Wound Exudate and Super-Absorbent Dressings with High Fluid Retention Capacity: The Disconnect Between Clinical Perception and Documentation

Background: Superabsorbent dressings (S-ADs) are used for moderate to high exudating wounds, though fluid retention capacity may differ between manufacturers due to both design and construction. Because of their ability to retain exudate without peri-wound maceration, S-ADs reduce dressing change frequency. In vitro studies demonstrate S-ADs can reduce inflammatory matrix metalloproteases and bioburden. Despite this, dressing availability is often governed by regulatory requirements based on amount of exudate. Under the current Medicare Surgical Dressing Benefit, S-ADs can be obtained on daily, assuming documentation in the medical record reflects moderate to large amounts of drainage. Unfortunately, exudate amounts are often based on the perception of the user, and not on clinically reliable and valid methodologies. Unintentionally, a clinician can categorize drainage on a S-AD as “scant/minimal” or “low” exudate when the fluid capacity of the S-AD is “large”.

Method: 20 wound clinicians were first asked to determine how many cc’s would constitute the amount of drainage on the S-AD continuum in terms of “scant”, “small/minimal”, “moderate”, “large/copious”. Using a S-AD that holds a minimum of 500 cc exudate*, they were then shown a S-AD dressing impregnated with fluid levels of 10 cc, 50cc, 100cc, 150cc and 200 cc and asked to describe the amount of drainage in the scant to large continuum in a random order.

Results: There was a disconnect between the perception of exudate along a continuum on a S-AD dressing with high fluid retention capacity and that of the clinician, often underestimating the amount of fluid in the S-AD dressing.

Conclusion: The underestimation of fluid capacity of a S-AD dressing when documenting exudate amount can affect treatment decisions and S-AD availability under the Surgical Dressing Benefit. Clinicians using S-ADs should familiarize themselves with exudate retention ability and its clinical appearance in order to provide accurate medical record documentation.