B-01: Abscess Drainage
  • Indications
    • Accessible abdominal, retroperitoneal, pelvic or pleural fluid collection
  • Contraindications
    • Uncorrected coagulopathy
    • Hematoma from recent hemorrhage
  • Patient Evaluation
    • Able to lie flat and in appropriate position for procedure
    • Able to cooperate with breath holding as required
  • Preprocedure Orders
  • Tools
    • Cope, Accustick or Jeffery entry set w/ 21ga needle and .018" guide wire
    • Amplatz or Coons guide wire
    • Vascular dilators
    • 8-14 Fr. drains (Cope loop or vonSonnenberg type)
  • Entry site
    • Direct into collection without transgressing bowel or organs.
    • Pancreatic pseudocyst - may use transgastric approach if no evidence of infection
    • Pleural collections - oblique entry to reduce risk of pneumothorax after catheter removal
  • Technique
    • Modified Seldinger entry technique. Obtain small volume specimen for culture from needle (do not decompress collection through needle) - Once catheter is placed, aspirate cavity dry. Do not irrigate vigorously. Send additional material for labs. Secure catheter with sutures and attach drainage bag
  • Post-procedure Note
    • Record quantity and character of material drained
    • Note which labs were ordered on specimen
  • Post-procedure Orders
    1. Drainage catheter(s) to gravity/Hemovac/J-vac/intermittent low wall suction.
    2. Record output q shift
    3. Strict bed rest x 24 hours
    4. Check entry site(s) for bleeding and check and record VS (HR, BP, RR)
      • q 15 min x 2, then
      • q 30 min x 4, then
      • q 60 min x 4, then
      • q 4 hours if stable
    5. Check and record temp q 2 hr. x 4, then q 4 hr. if stable
    6. Call H/O for any change in VS
    7. CBC at (4 hr. post procedure)_______p.m., CBC & DIFF at 8 a.m.
    8. Continue antibiotic coverage per H/O (minimum48-72 hr. post drainage)
    9. Continue IVF x 24 hr. minimum (IVF Orders per H/O)
    10. Catheter irrigation - (usually 10-25cc NS q shift based on catheter type and size of collection)
    11. Resume other preprocedure orders
    12. H/O to review and cosign these orders.

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