Abscess Incision and Drainage (I&D): Difference between revisions
From Guide to YKHC Medical Practices
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Small abscesses may be drained via needle decompression however most abscesses seen in the emergency room benefit from scalpel incision and drainage. | Small abscesses may be drained via needle decompression however most abscesses seen in the emergency room benefit from scalpel incision and drainage. | ||
*Although incision and drainage is not a sterile procedure and does not require sterile technique, typically skin is cleansed with chlorhexidine or povidone-iodine prior to placement of a field block with lidocaine or bupivacaine. | *Although incision and drainage is not a sterile procedure and does not require sterile technique, typically skin is cleansed with chlorhexidine or povidone-iodine prior to placement of a field block with lidocaine or bupivacaine (step A in image). | ||
*Use a scalpel with a #11 blade to make an incision into the abscess pocket and loculations are bluntly dissected with forceps or wound probe. | *Use a scalpel with a #11 blade to make an incision into the abscess pocket and loculations are bluntly dissected with forceps or wound probe (step B-D). | ||
*While small abscesses may be allowed to drain on their own, most abscesses warranting I&D benefit from packing with either plain gauze, iodoform gauze or a drain. | *While small abscesses may be allowed to drain on their own, most abscesses warranting I&D benefit from packing with either plain gauze, iodoform gauze or a drain (step E). | ||
*Large abscesses may require two incisions to be made and placement of a through Dermastent or penrose drain. | *Large abscesses may require two incisions to be made and placement of a through Dermastent or penrose drain. | ||
*''All purulent drainage should be sent for wound culture to guide antibiotic therapy.'' | *''All purulent drainage should be sent for wound culture to guide antibiotic therapy.'' | ||
*Per YKHC guidelines abscesses with >/= 10 cm of cellulitis should be covered with antibiotics. | *Per YKHC guidelines abscesses with >/= 10 cm of cellulitis should be covered with antibiotics. | ||
*If there is concern for deep abscesses formal or bedside US may assist in evaluation. | *If there is concern for deep abscesses formal or bedside US may assist in evaluation. |
Revision as of 23:00, 6 October 2020
Small abscesses may be drained via needle decompression however most abscesses seen in the emergency room benefit from scalpel incision and drainage.
- Although incision and drainage is not a sterile procedure and does not require sterile technique, typically skin is cleansed with chlorhexidine or povidone-iodine prior to placement of a field block with lidocaine or bupivacaine (step A in image).
- Use a scalpel with a #11 blade to make an incision into the abscess pocket and loculations are bluntly dissected with forceps or wound probe (step B-D).
- While small abscesses may be allowed to drain on their own, most abscesses warranting I&D benefit from packing with either plain gauze, iodoform gauze or a drain (step E).
- Large abscesses may require two incisions to be made and placement of a through Dermastent or penrose drain.
- All purulent drainage should be sent for wound culture to guide antibiotic therapy.
- Per YKHC guidelines abscesses with >/= 10 cm of cellulitis should be covered with antibiotics.
- If there is concern for deep abscesses formal or bedside US may assist in evaluation.