A Bartholin's cyst can be a tricky beast to manage if you don't know what you're doing. In this video, from our Emergency Procedures Masterclass (Part 2), you'll learn the procedure and tools required for draining a Bartholin’s gland abscess, when to prescribe antibiotics, and what technique to use when the abscess is too large.
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In this course, you will learn a variety of procedures used in emergency medicine. These procedures will help you to diagnose and treat common infections, injuries, and other problems, such as joint infections, dislocations, soft tissue abscesses, and priapism. You’ll also cover the ultimate airway rescue procedure—the cricothyrotomy. This masterclass is a companion to the Emergency Procedures Masterclass (Part 1).
In this lesson, I'll teach you the tools and procedure for draining a Bartholin gland abscess. Let's first gather the equipment we need. You'll need sterilizing solution, in this case, I use betadine solution, 1% lidocaine with epinephrine, and a small 27 gauge needle, as well as a 3cc syringe. You'll also need a #11 blade scalpel, a hemostat a Word catheter, a 20 gauge needle and a 5cc syringe filled with water.
A Word catheter is basically a balloon catheter. After you've made your stab incision, and most of the pus has drained you'll place this catheter into the empty cavity and blow up the balloon so that it stays in the cavity and allows for the remaining pus to keep draining until the patient follows up with their gynecologist.
If you don't have a Word catheter and the abscess is large enough, you can just do the loop drainage technique I described in an earlier lesson. All right, it's time to perform the procedure. Before we begin, there is an important pearl I learned the hard way. Often, the pus in a Bartholin abscess is under a lot of pressure and it can spray out.
So it's a good idea to wear a face mask and personal protective gear to protect yourself before you start. Step one is to place the patient in stirrups in the lithotomy position. In this position, you can see the abscess much better. The incision has to be made on the mucosal inner surface of the vagina. So pull the abscess outward.
You should numb the most fluctuant part of the abscess on the mucosal side. Once the patient is numb, use your #11 blade to make a stab incision, no bigger than half a centimeter into the mucosal surface you just numbed. This area will be blanched from the epinephrine. Sometimes, depending on the size of the abscess, you can use a hemostat to gently probe and open up any possible loculations.
Once all the pus is drained, insert the Word catheter and fill it with 3cc of fluid. If you don't have a Word catheter and the abscess is small, you can just skip this step. If you do place a Word catheter, the gynecologist will remove it on the follow up visit. Here's a video of the procedure after anesthesia. Start by pulling the labia laterally to expose the mucous membrane and numb the area using lidocaine with epinephrine.
Then make your stab incision with your #11 blade and be ready for a splash of pus. Finally, insert your Word catheter and inflate it with 3-5cc of water. Some people use air but fluid works better because it won't leak out. The only thing left to do now is to arrange for follow-up in about two days. Antibiotics are not needed unless the patient has a fever or is immunocompromised. Alright, congratulations, you now know how to treat a Bartholin gland abscess.