Cutting and draining an abscess
Attention
Do not attempt procedure if
- Abscess large
- Person very sick from bacterial infection
- Abscess around the spine
- Abscess over major organ, bone, joint, nerve, face or feet in person with diabetes — specialist consult for treatment instead
What you need
- Chlorhexidine
- 2–5mL lidocaine (lignocaine) 1%
- 5mL syringe, 18G, 21G and 25G needles
- 20mL syringe
- Normal saline
- 2 x sterile dressing packs
- Extra sterile gauze swabs
- Sterile
- No. 23 scalpel blade and handle
- Artery forceps
- Wound probe
- Combine pad
- Tape to secure
- Pathology equipment (if culture needed)
What you do
Preparation and local anaesthetic
- Lay out first dressing pack, chlorhexidine, equipment for local anaesthetic (lidocaine)
- Wash hands, put on sterile gloves
- Clean site, drape with sterile towels from dressing pack
- Draw up local anaesthetic with 18G needle
- Maximum safe dose of lidocaine (lignocaine) 1% is 3mg/kg up to 200mg (20mL)
- Lidocaine (lignocaine) 1% is 10mg/mL
- Do not repeat the maximum dose within 1.5 hours
- Do not use solutions containing adrenaline (epinephrine) for fingers, toes, penis, nose, ears
- Anaesthetise over top of abscess by inserting 25G needle just under and parallel to surface of the skin
- Inject anaesthetic into intradermal tissues very superficially — not into abscess cavity
- Use gentle pressure to infiltrate the skin — you will see the skin blanching ( going pale) as anaesthetic spreads out
- Wait for anaesthetic to work (10 minutes), clear away first dressing pack
- Lay out second dressing pack, instruments, normal saline, 20mL syringe, extra gauze
Incision and dressing
- Make cut across abscess for its whole length — not just small hole
- Take swab for MC&S if needed
- Mop out pus with gauze
- Open up cavity (hole) using gauze swab wrapped around forceps or sterile gloved finger
- Break up chambers inside abscess, make sure all the pus runs out
- Using 20mL syringe with 18G blunt needle and normal saline, flush out hole until pus has gone
- Pack hole with sterile gauze pads soaked in normal saline to level of skin
- Do not pack too tightly
- Count packing swabs, record in file notes
- Cover with non- adherent, absorbent dressing
- Ask person to return in 24 hours to check dressing. If not full of pus or dirty — leave in place for another 24 hours, then remove. Count packing swabs
- If delayed granulation or signs of infection — see Wound dressings for follow-up