Infections

Tom RaderStaff - June 6, 2021

All wounds can become infected. Even the exposed end of a broken bone sticking through the skin is a soft tissue wound that can become infected (in ad
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I’ve met multiple unhoused folks who have abscesses (I believe a combination of drug use, lack of access to hygiene, lack of access to medical care).

Previous googling has led me to believe that I should not attempt to drain the abscess, and should instead just offer hand warmers as a less invasive mitigation.

What is the risk of leaving an abscess alone? That the infection becomes worse? If I feel that I can safely drain the abscess without damaging more tissue, is that better for the patient than leaving it be? Should I bandage the drainage site just like any other wound?

 

Is it safe to reuse the needle in the future, so long as I clean it and store it in alcohol?

 

The previous googling advice is probably due to the “don’t do any of this stuff if you’re not a professional” philosophy. Which is understandable in that situation, since you’d have a hard time monitoring the patient after the draining + they will likely recontaminate it themselves given their circumstances.

Legal issues aside, the advice here is that draining is better than not draining because infected material is bad. If you consider the totality of the circumstances and decide (with your patient) that the right thing to do is drain it, then okay, do it. 

Yes, an abscess left alone is likely to get worse. But maybe when talking with your homeless patient you learn that the abscess has been there a long time, hasn’t changed much, and doesn’t seem to be causing other problems. In that case, I’d probably chose not to do anything, even if my heart really wanted to. 

 

For draining an abscess, do you use a needle like you’d find at the end of a syringe (e.g. this) or like a sewing needle? If the former, which gauge do you prefer?

Do you recommend something like this for holding the used sharps?

 

Your question above about reusing needles: Ideally you don’t. But if you’re in an austere situation and are worried about scared resources, then yes, you could do your best to sterilize the needle. Putting it in boiling water first would be helpful, then storing in alcohol if possible. But I wouldn’t want to potentially contaminate my bottle of alcohol if it’s the only sterile fluid I otherwise had.

For draining, you could use any type of needle, because you’re essentially just trying to poke a hole. You wouldn’t cut/tear with any needle tip the way you would with a sharp blade.

Yes, use sharps containers when you can! eg. If you’re going out to be a street medic and anticipate using needles, you definitely want a way to protect those tips once used, especially being among the homeless population.

If you don’t have a proper sharps container, use something like a plastic soda/water bottle. The sturdier disposable bottles laying around are better than nothing. (But note that a needle can often still poke through the cap/walls with enough force.)

 

If an abscess had to be drained in an austere setting and needed to be opened up with a blade, do you make the incision only as wide as the abscess? Or slightly wider to allow for more irrigation? Also, when it’s a smaller abscess and more appropriate to use a needle instead, are you just making a puncture or deroofing the entire abscess? Is there an ideal placement for a puncture to allow for maximum drainage (e.g. edge of the abscess, middle, etc)?