- Position the patient: Make him sit upright, eye to eye with the operator, with a good source of light (headlight or mirror with the light source behind the patient).
- Explain what you’re going to do and obtain consent.
- Palpate the soft palate to determine the fluctuant area. This is the aspiration site. This is usually superior to the tonsil.
- Spray 4 per cent lidocaine topical on the aspiration site.
- Inject a small amount – 0.5 cc or so – of local anesthetic at the aspiration site. Best to use a small gauge (25, 27) long needle.
- Prepare the aspirating syringe: Use about a 10 cc syringe. Needle: can use a long 18 gauge needle, an 18 gauge spinal needle, or the Trocar from inside or a long IV catheter. Can use a Steristrip to mark one centimeter from tip of needle to prevent yourself from going too deep (don’t forget there’s a carotid artery in there!).
- Pick up a tongue depressor in your non–dominant hand and the aspirating syringe in your dominant hand.
- Depress the tongue, insert the needle at the aspiration site and aspirate.
- If you get pus, aspirate until no more comes out.
- If there is none, slightly withdraw the needle and redirect inferiorly and re–aspirate.
- If there is still no return, one can choose a second site as per the diagram (lower and slightly more lateral).
- Have the patient rinse and spit (water or saline).
- If the patient can eat or drink, has no airway symptoms, and doesn’t seem too sick he can be sent home.
Abscess Site- Soft diet.
- Rinses after eating and several times during day.
- Antibiotics.
- Analgesics.
- If the patient can’t drink or has difficulty breathing he should return.
- If they’re doing well they should be re–examined at 48 hours.
- If improving, continue antibiotics.
- If no better or worse: re–aspirate, IV antibiotics.
