The LSUHSC New Orleans
Emergency Medicine Interest Group

Presents

The Student Procedure Manual


Incision & Drainage

by Ashley Stuckey

Indications
Prerequisites
Equipment
Procedure
Complications
Follow-up
References

Indications

Prerequisites

Equipment

Procedure

  1. Nitrous oxide or IV anesthesia/sedation (morphine, midazolam, meperidine, or fentanyl) should be given and is usually more effective than local anesthesia. Benzodiazapines are optional to relax the patient. Depending on the location, size, and innervation of the wound; regional, Bier, or field blocks can be used.
  2. In high-risk patients that are septic or
    immunocompromised, parenteral antibiotics (ist generation cephalosporin) should be given one hour before incision and drainage.
  3. The skin should be washed with iodine and then the patient and field draped.
  4. Incise the abscess along the superficial skin creases across the entire fluctuant area with a #1 I blade scalpel for small abscesses and a #15 or #10 for larger abscesses. For larger abscesses, it may be helpful to elliptically incise along the roof of the abscess to gain better entry to the cavity.
  5. Remove any necrotic or devascularized tissue with scissors. Smaller cavities can be probed with forceps to break up loculations while larger cavities respond well to a finger covered with gauze.
  6. Low-pressure irrigation with a bulb syringe should be used on clean wounds. High-pressure irrigation with a 18 gauge IV catheter and a 35ml syringe of 250ml-IL of saline for dirty or contaminated areas is necessary. Hold the catheter, fastened to the saline-filled syringe, perpendicular to the wound and evacuate the contents of the syringe in a pulsatile manner.
  7. Loosely pack the cavity with iodoforin gauze as overpacking will inhibit proper healing. This is not a contest to see how much you can pack into the cavity. Simply filling the space is sufficient. Packing will continue the drainage and prevent the wound edges from closing too early.
  8. Apply an absorbent dressing.
  9. Instruct the patient to apply warrn compresses to aid the drainage.
  10. No outpatient antibiotic therapy is recommended in the healthy patient unless significant signs of cellulitis are present.
  11. Antibiotic prophylaxis is recommended in the following situations:

Complications

Follow-Up

References

  1. Allison, E. Jackson, Jr. and John Gough. "Cutaneous Abscesses." Emergency Medicine-A Comprehensive Study Guide. New York: McGraw Hill, 1996.
  2. Connell, Patrick and John 1. Ellis. "Cutaneous Abscesses and Gas Gangrene." Principles and Practice of EmerR-ency Medicine. 3rd ed. Philadelphia: Lea & Febiger, 1992.

 


This page copyright 1997-2002 LSUHSC EMIG. All rights reserved.