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How To Incise and Drain an Abscess
Step by Step Description of Incising and Draining an Abscess
Consider parenteral analgesia (eg,fentanyl1 to 2 mcg/kg IV) for patients with significant pain, anxiety, or large abscesses. If available, point-of-care ultrasound may be used to identify extent of abscess and possible loculations. Cleanse the site withpovidone-iodineorchlorhexidinesolution. Inject local anesthetic using a 25-gauge needle either along the line of incision over the dome of the abscess, or, more effectively, as a field block around the entire abscess; in some locations, a nerve block also can be used. If injecting along the incision, be careful not to inject into the abscess cavity, which is painful and fails to numb the skin. To create a field block, inject local anesthetic in a diamond-shaped pattern around the entire abscess. Start at one of the apices of the diamond and inject for the length of the needle, then reinsert it through anesthetized skin as you continue around the abscess. Make a linear incision over the full length of the abscess using a #11 scalpel, following skin creases if possible. Gently squeeze the wound to express the pus. Culture of the abscess is not routinely necessary but may be done in patients who have systemic symptoms and signs, severe local infection (cellulitis), recurrent abscesses, or failure of initial antibiotic treatment and in patients at the extremes of age or who are immunocompromised. Sweep a hemostat or forceps around the abscess cavity to break up loculations. Consider using a blunt-ended, rigid suction device to extract pus from large or deep abscesses, which also assists in breaking up loculations. Correct predisposing conditions, such as obstruction of natural drainage (eg, due to redundant skin folds) or the presence of a foreign body. If it is difficult to completely evacuate the abscess contents, irrigate the cavity with normal saline solution. Although packing was commonly done in the past, it is not considered necessary except for pilonidal abscesses > 5 cm and, possibly, abscesses in immunocompromised patients and those with diabetes. Place an absorbent gauze pad over the wound. If on an extremity, secure the pad with circular dry gauze wrap. Splint the affected part if possible, particularly if a joint is affected. 