26 terms

I&D of Abscess

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Abscess Def
localized infection
-characterized by: collection of pus surrounding inflamed tissue
funicle (boil)
sweat gland or hair follicle infection that form an abscess
carbuncle
multiple follicles w/ abscess
Paronychia
abscess involving nail
felon
abscess in tuft of soft tissue in distal phalanx of finger
hordeolum
abscess on eyelid margin
chalazion
chronic abscess of eyelid itself in meibomian glands beneath tarsal plate
Hidradenitis suppurativa
chronic condition in axilla & going w recurrent abscess formation
Most common causitive agent
Staphylococcus aureus
-others: streptococcus or combo of microorgansisms (gram-neg & anaerobic)
Perineal abscess: cause
mix of aerobic & anaerobic
Common abscess sites
extremities, buttocks, breast or hair follicle
Small abscess: Tx
warm compress or ABX & drain spontaneously
Abscess Tx of choice
I&D
-ABX not usually necessary
Abscess that occurs away from areola (rare): Tx
-prompt Bx
-I&D
Pt. w/ DM, debilitating disease, or immunocompromised
observe closely after I&D
-may warrant ABX that covers S. aureus
Community-associated S. aureus
clindamycin, Bactrim, doxycycline, rifampin
Consider if abscess recurs after I&D
MRSA
-C&S
-Tx w/ appropriate ABX based on result
most common pathogen for infections w/ pt. who present to ER
MRSA
I&D indications
localized collection of pus that is tender & not spontaneously resolving
-not pointing and localized= trial ABX
-ABX usually inadequate once a collection of pus is present
I&D: CI
1. small, nonfluctuant facial furuncles w/out surrounding cellulitis if located w/in the triangle formed by bridge of nose & corners of mouth
-Tx w/ ABX (cover for MRSA), & warm compresses
-risk of septic phlebitis w/ intracranial extension after I&D
-large & fluctuant= drainage (regardless of site)
I&D: Equipment
1. local (1-2% epi, Na bicarb 7.5%, benadryl 50mg/mL
2. 25-30-g needle, 1/2-1 in.
3. ?Cryo unit or ethyl chloride for anesthesia
4. alcohol or betadine wipe
5. 4x4 gauze
6. no.11 blade
7. curved hemostats
8. ?iodoform gauze
9. ?culture materials
10. bandage scissors
11. dressing
Technique
-wear protective eyewear
1. prepare w/ alcohol or betadine
2. field block (avoid infiltration of abscess cavity), or cryocautery (N2O, liquid N, ethyl chloride)
3. Incision w/ no. 11 blade to allow drainage & prevent premature closure of incision
-large: 1cm
-incision in skin lines
4. Culture if needed
-collect from cavity
5. External pressure to express all pus
-explore w/ steril cottonptipped applicator or w/ hemostats
-break down walled-off pockets or possible septa
-curette cavity to remove sac (disposable too sharp)
-pack w/ Penrose drain or packing material (iodoform gauze)
-apply ointment (prevent gauze from sticking)
6. Remove gauze slowly over several weeks (ensures wound won't close off too soon & decrease recurrence rate)
-change after 5-7 days
-larger wound: leave wick in for 4 weeks: advance every few days & cut 2 inches at a time.
7. Sterile dressing to collect discharge
-change several x/d
-heals from inside out= epithelialization of abscess cavity should occur before healing of incision site (minimizes recurrence)
8. Hidradenitis: I&D may traumatize area & cause long-term abscess
-pain so severe that I&D is necessary
-long-term ABX
-?resection of axilla or groin tissue involved
9. Felon
-distal block
-incise in midline parallel w/ digit
-small wick of iodoform x24 hr
-ABX to cover S. aureus
Complications
1. Pain from tight packing
-Tylenol or NSAID
2. Recurrence
3. Scar or keloid
4. Failure to resolve, cellulitis, progression to septicemia
5. Fistula formation
6. Osteomyelitis
Abscess in palmar aspect of hand
1. can extend from superficial to deep tissue through palmar fascia
2. suspect deep infection: simple I&D fails to reduce redness, pain, pus, or swelling
3. Tx: Surgical debridement, hospitalize, IV ABX
-Deep palmar abscess= surgical emergency
Recurrent paronychia
1. removal of nail to resolve infection
2. ?Tx of Candida infection in fingernails
Post-procedure Pt. Prep
1. Teach pt., family member or use home visit or f/u appt. for dressing changes
2. Mx: recurrence, infection
3. Notify clinician immediately
-recollection of pus in abscess
-fever & chills
-increased pain or redness
-red streaks near abscess
-increased swelling
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