Incision and Drainage I & D

  Assisting with Incision and Drainage

  1. Perform hand hygiene and apply gloves and eye protection.
  2. Verify the patient's identity in accordance with institutional policy.
  3. Assess the area for inflammation: heat, pain, redness, and swelling.
  4. Assess neurovascular status using the 8 Ps: pain (administer analgesics as indicated and prescribed), pallor (i.e., color), pulses (i.e., circulation), paresthesias (i.e., sensation), paralysis (i.e., movement), puffiness (i.e., edema), position (i.e., angulation), and pressure (i.e., tense compartment).
  5. Call or participate in a "time out" before initiating an invasive procedure, in accordance with institutional policy.
  6. Drape the area with waterproof drapes.
  7. Clip the hair or shave the area as indicated.
  8. Cleanse the area with antiseptic solution with firm, circular scrubbing motions from the abscess outward.
  9. The physician or advanced practice nurse anesthetizes the area with local anesthetic. Intravenous analgesia and sedation may be necessary for large or deep abscesses. Abscesses may be difficult to anesthetize adequately, and drainage in the operating room may be indicated.
  10. The physician or advanced practice nurse incises the periphery of the abscess cavity with the scalpel; purulent material is expressed immediately.
  11. The physician or advanced practice nurse disrupts adhesions with a hemostat.
  12. Obtain anaerobic and aerobic cultures from the drainage.
  13. Cleanse the cavity with cotton swabs and then irrigate with sterile saline solution.
  14. The physician or advanced practice nurse packs the wound loosely with plain or iodoform gauze strip, leaving 1 cm of gauze exiting from the cavity.
  15. The physician or advanced practice nurse inserts a sterile rubber band or penrose drain appropriate for size of abscess, allowing end to extrude from wound at least one centimeter.
  16. Apply a sterile dressing, and secure with adhesive tape.
  17. Reassess neurovascular and pain status.
  18. Discard supplies, remove gloves and eye protection, and perform hand hygiene.
  19. Document the procedure in the patient's record.

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