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Updated August 26, 2015.

If you're human--which I'm assuming you are--chances are you've experienced a boil or an abscess.  As we can all attest to, abscesses hurt like heck.  However, ridding yourself of the pus and debris retained by an abscess can be a bit tricky and requires the service of a physician, physician assistant, nurse practitioner or so forth.  Solely for your own edification, I'm going to tell you how this procedure is done.


I implore you, if you have a fluctuant abscess ("bubbly" with a head or point) please make an appointment with your primary care physician, or, depending on the severity, go into the emergency department.  An abscess must be drained in a sterile field using sterile instruments.  Furthermore, in this article, I'll be discussing only cutaneous abscess that affect fleshy parts of the skin (think upper leg or torso); boils that affect the face, neck, hands, ankles, genitals, anus and so forth need special attention and may require bona fide surgery by a specialist in the operating room. 

Of note, depending on its size and other factors, even a cutaneous abscess may need drainage by a surgeon in the operating room.  On a related note, if you have diabetes or are immunocompromised in some way, you'll likely need special care.

 

Materials needed to drain an abscess

 

Here's some stuff that's needed to drain a boil.  As you can imagine, these materials are sterile and can are found in the hospital or clinic.

• Protective gown, mask, gloves, and goggles;
• Mounted surgical blade;
• Mosquito clamps;
• Gauze (or other packing material);
• Forceps;
• Plastic absorbent pad;
• Sterile saline;
• Wound dressing;
• Lidocaine;
• Drapes;
• Irrigating syringe and basin;
• Culture tube;
• Needle.

 

How the abscess is drained

 

Before an abscess is drained, you must be properly positioned.  In other words, you should comfortably lie on a firm surface like an examination table with the area to be drained completely exposed.

One other note before we delve into specifics:  Anesthesia is challenging during the drainage of a boil.  Oftentimes, anesthesia using lidocaine and a needle is ineffective especially with the first knick.  Shooting an ebscess up with lidocaine will not only do little to relieve pain but also may make the entire procedure more painful.  Instead, lidocaine may be useful with subsequent incisions especially with larger abscesses.  (Nerve blocks don't work that well either and require an anesthesiologist.)  Moreover, your physician may decide to give you some oral narcotics (morphine) before you begin to take the edge off or use ethyl chloride to freeze the area during the procedure.  Rest assured that once the boil is drained and the pressure is relieved, you'll feel relief. 

1. The practitioner dons a gown, sterile gloves and so forth.  A sterile field is also set up using drapes.  A plastic absorbant pad is placed under the area to be drained.
2. The area is examined for a point of maximal fluctuance (head or point).  This step may require some palpation or poking about and can be painful.
3. If ethyl chloride is being used, it's applied now.
4. The practitioner makes a quick knick where the abscess is most fluctuant, and, at this point, the abscess should ooze pus on its own.
5. Depending on the size of the abscess, the practitioner will make subsequent incisions to ensure that the abscess is completely opened and all the pus is extruded.  With subsequent cuts, the practitioner might choose to use a syringe filled with lidocaine for anesthesia.
6. Pus may be collected and sent to pathology for culture.
7. Depending on need, the practitioner can use a clamp to break up loculations or hardened areas in the abscess.
8. The cavity (drained abscess) is irrigated or cleaned with sterile saline.
9. The cavity is packed with gauze.
10. The wound is dressed and bandaged.

 

After your abscess is drained, your physician should prescribe you antibiotics.  Because community-acquired MRSA is a common cause of skin and soft-tissue infections, Bactrim (TMP-SMX) is a wise choice.  Please remember to take the entire course of antibiotics!  Furthermore, make sure to make your follow-up appointment with your primary care physician within the next few days.

 

<sub>Selected Sources

Partin W, Dorroh C. Chapter 7. Emergency Procedures. In: Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment Emergency Medicine, 7e. New York, NY: McGraw-Hill; 2011. Accessed August 18, 2015.</sub>