Incision and Drainage Consent Form
Nitrile exam gloves (1 pair)
11 Blade disposable scalpel (1)
Culture swab (1 swab)
1 Liter normal saline or sterile water (1)
60 ml (or largest available) syringe (1)
Splash guard (1) if available
Wash basin (1)
Kidney basin (1)
Forceps, curved (1 pair)
Forceps, straight (1 pair)
Sterile 4x4 gauze (10)
Iodoform gauze (1 new bottle)
Iodine swab sticks (3)
Alcohol swabs (10)
1% or 2% lidocaine: If fingers, toes, penis, or nose - then without epinephrine. Otherwise with epinephrine. (1 vial)
10 ml syringe (1)
18 gauge 1.5 inch needle (1)
27 gauge 1.5 inch needle (1)
Exam-room sheet (1 sheet)
Chux pads (10)
ABSCESS INCISION AND DRAINAGE
Risks and benefits of the procedure were discussed, including the risk of bleeding, pain, the need for repeat procedure. Patient indicated understanding and wished to proceed. Timeout performed.
Area of concern was cleaned and draped. Alcohol used to clean skin over area of injection. Injected _ ml of _% lidocaine with epinephrine. Area further swabbed with iodine swab sticks and allowed to dry. Using scalpel performed linear incision over lateral aspect of of induration. Drained _ ml of purulent fluid. Probed wound for loculations and broke them down using gentle opening motion of forceps. Irrigated wound with copious clean water. Wound packed with _. Covered with sterile dressing.
Patient tolerated the procedure well with approximately _ ml of bleeding.
Instructed patient to follow-up in _ days for removal of packing. Return immediately for fever, significantly worsening pain, spreading redness around the area, or other concerning symptom.