Difference between revisions of "Incision and drainage"

(Equipment Needed)
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==Indications==
 
==Indications==
 
+
*Abscess of skin or superficial soft tissue
  
 
==Contraindications==
 
==Contraindications==
 +
*No absolute contraindications
  
 +
*Abscesses that may require OR management or specialist consultation include<ref>Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess incision and drainage. N Engl J Med. 2007 Nov 8;357(19):e20.</ref>:
 +
**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==
 
==Equipment Needed==
 +
*PPE
 +
*Local anesthetic
 +
*Incision and Drainage Tray:
 +
**Scalpel
 +
**Hemostat
 +
**Forceps
 +
**Gauze
 +
**Drape / towel
 +
**Iodine swabs
 +
 
{{Maximum doses of anesthetic agents}}
 
{{Maximum doses of anesthetic agents}}
  
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==Follow-up==
 
==Follow-up==
*Wound check in 1-2 days and wound care sheet
+
*Wound check in 1-2 days.
*[[Antibiotics]] only indicated if overlying cellulitis or evidence of systemic infection
+
*[[Antibiotics]] only indicated if overlying cellulitis or evidence of systemic infection<ref>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.</ref>
 
**Cover [[staph]] and [[strep]]
 
**Cover [[staph]] and [[strep]]
*Update [[Tetanus]], if indicated
 
  
 
==See Also==
 
==See Also==

Revision as of 02:31, 23 June 2015

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
  • 1% soln contains 10 mg/ml
  • 2% soln contains 20 mg/ml
Mepivicaine 7 mg/kg 8 mg/kg
Bupivicaine 2.5 mg/kg (max 175mg) 3 mg/kg (max 225mg) 6-8 hr
  • 0.5% soln contains 5 mg/ml
  • May cause cardiac arrest if injected intravascularly
  • Do not buffer with bicarbonate
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]

See Also

References

  1. Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess incision and drainage. N Engl J Med. 2007 Nov 8;357(19):e20.
  2. 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.
  • 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
  • Singer A, Talan D. Management of Skin Abscesses in the Era of Methicillin-Resistant Staphylococcus aureus. N Engl J Med 2014; 370:1039-1047