How to care for wound drainage safely and effectively

According to Cleveland Clinic, serous wound drainage is a normal and healthy part of the body's healing process. Knowing the different types of wound fluid and the proper techniques for managing it is a critical skill for anyone needing to care for wound drainage at home.

Quick Summary

This article explains how to identify and manage different types of wound drainage, from healthy, watery discharge to signs of infection. It details the proper steps for cleaning and changing dressings and outlines when to consult a healthcare professional.

Key Points

• Identify Drainage Types: Recognize the four main types of wound drainage—serous, sanguineous, serosanguineous, and purulent—to assess healing progress or potential infection.

• Practice Proper Hygiene: Always wash hands thoroughly before and after handling a wound or changing a dressing to prevent infection.

• Choose the Right Dressing: Select an appropriate absorbent dressing (e.g., foam, alginate, or superabsorbent) based on the volume of drainage to manage moisture and protect the surrounding skin.

• Manage Surgical Drains Correctly: If using a surgical drain, follow specific instructions for emptying the reservoir and stripping the tubing to maintain suction and prevent clogs.

• Know When to Seek Medical Help: Be vigilant for signs of infection, such as thick, colored, or foul-smelling drainage, fever, or increased pain, and contact a healthcare provider immediately if they appear.

• Protect Surrounding Skin: Use barrier films or creams to prevent the skin around the wound from becoming macerated or damaged by excess fluid.

Understanding the Types of Wound Drainage

Understanding the fluid coming from a wound, known as exudate, is crucial for assessing its healing progress and knowing when to seek professional help. Drainage can vary in color, consistency, and amount, with different types indicating different stages of healing or potential problems.

Serous Drainage

Serous drainage is a thin, clear, or pale yellow watery fluid. It is the liquid portion of the blood plasma that seeps out into the wound. This type of drainage is normal and indicates that the healing process is progressing well, particularly during the early inflammatory stages.

Sanguineous Drainage

Sanguineous drainage is fresh, red blood, and its appearance indicates active bleeding. A small amount is normal immediately after an injury or surgery. However, if the drainage is copious or persists for an extended period, it may signal an underlying issue that requires medical attention.

Serosanguineous Drainage

This is a mix of serous and sanguineous fluids, appearing as a thin, watery, pink, or light red discharge. This type of drainage is also a normal part of the healing process, especially during the later inflammatory and proliferative stages.

Purulent Drainage

Purulent drainage, or pus, is a thick, milky fluid that can be yellow, tan, brown, or green. It is composed of dead cells, tissue, and bacteria. This is a clear sign of a wound infection and almost always requires medical evaluation and treatment. It is often accompanied by a foul odor.

Step-by-Step Guide to Changing a Draining Wound Dressing

Proper dressing changes are essential for managing wound drainage, preventing infection, and promoting healing. Always follow your healthcare provider's specific instructions, but here are the general steps:

1. Gather Supplies: Collect everything you will need before you begin. This includes a trash bag, clean gloves, saline or wound cleanser, sterile gauze pads, absorbent dressings (e.g., foam or alginate for heavy drainage), tape, and any prescribed ointments.
2. Wash Your Hands: Vigorously wash your hands with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
3. Prepare a Clean Surface: Lay out your clean supplies on a disinfected surface to maintain a sterile field.
4. Remove the Old Dressing: Put on a pair of clean, non-sterile gloves. Carefully remove the tape and old dressing. If it is sticking, use a small amount of saline or warm water to loosen it to avoid damaging new tissue.
5. Dispose of Waste: Place the old dressing and gloves into a plastic bag and seal it.
6. Clean the Wound: Put on a fresh pair of gloves. Gently clean the wound and the surrounding skin with saline or a mild soap and water, wiping from the center of the wound outward. Avoid harsh solutions like hydrogen peroxide, as they can damage delicate new cells.
7. Dry the Area: Pat the surrounding skin dry with a fresh piece of sterile gauze.
8. Apply New Dressings: Depending on the type and amount of drainage, select the appropriate dressing. For example, use absorbent dressings like foams or alginates for moderate to heavy drainage, or hydrocolloids for lighter drainage. Secure the new dressing firmly with tape.
9. Final Clean-up: Dispose of all remaining waste and gloves. Wash your hands thoroughly once more.

Managing Common Surgical Drains

For surgical wounds, doctors often place drains to remove excess fluid and prevent buildup, such as the Jackson-Pratt (JP) or Hemovac drains. Care for these drains involves monitoring and emptying them regularly.

