Are you able to distinguish sanguineous drainage from other exudate types? And do you know what it signifies for a wound and how to treat it?

Like serous exudate, sanguineous can be a common occurrence in some wounds. And while at times this can be typical, it can raise some concerns for both patients and clinicians alike.

To learn more, we spoke with two wound care experts, who shared more about the causes of sanguineous drainage, challenges, and how to address it effectively.

Defining sanguineous drainage

Sanguineous exudate is the fluid released from a wound, recognized by its vibrant red color caused by the presence of blood, said James Akindunbi, MSN, AGNP, WCS-C, a wound care nurse practitioner at ReNew Wound Care in Flossmoor, Illinois.

This drainage occurs in the early stages of wound healing as a natural reaction to injury, where blood and plasma are released from damaged blood vessels, he said.

“Sanguineous exudate is a normal part of the inflammatory phase of wound healing and is commonly seen in fresh surgical wounds or traumatic injuries,” said Akindunbi. “However, excessive or prolonged sanguineous drainage may indicate inadequate wound healing, infection, or other complications and should be carefully monitored by healthcare professionals.”

What it reveals

When sanguineous drainage is present, it can indicate trauma-associated edema and bleeding. But sometimes, it can point to something more ominous, such as the presence of a hematoma, said Brian Evans, MD, a board-certified plastic and reconstructive surgeon and Director of the Wound Care and Hyperbaric Medicine Programs at West Hills Hospital and Medical Center in West Hills, California.

This drainage can also be an early indicator of infection. “The presence of sanguineous wound exudate is a sign that should alert you to the fact that something is going on, and you need to investigate it further,” Evans said.

And according to Akindunbi, it’s also important to consider other factors to determine the underlying cause, including:

  • The amount of exudate
  • The overall wound appearance
  • Any accompanying symptoms

Physical characteristics

Monitoring sanguineous drainage and its characteristics is crucial, as it provides valuable information about the healing process and potential complications, Akindunbi said.

He described the following features of this exudate type:

  • Color: It appears bright red, indicating the presence of blood.
  • Consistency: It is often thin and watery.
  • Odor: It may have a metallic or iron-like odor due to the presence of blood. In some cases, sanguineous drainage may not have any noticeable odor.

If sanguineous is malodorous, it can indicate an early stage of an infectious process, Evans added.

Common treatment methods

According to Evans, when you see this exudate, it is imperative you conduct a history and physical first to determine the etiology.

“Is the sanguineous wound exudate due to trauma, a burn, an infectious source, or an insect bite?” he said. “You need to identify the cause first. Once you do that, it guides your direction for providing the appropriate treatment.”

Evans described the following steps for treating wounds with this drainage:

  • Determine the underlying etiology.
  • Clean the wound with saline, or if an infection is suspected, use Dakin’s, Vashe, or chlorohexidine.
  • Apply a topical antibiotic if you suspect an infection.
  • Utilize systemic medications as indicated.
  • Wrap with a clean, compressive dressing.

In addition to these steps, Evans added it can help to use elevation and immobilization as needed.

For patients cleaning a wound at home, Evans said, “Good old-fashioned soap and water, which utilizes mechanical cleansing of the wound, may be as beneficial as using a saline wash.”

Akindunbi said treatment modalities usually involve cleaning the wound, removing dead tissue, and using suitable dressings.

“Treatment may also include using topical antibiotics to prevent infection, as well as systemic medications to address any underlying issues that may be hindering the healing process,” said Akindunbi.

Topicals to consider:

According to Evans, if bacteria are suspected or present and your patient does not have any contraindications or allergies, the following topical antibiotics can be considered:

  • Neosporin
  • Polysporin
  • Gentamycin
  • Bacitracin

Dressings to consider:

To manage sanguineous exudate, Akindunbi said, absorbent dressings can also be used such as:

  • Silver foam or alginate silver (to control fluid and create a moist environment for healing)
  • Silver nitrate sticks (commonly used to stop minor bleeding)

Possible challenges with sanguineous drainage

Evans cited two main challenges when treating wounds with sanguineous drainage:

  • Accurate and timely identification of the wound’s etiology, which directs your treatment
  • Ensuring there is an adequate blood supply to the wound

It’s paramount that the patient’s wound has a good blood supply. Without an adequate blood supply, it will be difficult to achieve wound healing, he said.

He added that patients are at a higher risk for compromised blood flow if they have comorbidities, including:

  • Diabetes
  • Peripheral artery disease (PAD)
  • Peripheral venous disease (PVD)
  • Heart failure
  • Renal failure

Another challenge when treating wounds with this drainage may include excessive bleeding, especially in cases of severe trauma, vascular compromise, infection, or poor wound healing, Akindunbi said.

“Maintaining optimal wound healing conditions when continuous exudate production is present and managing the associated pain and discomfort for the patient are imperative,” he said.

It’s crucial to monitor the amount and consistency of any ongoing sanguineous drainage to assess the healing progress, look for any signs of infection, and identify any potential complications, he added.

The power of patient education

“Teaching patients the correct methods for caring for their wounds and how to recognize the signs of complications are crucial for achieving successful healing results,” said Akindunbi.

For complex cases, working as a team with experts such as wound care specialists, nurses, and surgeons may be needed for thorough wound management.

“Monitoring wounds closely with proper assessment and skilled management are essential for optimum patient outcomes,” he said.

If you're interested in expanding your knowledge of wound care, networking with colleagues, or seeing the latest wound care innovations, register for the Wild on Wounds (WOW) conference August 14–17 in Phoenix, Arizona.

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Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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