Wound exudate types

BY: NANCY MORGAN, RN, BSN, MBA, WOCN, WCC, CWCMS, DWC

What exactly is wound exudate? Also known as drainage, exudate is a liquid produced by the body in response to tissue damage. We want our patients’ wounds to be moist, but not overly moist. The type of drainage can tell us what’s going on in a wound.

Let’s look at the types of exudates commonly seen with wounds.

  • Serous drainage is clear, thin, watery plasma. It’s normal during the inflammatory stage of wound healing and smaller amounts is considered normal wound drainage. However, a moderate to heavy amount may indicate a high bioburden.
  • Sanguinous exudate is fresh bleeding, seen in deep partial-thickness and full-thickness wounds. A small amount may be normal during the inflammatory stage, but we don’t want to see blood in the wound exudate, as this may indicate trauma to the wound bed.
  • Next we have the famous serosanguineous exudate, which is thin, watery, and pale red to pink in color. It seems to be everyone’s favorite type of drainage to document, but unfortunately, it’s not what we want to see in a wound. The pink tinge, which comes from red blood cells, indicates damage to the capillaries with dressing changes.
  • Seropurulent exudate is thin, watery, cloudy, and yellow to tan in color.
  • Purulent exudate is thick and opaque. It can be tan, yellow, green, or brown in color. It’s never normal in a wound bed.

So what types of drainage do you see being documented? The famous serosanguineous exudate? Are you really seeing drainage that indicates trauma to the wound bed, or is the drainage type mislabeled? Are you rethinking the need for a contact layer on the wound bed now?

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20 thoughts on “Wound exudate types

  1. Hello,
    I had a mastectomy 5 weeks ago. While most of the incision is healed, there is an opening which is producing large amouts of serous drainage requiring dressing changes twice a day. There is no infection and my surgeon says this is normal and will stop when the skin heals/closes. My concern is the length of time it has been and possibly will be, and the amount of exudate. The opening is a little larger than a quarter coin in size. Any comments or thoughts would be greatly appreciated!
    Thank you,
    Holly

  2. Hi Holly,
    I wish that I could give you a concrete answer on your wound here, but every surgical patient and surgical wound is different… my only advice is to keep the faith and continue to follow up with your surgical and wound care team! As with any wound that is slow to heal we always want to be sure that our patients are meeting their nutritional goals and if we as wound care clinicians aren’t getting the healing for our wounds that we would expect after a certain time frame, we might refer our patient for an advanced type of treatment/or modality to help speed things along if appropriate – hyperbaric oxygen therapy or negative pressure wound therapy for example. These are things you can always ask your surgical team or wound care team about and get more information on :)
    Good luck!

  3. I HAVE A PATIENT THAT HAS A VENOUS ULCER, ITS DRAINING GREEN EXUDATE, I AM USING ALGINATE SILVER TO THE WOUND AND USING COMPRESSING. WHAT DO U RECOMMEND

  4. I had an gental infection in front and on the outer ,this is said to have been from my wife who has been strungling with verginal yeast for years now. It was inflamatory at first and now it has developed a wound on the urethinties this wound pass some yellow exudate which becomes think and closes the passing out of urine i am a male aged 45 . After cleaning it , it stats again what should i do for my healing

  5. Hi Obrien,
    It sounds like you still have some effects of the genital infection present. I would recommend you go to your MD immediately to get this re-evaluated as this could become worse and may need medical treatment/intervention. Good luck!
    Nancy WCEI

  6. I have a small wound on my feet due to the small bumps with water inside it, I pop it using a pin but after that I thought it was okay but it releases water everytime

  7. Hi Judito,
    I am not sure what kind of wound you have or what caused it but in general it is best not to “pop” blisters. The fluid inside the blister is filled with cells of repair and actually aide in the healing process. The experts say that it is best to leave it alone and let the body do its job. When we open or “pop” the blisters then we are creating away for bacteria to get inside and are putting ourselves at risk for infection. It really is best to leave the blister intact, let it “dry” up and reabsorb on its own without popping it. :)
    Thanks,
    Nancy WCEI

  8. I had surgery to shave a tailor’s bunion and to remove the toenails off my big toes. Was in the ER om the 3rd, told I have cellulitis. On two antibiotics now. Noticed thin neon yellow line of exudate when changing nab dates on incision site? I don’t have another appointment until Thursday. Also, the big toe on the same foot is hurting more. Surgery was 12/17/13. Thanks

  9. Hi
    I have had 9 stitches on my ankle removed and still 1 week later it oozes sticky brown pus. I am on antibiotics.. But it doesn’t seem to be stopping. Although the cut was to the bone,is it normal to still be seeing this?

  10. Sam not the norm at all glad you are seeing your MD on this and you are on antibiotics! Cause we don’t want this to infect the bone. I would follow up with your MD on this…..you should see it getting better not staying the same or getting worse.

  11. I’m sorry to trouble you, but any help you can give me would be appreciated. I had a smash/crush injury (bite without broken skin) to my thigh in Feb. A hematoma apparently developed that was encapsulated and couldn’t drain but from the outside the area just looked badly bruised and swollen like a baseball. On 2/22, the 1st surgeon aspirated the hematoma but didn’t check for necrotic tissue, and when swelling returned in the area, 5 days later a different surgeon had to operate to remove the necrotic tissue (he cupped his hands like a baseball and said that was the amount of tissue he had to remove.) He placed a Jackson-Pratt drain in, which he removed two weeks later, but the wound site (about 8 inches long on thigh) keeps filling up. Since he took out the J-P drain, he has aspirated it with a needle once and removed 30 cc’s (on Wed.). Today is Friday and it has already completely filled up again. He is out of the office. My question is, is this normal and OK for it to fill up again so quickly? Do I just wait until Monday and don’t worry about it? Again, any help you can give me would be most appreciated!!

  12. I have a total knee that was infected. had 7wks of IV antibiotics and now on oral. a]Now 4 months post op I have developed a serolus leak that unless elevated needs 2-4 dressing changes a day even though it is wrapped with ace bandage. Major worry is my lower leg at mid thigh are is 2 inches bigger than other. is this going to be permanent? and where does the fluid come from at this late post op stage?? and how is it going to be stopped. I can not sit all my life with leg elevated and do nothing.

  13. I had a 1st compartment dorsal release 8 days ago. I have had multiple issues with nerve entrapment. The 2 inch incision has closed about 75% of incision line however in 1 are it has opened a hole even tho I still have internal stitches. It constantly has a white foam that bubbles out of it. There is no odor but it is a large amount. I cant seem to figure this one out. Help lol.

  14. I have a new loop illeostomy and on top the margin has developed an abscess that is over 6 cm deep. It constantly drains and I can’t keep a illeostomy appliance on. I am suppose to be getting some aqua cel rope to pack with but now using me salt. I need help to keep the stool out and cover the abscess so the drainage will let a wafer stay.

  15. @Julie aquacel rope is a good option to use it will absorb drainage and buy you longer wear time. They even have that with “silver” called Aquacel AG this would be used if you have any signs of infection locally in case stool got in there. Silver will help with bacteria load.

  16. i have once heard of this evisceration that can result in wound layers protruding through the skin,so can there be other means of controlling this effect and when does it really occur?

  17. Evisceration is when separation occurs of all the incision/wound layers and may lead to the internal organs, usually the bowel, protruding through the open surgical wound – a very serious complication that requires immediate medical intervention. Prevention includes infection prevention and following post-op surgeon orders with lifting and splinting/bracing to support the incision line.

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