Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Check PT, PTT, plt ,Hgb ,WBC with differential
Clear liquids p MN
Cover patient with antibiotics (usually broad spectrum)
Scan to localize - aim to place drain in dependent position
Puncture with 18G needle
Aspirate a sample back for micro
0.038 guide wire through needle
Dilate out tract
Put in 12-14 Fr drain and secure it
Aspirate abscess cavity as completely as possible
Flush abscess cavity with sterile saline until you get clear return
Put Hypaque through drain and do fistulogram using a CT pilot to define entire abscess cavity
Guidelines : try not to let cath traverse bowel or viscera if possible
Maintenance: if daily drainage > 50-100 ml suspect a fistula, allow 1-2 weeks for drainage
Post Drain Orders:
Check vital signs, puncture site, and for signs of sepsis q 15 min x 4, q 30 min x 2, q 60 min x 2
Resume pre procedure diet
Bed rest x 2 hours - may have HOB up
Then may ambulate at will
Have patient up in rocking chair q shift
CBC with differential in AM
Maintain patient on IV Antibiotics
Drain care: strict I and O's, do not manipulate drain, single lumen drain - keep to dependent drainage and double flush q shift, sump drain - keep to low suction and double flush q shift
Page radiologist with questions
Explain drain to nurse
Views to Take:
See References Chapter.
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