I&D Flashcards
Define Folliculitis
Superficial infection of the hair follicles in the epidermis
Treatment of Folliculitis
Usually resolve spontaneously
Warm compresses
Avoid shaving involved areas
Common Bug with Hot Tub Folliculitis
Pseudomonas aeroginosa
Define Skin Abscess
Collection of pus within dermis & deeper skin tissues
Define Furuncle (Boil)
Infection of hair follicle: pus extends through dermis into subQ tissue
Define Carbuncle
Coalescence of several infected follicles into a single mass with several draining sites
Contraindications or Concerns with an I&D
Abscess location may mandate drainage by surgeon
Abscess types
Patient factors
Will leave a scar & may return
Abscess Locations that Should be Drained by a Surgeon
Perirectal area Anterior & lateral neck Breast near areola Near vital nerves/blood vessels Hand abscesses Central triangle of face
Abscess Types Indicating Surgical I&D
Recurrent & interconnected abscesses
>5 cm
Patient Factors to Indicate Surgical I&D
Airway issues
Bleeding disorder or anticoagulation
Risk Factors for Skin Abscesses
DM
Immunologic abnormalities
Breaches of skin barrier
Pre-procedure Preparation
Evaluation of abscess
Medical issues
Patient counseling
Medical Issues & I&D’s
Lidocaine allergy
Heart valve or total joint: need antibiotics
Patient Counseling for I&D
Explain procedure, risk of recurrence, & scar formation
May need bigger incision than anticipated
Involves some discomfort
Explain after care
Will not be totally comfortable in out-patient setting
When to Consider Antibiotic Therapy
Abscess >5 cm Extensive cellulitis Signs of systemic infection Co-morbidities Immunosuppression Prosthetic joints & valves
Antibiotic Agents for I&D’s
Clindamycin
Doxycycline
SMX/TMP
Vancomycin (MRSA, IV)
Supplemental Sedation for Children or Large Abscesses
Lorazepam
IV MS or dilaudid
Have Narcan (naloxone) & Romazicon (flumazenil) on hand
Equipment for I&D
Sterile gloves, drapes, & 4x4 gauze Goggles or eye protection Povidone-iodine solution Local anesthetic 3-10 mL syringe with 25 or 27 gauge needle Culture swab #11 blade & scalpel handle Curved hemostat, forceps, scissors 30-60 mL syringe with irrigation device with splash protection Basin with sterile saline Packing material Dressing of choice
I&D Procedure
Prep & drape wound
Establish anesthesia
Incise skin in line with natural folds
Culture pus within the wound
Spread wound with hemostat & look for pockets
Debride necrotic tissue
Irrigate with isotonic saline until wound is clear
Pack or drain wounds with significant dead space
Apply dressing
Antibiotics??
Abscess Best Left Open in Which Patients
Immunocompromised
Systemic infections
Significant cellulitis
When to Pack a Wound
Where there is a cavity
Keep wound from closing
Penrose drain
Covering an Abscess
Sterile ace dressing
Sterile tape
Instructions & Follow Up After an I&D
Leave dressing alone
Elevate extremity
Seek medical attention if: fever/chills, reaccumulation of pus, red streaks, increased swelling
Recheck wound in 24-48 hours
Resolving Wounds After I&D Procedure
Soak in warm, soapy water or shower
Protect with dry, sterile dressing until wound is closed
Complications More Likely In
Anterior facial triangle
Nose & mouth
Pilonidal cyst
Perirectal area
Types of Complications with I&D Procedure
Inadequate drainage may result in local extension
Overly aggressive debridement may damage deep structures
Bacteremia