• Emptying the Drain: Empty the collection bulb or reservoir when it is about half full to maintain suction. Follow these steps:
  1. Wash your hands and put on gloves.
  2. Open the plug on the reservoir.
  3. Empty the contents into a measuring cup.
  4. Squeeze the reservoir bulb flat and replace the plug while it is compressed to re-establish the vacuum.
  5. Record the amount and appearance of the fluid.
• Stripping the Tubing: Some surgical drains require stripping or milking the tube to prevent clogs. Your healthcare provider will give specific instructions on this technique.

When to Seek Medical Attention

While some wound drainage is normal, certain signs indicate a potential problem that requires professional medical evaluation. Consult your healthcare provider immediately if you experience any of the following:

• Change in Drainage: Any change in color, consistency, or odor, especially a milky, thick, or foul-smelling discharge.
• Increased Drainage: A sudden and significant increase in the volume of drainage, or if the dressing becomes soaked quickly.
• Increased Pain: Worsening or new, severe pain at the wound site.
• Spreading Redness: Redness around the wound that spreads or a red streak extending from the wound site.
• Swelling and Warmth: Increased swelling or warmth around the wound.
• Systemic Symptoms: Fever, chills, or a general feeling of being unwell.
• Excessive Bleeding: Sanguineous drainage that does not stop or is gushing.

Comparing Normal vs. Abnormal Wound Drainage

Feature	Normal Wound Drainage	Abnormal Wound Drainage
Appearance	Clear to pale yellow (serous) or thin, light pink/red (serosanguineous).	Cloudy, thick, yellow, green, or brown (purulent).
Consistency	Thin, watery fluid.	Thick, milky, or pus-like.
Odor	None to very minimal.	Often foul or unpleasant.
Amount	Decreases over time as the wound heals.	Increases, requiring more frequent dressing changes.
Associated Symptoms	Typically none, though mild swelling and redness are normal early on.	Increased pain, swelling, warmth, redness, fever, or chills.

Dressing Options for Wound Drainage

Selecting the right dressing is vital for maintaining a moist wound environment without causing maceration of the surrounding skin.

• Foam Dressings: Highly absorbent and conformable, ideal for moderate to heavily draining wounds. Some have adhesive borders to secure them.
• Alginate Dressings: Derived from seaweed, these form a gel upon contact with exudate, making them effective for heavy drainage. They should not be used on dry wounds.
• Hydrocolloid Dressings: Best for low to moderate drainage, these dressings help maintain a moist environment. They have a waterproof backing and gel as they absorb fluid.
• Superabsorbent Dressings: For very heavy drainage, these specialized dressings can handle large volumes of fluid and help reduce the frequency of dressing changes.
• Barrier Creams and Films: Protect the skin surrounding the wound from the damaging effects of excessive moisture.

For more in-depth information on different dressings and wound care techniques, consult resources from reputable institutions like The Cleveland Clinic.

Conclusion

Effectively managing wound drainage is a fundamental aspect of promoting proper healing and preventing complications like infection. By understanding the different types of drainage and what they signify, individuals can confidently monitor their wound's progress. Adhering to strict hygiene protocols during dressing changes and using appropriate absorbent materials are key practices. Equally important is knowing when to recognize abnormal drainage or other signs of infection, such as increased pain, swelling, or systemic symptoms like fever, and seeking immediate medical help. Following these guidelines ensures a safe and effective recovery process.

Frequently Asked Questions

What does clear wound drainage mean?

Clear or pale yellow, watery fluid, known as serous drainage, is a normal and healthy sign of the body's healing process, especially in the early stages.

When should I be concerned about wound drainage?

You should be concerned if the drainage becomes thick, cloudy, or foul-smelling; increases significantly in volume; or is accompanied by signs of infection like fever, increased pain, or spreading redness.

How often should I change a dressing for a draining wound?

The frequency of dressing changes depends on the amount of drainage. Change the dressing at least once a day, or more often if it becomes soaked or dirty.

What type of dressing is best for heavy wound drainage?

For heavy drainage, highly absorbent dressings like foams, alginates (made from seaweed), or superabsorbent dressings are best. They effectively manage excess fluid and prevent skin damage.

What is purulent drainage?

Purulent drainage is thick, pus-like fluid that is typically yellow, green, or brown. It is a clear sign of a wound infection and requires prompt medical attention.

Can I use hydrogen peroxide to clean a draining wound?

No, it is not recommended. Harsh cleaners like hydrogen peroxide can damage the new, delicate cells that are forming, which can slow down the healing process.

What is maceration and how do I prevent it?

Maceration is the softening and breakdown of skin caused by prolonged exposure to moisture, such as wound fluid. To prevent it, use absorbent dressings that effectively lock fluid away from the surrounding skin and consider using a protective barrier cream or film.