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Incision and Drainage Bucky Boaz, ARNP-C

Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

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Page 1: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Incision and Drainage

Bucky Boaz, ARNP-C

Page 2: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Abscess Etiology

• Staphylococcal strains

• Group A B-hemolytic streptoccal

• Anaerobic bacterial

Page 3: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Pathogenesis

INTACT SKIN

HIGHCONCEN. OCCLUDE

MOISTENV.

NUTRIENTS

TRAUMA

HOSTS

MANUAL LABOR

WOMEN

IV DRUG USERS

CELLULITIS

NECROSISLIQUIFY&

ACCUM

ABSCESS LOCULATIONOF PUS

Page 4: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

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

Page 5: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Special Considerations

• Parental drug users

• Insulin-dependent diabetics

• Hemodialysis patients

• Cancer patients

• Transplant recipients

Page 6: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Laboratory Findings

• Offer no specific guidelines for therapy

• Not indicated

• Gram stain not indicated

• Routine culture not indicated– Except immunosuppressed

Page 7: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Indications and Contraindications

• Incision and drainage is definitive treatment

• Antibiotics alone are ineffective

• Premature incision

• Heat

• Nonsurgical recheck <24-36 hours

Page 8: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Ancillary Antibiotic Therapy

• Prophylactic Antibiotics– Endocarditis– Bacteremia in other conditions

• Therapeutic Antibiotics

Page 9: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Incision and Drainage Procedure

• Procedure site• Equipment and

Anesthesia• Incision• Wound Dissection• Wound Irrigation• Packing and Dressing

Page 10: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

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

Page 11: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Specific Abscess Therapy

• Staphyloccal Disease• Hidradenitis

Suppurativa• Breast Abscess• Bartholin Gland

Abscess• Pilonidal Abscess• Infected Sebaceous

Cyst

Page 12: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Specific Abscess Therapy

• Perirectal Abscess– Pathophysiology

– Epidemiology

– Physical and laboratory findings

– treatment

Page 13: Incision and Drainage Bucky Boaz, ARNP-C. Abscess Etiology Staphylococcal strains Group A B-hemolytic streptoccal Anaerobic bacterial

Questions?