Incision and drainage
Indications
- Abscess of skin or superficial soft tissue
Contraindications
- No absolute contraindications
- Abscesses that may require OR management or specialist consultation include[1]:
- Large or deep abscesses that are difficult to access or anesthetize
- Abscesses of the palms, soles, or nasolabial folds
- Areas in which cosmesis is important (face, breast)
Equipment Needed
- PPE
- Local anesthetic
- Incision and Drainage Tray:
- Scalpel
- Hemostat
- Forceps
- Gauze
- Drape / towel
- Iodine swabs
Maximum Doses of Anesthetic Agents
| Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
| Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
| Mepivicaine | 7 mg/kg | 8 mg/kg | ||
| Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
| Ropivacaine | 3 mg/kg | |||
| Prilocaine | 6 mg/kg | |||
| Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
| Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
Procedure
Complications
Follow-up
- Wound check in 1-2 days.
- Antibiotics only indicated if overlying cellulitis or evidence of systemic infection[2], or for immunosuppressed patients or abscess that does not respond to standard treatment [3]
See Also
References
- ↑ Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess incision and drainage. N Engl J Med. 2007 Nov 8;357(19):e20.
- ↑ Fahimi J, Singh A, Frazee BW. The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis. CJEM. 2015 Feb 20:1-13.
- ↑ Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047
- Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:e18-e55