you treat patients? And are there any preventative measures you regularly put in place that seem to help? If you have additional ideas, or any stories to share, please leave them below!

 

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

 

Warm Wound Healing? It’s All About Foam Dressings

Thursday, February 4th, 2016

Keeping a wound warm is an important part of wound care treatment, and foam dressing does the trick because it effectively maintains optimum temperatures and promotes healing. 

Foam for Warm Wound Healing

 

For wound care clinicians – and anyone else who ever treats wounds – it’s important to know that moist wounds heal faster. However, moisture on any surface (including wounds) will begin evaporating when exposed to air, and at a quicker rate as the surface cools. So the challenge of healing wounds effectively is to keep a wound moist and warm. Fortunately, foam dressings maintain optimum healing conditions, and help our patients heal faster.

Why warm is better

As wound tissues lose moisture, a cooling effect occurs in the wound. Because cells and enzymes function optimally at normal body temperature, a drop of just 2 °C is sufficient enough to negatively affect the biological healing process.

In fact, when a wound dressing is changed, it can take a wound base temperature up to four hours before it returns to normal. This is an important factor to consider when anticipating healing times, as well as when prepping your patient for a dressing change. Additionally, when tissue cooling occurs, it can lead to a higher risk of infection due to vasoconstriction, and hemoglobin’s increased need for oxygen. This, in turn, decreases the amount of oxygen available for neutrophils, which fight infection.

So how does this all tie in to dressings? By using the right type of dressings – and applying them properly – you can create an optimum environment for wound healing. The dressing that keeps the wound bed the warmest is foam.

Foam Dressing

Semipermeable polyurethane foam dressing is nonadherent and nonlinting. It has a hydrophobic or waterproof outer layer, and provides a moist wound environment. Other characteristics of foam dressing include:

  • It is permeable to water vapor, but blocks the entry of bacteria and contaminants
  • It can be purchased in various thicknesses, with or without adhesive border
  • It is available in pads, sheets, and cavity dressings

Consider using foam as primary or secondary dressing for partial- and full-thickness wounds, with minimal to heavy drainage. In addition, foam dressing:

  • Works well for granulating and epithelializing wounds
  • Provides insulation to keep wounds warm
  • As secondary dressing for wounds with packing
  • Can be used to absorb drainage around tubes
  • Helpful for hypergranulation tissue along with compression

The advantages to using foam dressing on wounds are that it:

  • Provides moist wound healing
  • Doesn’t adhere to the wound
  • Provides cushioning
  • Is easy to apply and remove
  • Can be used with infected wounds
  • Provides a bacterial barrier
  • Is effective with hypergranulation
  • Can be used under compression
  • Can be cut to accommodate tubes

The disadvantages to using foam dressing on wounds include:

  • It could be expensive if exudate requires daily dressing changes
  • Wound beds may desiccate if there is no exudate from the wound
  • A secondary dressing might be required
  • If it becomes saturated, it can lead to maceration of the periwound
  • It is contraindicated for use with third-degree burns, dry eschar, and sinus tracts

What do you think?

Knowing that moist and warm wounds heal faster obviously makes using the right dressings (and applying them properly) crucial to effective wound care. Do you regularly use foam dressings, and have you noticed a difference in healing time? And have you learned any special application techniques that help keep wounds at an optimum body temperature? We’d love to hear about your experiences – please leave your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Exudate: The Type and Amount Is Telling You Something

Friday, January 29th, 2016

Wound care clinicians need to know about the different types of exudate – and how much is present – for successful wound treatment and healing.

Know Your Exudate

Ooze. Pus. Secretion. 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. And while we want wounds to be moist, we don’t want them to be overly moist. Finding that balance can sometimes be a bit tricky – which is why it’s so important to know all about exudate.

Types of Exudate

First, let’s start with the types of exudate we most commonly see in our patients’ wounds. They are:

  • Serous – a clear, thin and watery plasma. It’s normal during the inflammatory stage of wound healing, and smaller amounts are considered normal. However, a moderate to heavy amount may indicate a high bioburden.
  • Sanguinous – a fresh bleeding, seen in deep partial- and full-thickness wounds. A small amount is normal during the inflammatory stage.
  • Serosanguineous – thin, watery and pale red to pink in color.
  • Seropurulent – thin, watery, cloudy and yellow to tan in color.
  • Purulent – a thick and opaque exudate that is tan, yellow, green or brown in color. It’s never normal in a wound bed, and is often associated with infection or high bacteria levels.

