Download Incision and Drainage

Incision and Drainage
Bucky Boaz, ARNP-C
Abscess Etiology
• Staphylococcal strains
• Group A B-hemolytic streptoccal
• Anaerobic bacterial
Pathogenesis
HOSTS
HIGH
CONCEN.
INTACT
SKIN
MOIST
ENV.
OCCLUDE
CELLULITIS
TRAUMA
NUTRIENTS
ABSCESS
MANUAL
LABOR
LOCULATION
OF PUS
WOMEN
IV DRUG
USERS
LIQUIFY
&
ACCUM
NECROSIS
Bacteriology of Cutaneous
Abscesses
• Head, neck, extremities, trunk
– Staphlocci
– Group a B-hemolytic streptococci
• Buttocks and perirectal
– Anaerobes
• Perirectal area, head, fingers, and nailbed
– Mixed aerobic and anerobic
Special Considerations
•
•
•
•
•
Parental drug users
Insulin-dependent diabetics
Hemodialysis patients
Cancer patients
Transplant recipients
Laboratory Findings
•
•
•
•
Offer no specific guidelines for therapy
Not indicated
Gram stain not indicated
Routine culture not indicated
– Except immunosuppressed
Indications and Contraindications
•
•
•
•
•
Incision and drainage is definitive treatment
Antibiotics alone are ineffective
Premature incision
Heat
Nonsurgical recheck <24-36 hours
Ancillary Antibiotic Therapy
• Prophylactic Antibiotics
– Endocarditis
– Bacteremia in other conditions
• Therapeutic Antibiotics
Incision and Drainage Procedure
• Procedure site
• Equipment and
Anesthesia
• Incision
• Wound Dissection
• Wound Irrigation
• Packing and Dressing
Follow-up Care
• Reevaluation 1-3 days (48 hours standard)
• Closely follow
– Immunosuppressed
– Facial abscess
• Instruct on wound care
• Decide on repacking
• Peroxide and Q-tips
Specific Abscess Therapy
• Staphyloccal Disease
• Hidradenitis
Suppurativa
• Breast Abscess
• Bartholin Gland
Abscess
• Pilonidal Abscess
• Infected Sebaceous
Cyst
Specific Abscess Therapy
• Perirectal Abscess
– Pathophysiology
– Epidemiology
– Physical and laboratory
findings
– treatment
Questions?