Incision and drainage: Difference between revisions
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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 | *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]] | ||
==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 |
|
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]
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.
- 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