ear, nose, and throat disorders
How To Drain a Peritonsillar Abscess
Step by Step Description of Draining a Peritonsillar Abscess
Consider whether IV analgesia is necessary (usually not if adequate explanation and local anesthesia are given). If needed, may givefentanyl1 to 3 mcg/kg, titrated if necessary, a few minutes before the procedure. Spray the topical anesthetic and wait several minutes for it to take effect. Have an assistant retract the cheek laterally to improve visibility. Push the tongue out of the way using a tongue depressor or finger. Identify the most prominent part of the abscess. Point-of-care ultrasound is sometimes used to localize the abscess. Inject 2 to 3 mL of anesthetic (1%lidocainewithepinephrine) into the mucosa using a 25-gauge needle attached to the 5-mL syringe. Some clinicians give a dose of IV corticosteroids (eg,dexamethasone10 mg,methylprednisolone60 mg) to decrease symptoms. For needle aspiration Use the 10-mL syringe with an 18- or 20-gauge needle Apply continuous suction and direct the needle in the sagittal plane (anterior to posterior) and not to the side (laterally). This is important to avoid the carotid artery. Aspirate the most prominent area first; it is usually the superior pole. If no pus is aspirated, aspirate the middle, then inferior pole. Do not aspirate the tonsil itself. Typically 2 to 6 mL of pus is obtained. Send a sample for culture. For incision and drainage Warn the patient that pus will flow and must be spit out. Use a scalpel with a No. 15 blade or a No. 11 with tape covering all but 0.5 to 1.0 cm of the blade. Make an 0.5 cm incision in the anterior-to-posterior direction over the most prominent area, or the location where needle aspiration (if done) identified pus. Use a suction catheter to remove pus and blood. Some bleeding is expected after incision. Place a closed tonsil clamp into the incised opening and gently open it to break up any loculations. Have the patient rinse and gargle with a saline or a dilute peroxide-saline solution. 