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Trick of the Trade: Peritonsillar abscess aspiration technique

2016-11-11T18:45:06+00:00
 
Photo1_MacbladesmA few weeks ago, I gave a Tricks of the Trade talk for the Stanford-Kaiser Emergency Medicine residents and faculty. I was overwhelmed by the great, creative ideas that came up during our discussion.

An always popular topic is the drainage of peritonsillar abscesses. Sometimes it can be difficult to aspirate from a syringe using only one hand, especially with the awkward angle that you might encounter.   I can never find syringes with the side rings to allow you to grasp the syringe more securely with one hand (see photo above).

 

Trick of the Trade: Peritonsillar abscess aspiration technique

Have an assistant apply negative pressure to a syringe connected to the needle using IV tubing

Build a kit similar to the butterfly phlebotomy setup (above drawing).

  • Attach IV extension tubing to the spinal needle. 
  • Attach the other end of the IV tubing to the syringe. 
  • Ask the assistant to apply negative pressure on the syringe once you have penetrated the oral mucosal surface.
  • Now you can focus on just directing the needle to the appropriate area.
PTA_IVadaptorSm
 
Photo2_SpinalNeedle2sm
 

syringe 3ml

If you don’t have an assistant, you can also rig a vacutainer hub to the end of the extension tubing, again similar to a phlebotomy set up. Just imagine the same setup as below except with a spinal needle at the end instead of a butterfly needle.

 

Thanks to Dr. Nick Kanaan (Stanford-Kaiser EM co-chief resident) for telling me about his trick.

Vacutainer

 

Photo #1 courtesy of Dr. Hagop Afarian (Fresno)

 

Michelle Lin, MD
ALiEM Editor-in-Chief
Academy Endowed Chair of EM Education
Professor of Clinical Emergency Medicine
University of California, San Francisco
Michelle Lin, MD
Michelle Lin, MD

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