Trick of the Trade: Peritonsillar abscess aspiration technique using IV tubing

A 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.

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.

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.