The Abscess Explosion Incident

Draining an abscess is not hard.  But, it does take a little practice to develop your own pus-draining style.  What little speech do you give to the patient to explain the procedure (mine is somewhere along the lines of “this is probably going to be the worst pain you have ever experienced but please just don’t kick me in the face while I stick this needle in your butt”)  Well, in my earlier days of practice I was a bit stylistically challenged when it come to the I&D resulting in what we will call the ‘abscess explosion incident’.

On a routine day much earlier in my career I picked up a chart revealing that my next patient would need treatment for an abscess.  Perfect.  I totally got this.  I won’t even have to bother my supervising physician with a million questions about this patient.  I am an I&D expert.

I walked into the patient’s room and introduced myself.  I examined the juicy abscess on his buttocks.  Ouch.  Exuding confidence to counteract his fear of a 24 year old girl taking a scalpel to his left butt cheek I explained the procedure.  I would simply cleanse the area with some betadine, inject some lidocaine to numb the area, cut open the abscess and pack it with gauze.  Simple enough.  Only 4 steps.

I left the room, gathered my supplies, returned and got to work.  Step 1- disinfect- no problems there.  Step 2- inject.  As I injected the lidocaine into the fluctuant abscess I chatted away trying to distract him from the pain.  “Great weather we’ve had this week, right?”.  Then, bam.  Without the help of my scalpel, the pressure of the lidocaine I was forcing into the skin surrounding the pus pocket exploded and liquid bits of infection flew everywhere.  Mainly in my hair.  Awesome.

I tried to keep it cool and make my dry heaves as silent as possible as I finished the procedure.  I hope my Pantene shampoo has enough chemicals in it to kill staph.  My abscess draining technique (and my hair washing regimen) changed that day.  My I&D procedure now includes placing a gauze 4×4 over the abscess as I inject.  I recommend you do the same.