Abscess Incision and Drainage (I&D)

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.

Resources/References

• Fitch et al. Abscess Incision and Drainage N Engl J Med 2007; 357:e20. DOI: 10.1056/NEJMvcm071319
• Skin and Soft Tissue Infection (YKHC Common/Unique Diagnoses)
• Skin and Soft Tissue Infection YKHC Clinical Guideline

Common ED Procedures
Common Outpatient Procedures