Cutaneous Abscess I&D: Procedure Demonstration

00:01 All right. So now we're going to actually go through the actual procedure.

00:05 So you've already gotten consent from the patient.

00:07 You've already talked to them about the goal.

00:09 You've let them know that we're going to be using a digital field block.

00:14 You want to make sure that your patient of course is not allergic to lidocaine.

00:18 And in this particular circumstance, we are going to use lidocaine with epinephrine because this is going to be on an extremity.

00:26 And that's okay to use there.

00:32 Now I'm going to take my alcohol.

00:34 And I want to go around the outside edges of the abscess so that I can do the digital block.

00:41 Please refer to our video on digital block to know how to perform.

00:50 Okay. Now we're going to throw that in the biohazard trash.

00:53 Next I'm going to take my lidocaine with epi that I've already drawn up.

00:59 And now we're going to inject.

01:00 We're going to start at the edge here of the abscess, and we're going to inject this way.

01:06 And then we're going to slightly pull out and inject this way.

01:09 And then I'm going to do the same thing at the top of the abscess.

01:13 So I already have my lidocaine drawn up.

01:16 As we talked about yesterday, you can go perpendicular with the straight needle or a technique that I had been taught by my preceptors was to actually bend the needle slightly so you can get a better angle to go in to do your field block.

01:31 So you're going to go here underneath and you're going to put 1 to 2 cc's.

01:38 You want to draw back to make sure you're not getting blood.

01:41 And then you want to push forward.

01:44 And then as you're withdrawing then you're going to turn and you're going to go the opposite direction again. You're going to pull back to make sure you're not getting blood and you're going to push forward. Now we're going to go to the top of the wound and we're going to do the same thing.

02:02 We're going to push the needle in.

02:05 We're going to withdraw to make sure we're not getting any blood, and we're going to push forward.

02:11 We're going to slowly remove out as we're pushing forward, and we're going to do the same thing on the opposite side.

02:18 One of the things about abscesses is they're really hard to anesthetize, so sometimes you may need more of the lidocaine.

02:28 Also know that sometimes when you're putting in the lidocaine, sometimes that may cause the head to open up slightly, but not enough that you still would need to perform the I&D.

02:38 So just keep that in mind when you're performing the procedure.

02:41 Next, you're either going to want to get a 10 or 11 grade scalpel.

02:46 You also want to make sure that you have, um, gauze here as well, so that you're able to take away any of the pus or infection that may come out.

02:58 One of the other things that I wanted to point out to you is that you want to make sure that you're measuring the diameters of your abscess, so you can put this in your documentation at the end. So we're going to look at the point of maximum fluctuation.

03:13 And we're going to make a small incision.

03:21 So I've opened my incision.

03:23 Make sure to put your blade where you know where it is.

03:26 And you're going to take your gauze.

03:28 And then on both sides you're going to press out the abscess material.

03:36 You're going to want to take that away and throw that away. You're going to want to see if you have any additional that needs to come out.

03:45 There still is a little bit.

03:46 Then the next thing that you're going to want to do is you're going to want to use your Q-Tip or you could also use your hemostats to see if there's any flocculation.

03:58 We're first going to try with our Q-Tip.

04:03 In this particular one, we've got a little bit of tunneling, but I don't feel any flocculation.

04:09 If you happen to have some flocculation, you can use your hemostats to kind of go in and you can put your hemostats in and open them and close them in different areas to open that wound back up. And then you would go back in and see if you could express some more of the abscess by doing this. Okay,. I think for this particular example we have already completed that.

04:36 So now would be the time that we want to use the Iodoform.

04:40 You want to make sure that you're using forceps that you have not put anywhere else or used.

04:46 So you want to make sure you have clean forceps.

04:49 This is why it's a good reason to have someone helping you like your medical assistant, to be in there if you need additional supplies.

04:56 So I'm going to bring this over.

04:58 This is sterile in the container it is now.

05:01 I'm also going to make sure I have my scissors handy nearby.

05:05 So I'm going to make sure I have enough of the material that I think that I will need to, um, be able to pack the wound.

05:13 Remember, you're only wanting to keep about 25% packed.

05:19 So for this example, I'm just going to get about this much off.

05:24 Okay? You want to keep this material clean.

05:28 So you may need another pair of forceps, to be able to use when you are packing because my hand is clean, I'm going to use my hand because it's sterile.

05:39 To touch the other end, you can either use your forceps or you could also use a Q-Tip and you're just going to pack the material in here.

05:53 What this allows is additional drainage.

05:56 We want to make sure all that abscess material is out of the wound bed, so that we can get a complete and total healing process.

06:03 Normally, I would tape this across here.

06:06 That's another reason to have a medical assistant in here for you.

06:09 And then you can dress the wound.

06:11 Typically, I would not apply antibiotic cream directly to the wound.

06:15 Why would I not do this? Because that's going to start the healing process and the closing up of that opening. I don't want that to happen yet.

06:22 I still want it to drain.

06:24 So with this particular size, I would have the patient come back within 24 hours for me to be able to evaluate and repack and decide if there needs to be additional packing.

06:36 Remember also that you need to make sure that you're providing that aftercare instructions that we discussed earlier in the video with your patient.