Quantity of Exudate

Besides knowing the different types of exudate, you also need to be aware of the amount present in your patients’ wounds. This can be key for proper assessment, and help you choose the best wound treatment. The different exudate levels include:

  • None present – the wound is dry.
  • Scant amount present – the wound is moist, even though no measurable amount of exudate appears on the dressing.
  • Small or minimal amount on the dressing – exudate covers less than 25% of the bandage.
  • Moderate amount  – wound tissues are wet, and exudate involves 25% to 75% of the bandage.
  • Large or copious amount – wound tissue is filled with fluid, and exudate covers more than 75% of the bandage.

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.

What do you think?

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.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

 

Destination WOW? Be a Poster Presenter

Thursday, January 21st, 2016

Wild on Wounds conference attendee shares a wound-care mystery through her first-ever poster abstract, and has a message for fellow clinicians: “Don’t give up!”

Susie Lee, RN WCC, was the 2015 WOW Grand Prize recipient in the poster presentations.

Susie Lee, RN WCC, was the 2015 WOW Grand Prize recipient in the poster presentations.

Susie Lee, RN WCC, traveled from Honolulu, Hawaii last year to attend the Wild on Wounds National Conference (WOW) for the first time, and all because of a challenging wound care case. A nurse for 38 years (and specializing in wound care for the past 10 years), she submitted a poster abstract in order to share her experience with fellow clinicians and conference attendees.

At the time, Susie had never created a clinical poster before, let alone one of such magnitude. And on top of that, she had never been asked to present a case for such a large audience. But this opportunity was a perfect fit for WOW attendees, because they love learning and finding ways to better help and care for wound care patients.

Little did she know that her entry (and all the hard work that went with it) would not only be a smashing success, she would go on to receive the coveted Grand Prize, plus a complimentary conference registration for WOW 2016. The icing on the cake was that she enjoyed learning more about her passion – wound care – in a lively, fun and inspirational environment while attending the WOW conference.

The Case

So what was Lee’s poster topic? It all started with an old wound that refused to heal. Located around a patient’s colostomy site, the wound was a tricky one, accompanied by intermittent appliance leakage. But the kicker? The patient wasn’t feeling pain.

“It was so frustrating,” says Lee. “The wound would get better for months at a time, but then suddenly flare up again. After trying different methods of treatment, none of which seemed to work I researched symptoms and scoured the Internet, looking for related articles, photos and any clue that might help find a solution. A  dermatologist could not provide any diagnosis, so I finally consulted with another wound care nurse colleague.”

Again, since the patient wasn’t feeling any pain, it was more difficult to diagnose. But finally Lee experienced an aha moment. She learned that the patient had suffered from a stroke on her left side (where the colostomy was), which had caused extensive nerve damage. This suddenly explained the patient’s lack of pain.

The diagnosis? Peristomal pyoderma gangrenosum – a rare condition that causes large, painful ulcers to develop in the area surrounding an abdominal stoma. Working with a nurse practitioner, Lee decided to apply a high-dose of topical steroid cream. And guess what? It worked.

The WOW Experience

Although Lee’s case was difficult, the successful outcome – and the opportunity to share her story so that others might learn from it – inspired her to create the first poster presentation of her life. Being named the Grand Prize recipient was a surprise, for sure. But it was her message that meant even more. “The bottom line for me was to tell other clinicians that no matter how long it takes, don’t give up!” she says. “It’s such a great satisfaction to get a stubborn wound healed – for the patient, certainly, but also for you!”

Attending her first WOW conference was extra special because Lee’s daughter came with her to see the presentation. “It was kind of a role reversal,” she says. “My daughter came to see me participate in something. She was impressed with my poster, and it was nice for her to be proud of me, just like I’m always proud of her!”

As for her WOW trip, Lee says that she loved every minute. “I’ve been to other conferences, and they were really nice, but WOW is a whole other experience,” she says. “They had so many sessions and resources – on topics that I have to deal with every day. I met so many great people, and it was well worth the trip. WOW makes learning fun.”

A Little Background on Susie

Lee’s first class with the Wound Care Education Institute (WCEI) was in 2004, when she completed the Skin and Wound Management course presented by Nancy Morgan, WCEI Co-Founder.  Later, she sat for the Wound Care Certified Examination provided by National Alliance of Wound Care and Ostomy, and then became a WCC. “No doubt about it, my career path is a direct result of WCEI,” she says.

More about WOW

What have your experiences at WOW conferences been, and how many times have you attended? What were your favorite moments, sessions or experiences? Please leave your comments below. And if you’re interested in sharing the details of an unusual or particularly challenging case, get your 2016 Poster Submission Form here. We can’t wait to see you in Las Vegas!

To learn more about the case, “Atypical Presentation of Peristomal Pyoderma Gangrenosum,”  see Lee’s article in the Jan/Feb 2016 issue of Wound Care Advisor.