What is Exudate?
By Nursing Home Law Center
When a patient develops a bedsore, pus and other fluid can leak out of blood vessels and into other tissues. The pus is made of cells, proteins and other solid materials. This material is called exudate.
Often, exudate can dry and crust over a wound. This makes it hard to assess the severity of the bedsore. A wound vac may be applied to get rid of the exudate and allow the wound to heal.
What is a Bedsore?
A bedsore forms when a patient has been lying immobile for too long. The pressure of the mattress or other surface on the body cuts off the blood flow. When the blood flow is cut off, the tissues in the area become deprived of oxygen and eventually die.
When they die, the dead skin breaks up and exposes the tissue underneath. A wound like a crater forms and this wound is called a bedsore. It can also be called a pressure sore or a decubitus ulcer.
Pressure sores grow in severity over time, and this severity determines their category.
- Stage I. At the first stage, the bedsore has not yet formed a wound. The skin is intact although it is red in color. After a while it may deepen into a purple hue. The affected skin may be harder than the skin around it, and may also be warm to the touch. Often there is swelling in the area.
- Stage II. At the second stage there is dead skin which has broken open. Abrasions may form, and so may blisters. Infection is now a risk since there is an opening in the protective layer of skin.
- Stage III. The third stage is more critical. The skin has now worn away and revealed damaged tissue underneath. It may exude a foul odor and the infection risk is elevated.
- Stage IV. The last stage of the bedsore is considered life-threatening. The tissue underneath the skin is gone now and the muscle and bone underneath can be seen. Infection is a virtual certainty. Damage occurs to the muscle and bone; patient requires immediate treatment.
Where do Bedsores Usually Form?
Pressure sores can form anywhere on the body. All that is required is pressure against a surface applied over time with few or no intervals of relief. Certain parts of the body are more likely to sustain pressure when a patient is immobile, and these can vary depending on the position the patient is in.
Body parts with little fat are at increased risk of developing bedsores. Fat can act as a cushion to relieve pressure. Without it, some parts of the body are more vulnerable.
The body parts that most frequently develop bedsores are:
- Back of head
- Ankles
- Heels
- Hips
- Lower back
- Knees
- Spine
What Treatment is There for Bedsores?
- Debridement. Debridement is the removal of dead or necrotic tissue. Removing this tissue allows healthy tissue to grow back which heals the wound. There are various methods of debriding a wound, including surgical, chemical, mechanical, autolytic and biological. The choice depends on the particular circumstances of the case.
- Wound Vacs. A wound vac is applied to a bedsore to get rid of exudate and dead tissue. The wound vac continues to drain exudate while a foam-like substance fills the wound. This will prevent infection and allow the bedsore to heal. A wound vac is often used after a debridement.
- Flap Reconstruction Surgery. If a bedsore is severe, it may leave a gaping crater that will not fully heal on its own. A surgeon may perform a flap reconstruction, wherein he takes healthy skin from another part of the body to close over the wound.
- Colostomy. A colostomy bag collects waste from the body and prevents fecal matter from getting into the wound. It also helps keep the skin dry, which aids in fighting bedsores.
- Amputation. As a last resort, a severe bedsore may necessitate the removal of a limb, in whole or in part.
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