Drainage of Abscess

Figure 42.1

Ultrasound of abscess demonstrating fluid present (Courtesy of Sarah Smith)

Contraindications to bedside or in-office drainage of an abscess would include the following and require specialization or additional anesthesia: Large size of abscess, location requiring specialization (face, eyes, hands, feet), extensive cellulitis without fluid collection, and conditions that require pre-medication such as anti-coagulation or pre-operative antibiotics [3].

Positioning and Anesthesia

Positioning for drainage of an abscess is based on abscess location and patient’s tolerance and comfort as well as ergonomics of the provider.

Anesthesia for abscess drainage can generally be achieved with local anesthetic using 1 % Lidocaine with epinephrine to minimize bleeding. If area to be anesthetized is at genitalia, the nipple/areolar complex or an area with low vascularity, it is appropriate to forgo the epinephrine. With purulent infections, complete anesthetization is challenging, as the uptake of anesthetic is reduced due to purulence. Progressive anesthesia throughout the procedure may be indicated.

In the event the patient does not tolerate complete drainage of the abscess due to incomplete anesthesia, it may be necessary to have patient to return in 1–2 days as with drainage, some inflammation may decrease and allow for tolerable debridement.

Description of the Procedure

(a)

Gather appropriate personal protective equipment and instruments for procedure (Table 42.1).

Table 42.1

Protective equipment

Personal protective equipment	Procedure equipment
Face shield	Skin cleansing agent
Fluid resistant gown	Local anesthetic
Sterile gloves	5–10 ml syringe
Mask	25–30 gauge needle
	Sterile gauze
	Scalpel
	Small curved hemostat
	Normal saline and sterile bowl
	Large syringe
	Culture swabs
	Packing material
	Scissors
	Tape