The minimally invasive loop drainage technique is associated with better outcomes for patients with soft tissue abscess compared with the conventional incision and drainage technique and should become the method of choice for nurse practitioners (NPs), according to findings from a poster presented at the 2021 American Academy of Nurse Practitioners National Conference (AANP 2021).1
Skin and soft tissue infections are among the most common complaints leading to unscheduled urgent care and emergency department visits. Approximately one-third of these infections lead to abscess formation, for which the most common therapeutic intervention is incision and drainage.
The burden of skin and soft tissue infections is significant, noted Denise Ramponi, DNP, FNP-C, ENP-BC, FAANP, FAEN, who presented the poster at AANP 2021. In 2017, approximately 3 million skin and soft tissue infections requiring an emergency department visit were performed in the United States. Across the country, soft tissue abscesses are consistently the 7th leading reason for all emergency department visits. In 2014, 226 million physician office visits were attributed to these infections, with a total yearly cost of $4.69 million.
Clinically, the increase in wound abscesses can likely be attributed to the increased prevalence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections, which typically require repeated incision and drainage to treat, noted Dr Ramponi, of Robert Morris University and Heritage Valley Health System in Pennsylvania.
Conventional incision and drainage and the loop drainage technique are common soft tissue abscess management procedures. In conventional incision and drainage — the traditional standard of care — providers make a linear incision through the center of the patient’s abscess and manually explore the cavity with purulence expressed. Hemostat is used to disrupt loculations and packing is placed.
In the loop drainage technique, the provider makes 2 small, 4-mm to 5-mm incisions at the periphery of the abscess. A hemostat is used to disrupt loculations and then the vessel loop is inserted and pulled through both incisions. Patients are instructed to slide the silicon vessel loop twice daily.
Previous research supports the use of the loop drainage technique over conventional incision and drainage, noted the presenter. One retrospective study published in 2015 found that among 233 pediatric abscesses, the failure rate was 10.5% in conventional incision and drainage compared with 1.4% in the loop drainage technique.2 Another comparison study, a systematic review and meta-analysis published in 2018, found that in 4 studies (n=470), conventional incision and drainage failed in 9.43% of cases vs 4.10% failure rate with the loop drainage technique.3
In a prospective, randomized study of 209 patients, the researchers sought to determine if irrigation could improve treatment success with conventional incision and drainage. The need for further intervention was not different in the irrigation vs no irrigation groups (15% vs 13%). There was no difference in pain visual analog scale scores (5.6 vs 5.7).4
A retrospective study of 576 pediatric patients (average age, 3.84 years) found that only 4.5% of patients treated with the loop drainage technique required additional procedures (2 patients with pilonidal cysts and 1 with accidental home removal).5
“Antibiotic resistance is an ever-increasing problem throughout the world. Conventional incision and drainage has been the gold standard for too long. Using this technique increases the use of antibiotics because of its 25% failure rate,” commented AANP 2021 attendee Mary Koslap-Petroco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing in Stony Brook, New York.
“The loop drainage technique should [become] the gold standard for incision and drainage. It is an evidence-based intervention that is easy for NPs to employ and is less invasive because it requires 2 smaller incisions rather than 1 large incision with no packing of the wound,” Dr Koslap-Petroco said. “It is also less painful for the patient and reduces hospital stays and the follow-up for home health visits.”
The loop drainage technique has “good patient tolerance and improved outcomes,” the presenter concluded, and “reduces the total cost of hospitalization.” Dr Koslap-Petroco agreed: “the loop drainage should be the preferred procedure for improved patient outcomes based on the best available evidence.”
1. Ramponi D. What’s new in minor soft tissue abscess management? Presented at: 2021 American Academy of Nurse Practitioners National Conference (AANP 2021); June 15-June 20, 2021. Poster 45.
2. Ladde JG, Baker S, Rodgers CN, Papa L. The LOOP technique: a novel incision and drainage technique in the treatment of skin abscesses in a pediatric ED. Am J Emerg Med. 2015;33(2):271-276. doi:10.1016/j.ajem.2014.10.014
3. Gottlieb M, Peksa GD. Comparison of the loop technique with incision and drainage for soft tissue abscesses: a systematic review and meta-analysis. Am J Emerg Med. 2018;36(1):128-133. doi:10.1016/j.ajem.2017.09.007
4. Chinnock B, Hendey GW. Irrigation of cutaneous abscesses does not improve treatment success. Ann Emerg Med. 2016;67(3):379-383. doi:10.1016/j.annemergmed.2015.08.007
5. Aprahamian CJ, Nashad HH, DiSomma NM, et al. Treatment of subcutaneous abscesses in children with incision and loop drainage: a simplified method of care. J Pediatr Surg. 2017;52(9):1438-1441. doi:10.1016/j.jpedsurg.2016.12.018
This article originally appeared on Clinical Advisor