Train Yourself: Incision and Drainage

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Regardless of etiology and nomenclature, subcutaneous abscess management is often the same.

Soft-tissue infections are commonly encountered in the emergency department setting. While most are only minor to moderate severity, proper evaluation and management of these infections are essential to prevent possible progression/systemic toxicity. Subcutaneous abscesses, in particular, have the potential for complication and/or recurrence if not appropriately treated.

Abscesses go by many names and descriptions: Pilonidal cyst, paronychia, eponychia, felon, Bartholin gland cyst, etc. They can be associated with specific disease processes (e.g. hidradenitis suppurativa) or patient populations (e.g. obese, immunocompromised), but can also occur in healthy individuals without predisposing risk factors. Regardless of etiology and nomenclature, subcutaneous abscess management is often the same: incision of drainage (I&D). [1]


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Barring contraindication, incision and drainage (I&D) is considered the definitive management for any abscess >5mm that can be accessed percutaneously. This trainer aims to allow medical students and providers easy access to practice US identification and I&D of abscesses at low cost.

We constructed this abscess trainer in just a few minutes using supplies readily available in every ED during a recent ED shift. While easily assembled at minimal to no cost, it has potential for easy modification/versatility for additional learning or challenges.

In addition to your regular I&D supplies, you will need the following items to construct the trainer:


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  • Microfoam surgical tape (7.6cm x 5cm)
  • Nitrile exam gloves
  • Ultrasound gel
  • Sheet of paper (8.5” x 11”)
  • Multipurpose medical tape (1”)

​​Assembly for abscess model:

  1. Place base layer of microfoam tape on a sheet of copy paper.

Train Yourself_ I n D Trainer fig 2

2. Cut finger from the glove and fill it with ultrasound gel.

3. Compress gel in closed-end while stretching glove tight. Then close the open end securely with a knot or medical tape.


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    1. Train Yourself_ I n D Trainer fig 3

4. Use another layer of microfoam tape to cover and secure “abscess” to the base layer from step 1.

Train Yourself_ I n D Trainer fig 5

5. Practice using ultrasound or aspiration to confirm abscess prior to I&D.

****Optional**** For greater realism, consider incorporating pudding or an over-filled word catheter into your trainer to simulate abscess material and capsule respectively [2]

References:

  1. Manthey DE. Incision and Drainage. In: Sherman SC, Weber JM, Schindlbeck MA, Rahul G. P. eds. Clinical Emergency Medicine, 1e. McGraw Hill; Accessed August 11, 2021. https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=991&sectionid=57306064
  2. Fitch, M.T., Manthey, D.E., McGinnis, H.D. et al. A skin abscess model for teaching incision and drainage procedures. BMC Med Educ 8, 38 (2008). https://doi.org/10.1186/1472-6920-8-38

 

 

ABOUT THE AUTHORS

Tyler Mills, DO is a senior resident at the AdventHealth Orlando EM residency.

Andy Little, DO specializes in Emergency Medicine at AdventHealth East in Orlando Florida.

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