Using ultrasound to guide subcutaneous abscess drainage

This video will show you how to use ultrasound to guide incision and drainage of a subcutaneous abscess.

Sara Damewood, MD
Sara Damewood, MD
17th Jan 2018 • 2m read

A subcutaneous abscess is never a pretty sight, and when you need to drain it, you'll want an ultrasound probe on hand to get it done right. This video will show you the technique for using ultrasound to guide incision and drainage of a subcutaneous abscess.

Want to perform your own procedural ultrasounds? Take our Procedural Ultrasound Masterclass course and start using ultrasound to improve the safety of your procedures. Your instructor, Dr Sara Damewood–the Emergency Ultrasound Section Chief and Clinical Ultrasound Fellowship Director at the University of Wisconsin–will guide you through the essentials of procedural ultrasound.

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Video Transcript

[00:00:00] Let's take a closer look at abscesses. Abscesses can appear either anechoic or complex. These are both abscesses. The abscess on the left has more complex fluid, here, compared to the simple appearing fluid in the abscess on the right. Once you have determined that there is an abscess present, the next step is to get it into the center of your screen, then

[00:00:30] to get a sense of size. Based on size and complexity, you may choose to pursue incision and drainage or needle aspiration. Smaller, simple collections can be aspirated via needle, instead of large complex collections like this one, would likely need an incision and drainage. Once you have found the largest pocket, you don't need ultrasound to directly guide you, necessarily. However, if you choose to use ultrasound, it is not necessary to use a sterile sheath, however, you might consider using a protective

[00:01:00] barrier for the ultrasound probe, from the likely infection that it is about to be exposed to. You can use a glove or an adhesive dressing. Either way, make sure to clean the probe thoroughly afterwards. If you're going to use ultrasound to directly guide you, you would hold the probe with your non-dominant hand using your well-coordinated hand, to handle the very sharp instrument you're about to use. You can also measure how deep the abscess runs. You might consider packing the abscess, after incision and drainage, for larger abscesses. Here, the depth of the ultrasound machine

[00:01:30] is set at 3 cm. So, the abscess is probably a little more than 2 cm at its deepest point. It also appears to be about 1 cm deep from the surface. Another important consideration of performing an incision and drainage is breaking up potential loculations of fluid. This patient had fibrinous loculations that you can visualize in parts of this ultrasound image. She required these loculations to be freed,

[00:02:00] to have complete drainage of the fluid in her abscess. Nice. Now, you know how to use ultrasound to guide incision and drainage of abscesses.