View source for Incision and drainage of an abscess

== Indications ==

* Fluid-filled abscess large enough to warrant I&amp;D

== Contraindications ==

* Extremely large abscesses which require extensive incision, debridement, or irrigation (best done in OR)
* Deep abscesses in very sensitive areas (supralevator, ischiorectal, perirectal) which require a general anesthetic to obtain proper exposure
* Palmar space abscesses, or abscesses in the deep plantar spaces
* Abscesses in the nasolabial folds (may drain to sphenoid sinus, causing a septic phlebitis)

== Materials ==

* Chlorhexadine or iodine for cleaning
* 25G needle on 5cc syringe for local anaesthetic
* 18-21G needle on 5-10cc syringe for aspiration
* 2% lidocaine (or 1% if necessary)
* Culture swab, if necessary
* Small scalpel (No. 11)
* Curved forceps
* Packing material and diluted iodine, if packing is required

== Technique ==

* Position patient for comfort during procedure
* Landmarking using linear ultrasound probe to:
** Confirm presence of fluid in an apparent abscess
* Identify largest pocket for drainage
* Clean area and drape appropriately to contain expelled pus</li>
* Inject 2% lidocaine to raise a bleb</li>
* Use larger-bore needle to aspirate abscess contents; these may be sent for C&amp;S if useful</li>
* Inject 2% lidocaine in field block around entire abscess</li>
* Create small incision using tip of blade</li>
* Expel as much pus as possible</li>
* Use curved forceps to break up any pockets within the abscess</li>
* Pack with packing material soaked in saline or iodine diluted 1:1 with saline, when:
**5 cm in diameter
**Pilonidal abscess
**Abscess in an immunocompromised or diabetic patient

== Post-Procedure Instructions ==

* Cover with bandage, leave wound unclosed, and keep clean
* Remove packing material in 3 days, if used
* Antibiotics not routinely indicated
** If MRSA positive, extra coverage required

[[Category:Infectious diseases]]
[[Category:Procedure]]