Percutaneous Abscess Drainage
An abscess is an infected fluid collection within the body. Percutaneous abscess drainage uses imaging guidance to place a needle or catheter through the skin into the abscess to remove or drain the infected fluid. It offers faster recovery than open surgical drainage.
Patients who undergo this procedure are usually hospitalized. Inform your doctor if there's a possibility you are pregnant and discuss any recent illnesses, medical conditions, allergies and medications you're taking. Your doctor may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instruct you not to eat or drink anything for several hours beforehand. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.
- What is Percutaneous Abscess Drainage?
- What are some common uses of the procedure?
- How should I prepare?
- What does the equipment look like?
- How is the procedure performed?
- What will I experience during and after the procedure?
- Who interprets the results and how do I get them?
- What are the benefits vs. risks?
What is Percutaneous Abscess Drainage?
An abscess is an infected fluid collection within the body. In general, people who have an abscess will experience fever, chills and pain in the approximate location of the area that is involved. If a patient has these symptoms, it is not uncommon that they will undergo an imaging test, (usually a CT scan or an ultrasound), to assist in identifying and making the correct diagnosis of an abscess. Once the diagnosis of an abscess has been made, your physician and an interventional radiologist will work together to decide the appropriate therapy. As long as it is deemed safe, percutaneous abscess drainage offers a minimally invasive therapy that can be used to treat the abscess.
In percutaneous abscess drainage, an interventional radiologist uses imaging guidance (CT, ultrasound or fluoroscopy) to place a thin needle into the abscess to obtain a sample of the infected fluid from an area of the body such as the chest, abdomen or pelvis. Then, a small drainage catheter is left in place to drain the abscess fluid. It may take several days for all the fluid to be removed. Occasionally, abscesses that cannot be treated by percutaneous drainage may require surgical drainage in the operating room.
What are some common uses of the procedure?
Percutaneous abscess drainage is generally used to remove infected fluid from the body, most commonly in the abdomen and pelvis. The abscess may be the result of recent surgery or secondary to an infection such as appendicitis or diverticulitis. Less commonly, percutaneous abscess drainage may be used in the chest or elsewhere in the body.
How should I prepare?
Patients who undergo percutaneous abscess drainage fall into two general categories:
- those who are hospitalized, frequently recovering from surgery.
- those who are not hospitalized and have symptoms as described above. In these cases, you may be admitted to the hospital on the day of your procedure.
Tell your doctor about all the medications you take, including herbal supplements. List any allergies, especially to local anesthetic, general anesthesia or to contrast materials. Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners before your procedure.
Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x-rays.
Other than medications, your doctor may tell you to not eat or drink anything for several hours before your procedure.
You will be given a gown to wear during the procedure.
You should plan to stay overnight at the hospital following your procedure.
What does the equipment look like?
A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter.
Percutaneous abscess drainage is typically performed with the guidance of CT, ultrasound or x-ray fluoroscopic imaging.
The CT scanner is typically a large, donut-shaped machine with a short tunnel in the center. You will lie on a narrow examination table that slides in and out of this short tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate control room. This is where the technologist operates the scanner and monitors your exam in direct visual contact. The technologist will be able to hear and talk to you using a speaker and microphone.
Ultrasound scanners consist of a computer console, video display screen and an attached transducer. The transducer is a small hand-held device that resembles a microphone. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out inaudible, high-frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.
The technologist applies a small amount of gel to the area under examination and places the transducer there. The gel allows sound waves to travel back and forth between the transducer and the area under examination. The ultrasound image is immediately visible on a video display screen that looks like a computer monitor. The computer creates the image based on the loudness (amplitude), pitch (frequency) and time it takes for the ultrasound signal to return to the transducer. It also takes into account what type of body structure and/or tissue the sound is traveling through.
The equipment typically used for this examination consists of a radiographic table, one or two x-ray tubes and a television-like monitor that is located in the examining room. Fluoroscopy, which converts x-rays into video images, is used to watch and guide progress of the procedure. The video is produced by the x-ray machine and a detector that is suspended over a table on which the patient lies.
Other equipment that may be used during the procedure includes an intravenous line (IV), ultrasound machine and devices that monitor your heart beat and blood pressure.
How is the procedure performed?
Image-guided, minimally invasive procedures such as percutaneous abscess drainage are most often performed by a specially trained interventional radiologist in an interventional radiology suite or under CT guidance in a separate area of the radiology department.
You will be positioned on the procedure table.
You may be connected to monitors that track your heart rate, blood pressure, oxygen level and pulse.
Your physician will numb the area with a local anesthetic. This may briefly burn or sting before the area becomes numb.
The area of your body where the catheter is to be inserted will be sterilized and covered with a surgical drape.
A very small skin incision is made at the site.
After the patient is sedated for the procedure, the interventional radiologist uses image-guidance to place a catheter (a long, thin, hollow plastic tube) through the skin and into the abscess to allow for drainage of the infected fluid.
Your IV line is removed before you go home.
This procedure is usually completed in 20 minutes to an hour.
Once in place, the catheter is connected to a drainage bag outside of your body. The catheter will remain in place until the fluid has stopped draining and your infection is gone. It may take several days to drain the abscess.
What will I experience during and after the procedure?
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight pinch when the needle is inserted into your vein for the IV line and when the local anesthetic is injected. Most of the sensation is at the skin incision site. This is numbed using local anesthetic. You may feel pressure when the catheter is inserted into the vein or artery. However, you will not feel serious discomfort.
If the procedure is done with sedation, the intravenous (IV) sedative will make you feel relaxed, sleepy and comfortable for the procedure. You may or may not remain awake, depending on how deeply you are sedated.
You will remain in the recovery room until you are completely awake and ready to return home.
You will remain in the recovery room until you are completely awake and ready to be moved to your hospital bed.
In general, patients who undergo percutaneous abscess drainage will remain hospitalized for a few days. Further follow-up is usually done on an outpatient basis and you will be seen by your interventional radiologist at regular intervals to ensure that the healing process is proceeding according to plan. Once you have recovered and your interventional radiologist is satisfied that healing is complete, the catheter will be removed.
Who interprets the results and how do I get them?
The interventional radiologist can advise you as to whether the procedure was a technical success when it is completed.
What are the benefits vs. risks?
- No surgical incision is necessary—only a small nick in the skin that does not need stitches.
- The procedure is minimally invasive and the recovery period is usually faster than after open surgical drainage.
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- There is a very slight risk of an allergic reaction if contrast material is injected.
- Very rarely, an adjacent organ may be damaged by percutaneous abscess drainage.
- Occasionally bleeding may occur.
- The catheter placed at the time of percutaneous abscess drainage may become blocked or displaced requiring manipulation or changing of the catheter. In addition, a very large or complex fluid collection may require more than one abscess drain.
Additional Information and Resources
Society of Interventional Radiology (SIR) - Patient Center
This page was reviewed on April, 04, 2019