Incision and Drainage Bucky Boaz, ARNP-C

Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Pathogenesis INTACT SKIN HIGH CONCEN. OCCLUDE MOIST ENV. NUTRIENTS TRAUMA HOSTS MANUAL LABOR WOMEN IV DRUG USERS CELLULITIS NECROSIS LIQUIFY & ACCUM ABSCESS LOCULATION OF PUS

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?