Abscess Incision and Drainage

Abscess Opener

This module describes how to identify and manage an abscess where incision and drainage is indicated.


  1. Fluctuant superficial abscesses > 5 mm in diameter


  1. Abscesses < 5 mm; treat with antibiotics

  2. Very large or deep abscesses; refer to surgery

  3. Perianal or periareolar abscesses; refer to surgery

  4. Abscesses in an inaccessible area; refer to surgery

  5. Neck and facial abscesses; refer to surgery

  6. Palm or sole abscesses; refer to surgery

  7. Cellulitis with no abscess; treat with antibiotics

  8. Patients with abnormal or artificial heart valves; give prophylactic antibiotics before proceeding


Always verify your patient’s identity and obtain informed consent before proceeding.

How do I explain this procedure?

“This skin infection is called an abscess or boil, which must be cut open to allow the pus inside to run out, before the area can heal.”

What can my patient expect?

“I will give you an injection for pain, first. Then I will make a small cut and clean out the pus.”

What is my patient’s role?

“Let me know if you have any allergies, a heart condition, or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Keep as still as possible. If you feel strange sensations like tingling or severe pain, tell me immediately.”


Arterial Blood Sampling - Equipment

Documentation

  1. Patient notes

Equipment

  1. Alcohol-based hand rub

  2. Sterile drapes

  3. Supplies for anaesthesia:

    1. Lignocaine (1-2% with adrenaline). For small abscesses not on the face, consider ethyl chloride spray. Consider procedural sedation for larger abscesses.
    2. Alcohol swab
    3. 5-10 ml syringe
    4. Blunt fill needle & a small gauge injection needle
  4. Suture pack

  5. No. 11 scalpel blade

  6. Bottle of normal saline for irrigation

  7. 20 ml syringe

  8. IV cannula

  9. Gauze pad and a dressing (transparent film or crêpe bandage as required)


Position the patient supine or reclining with the abscess within easy reach. When making the incision, incise along

of skin tension.


Follow medical asepsis with sterile gloves; however, due to the nature of abscesses, complete sterility may not always be achievable.

  1. Perform hand hygiene.

  2. Draw up approximately 5-7 ml lignocaine and

    the area, use ethyl chloride spray for small abscesses, or consider procedural sedation for large abscesses.

  3. Open the suture pack to create a sterile field. Pour cleaning solution into the well. Open the scalpel blade, 20 ml syringe, dressing and IV cannula onto the field. Open the bottle of normal saline.

  4. Don sterile gloves.

  5. and drape the area.

  6. Make a stab incision in the centre of the abscess over the point of fluctuance.

  7. Extend the incision if necessary.

  8. Apply pressure to the area around the abscess to expel pus.

  9. Insert a haemostat or curved forceps. Use

    to break down loculations inside the abscess.

  10. Apply pressure to expel remaining pus.

  11. Use the 20 ml syringe and cannula (needle removed) to irrigate the abscess cavity thoroughly.

  12. Dress the wound. Routine wound packing of small (<5cm) cutaneous abscesses is

    .

  13. Dispose of medical waste safely.

  14. Record the completion of the procedure in patient notes.

  15. Advise the patient to have a wound check in 24-48 h. If packing was done for a large abscess, remove gauze within 2 days.

Abscess I&D Procedure


I’m not sure whether this is an abscess or not.

To distinguish between cellulitis and abscess, use ultrasound to check for a dark collection of fluid contents under the point of maximum fluctuance/erythema and swelling.

My patient gets recurring abscesses.

After incision and drainage, take a deep swab and send for microbial culture and targeted antibiotics. For repeated axillary abscesses, refer to dermatologist to exclude hidradenitis suppurativa.


  1. Pain

  2. Injury to nerves, vessels, and other local structures

  3. Local cellulitis

  4. Bacteraemia and sepsis

  5. Sharps injury to healthcare personnel

  6. Vasovagal response (fainting)


  1. Pastorino A, Tavarez MM. Incision and Drainage. [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556072/

  2. Fitch MT, Manthey DE, McGinnis HD, Nicks BA, Pariyadath M. Abscess Incision and Drainage. N Engl J Med. 2007;357:e20