An abscess is a localized collection of pus, typically caused by a bacterial infection, resulting from the body’s immune response. Standard treatment involves Incision and Drainage (I&D), where a healthcare provider opens the abscess to release the pus and clean the cavity.
Packing the wound after I&D ensures the deeper parts of the cavity heal correctly. The packing material prevents the outer skin edges from sealing shut too early, which would trap fluid and lead to recurrence. This process encourages the cavity to heal from the base upward, known as secondary intention healing.
Necessary Supplies and Preparatory Steps
Before beginning the packing change, gather all necessary supplies and create a sterile work environment. Supplies include a specific type of packing material (like plain gauze ribbon or iodoform gauze), sterile gloves, sterile normal saline solution, sterile cotton swabs or forceps, and a clean, fresh outer dressing with medical tape.
Preparation begins with meticulous hand hygiene, scrubbing hands thoroughly with soap and water for at least twenty seconds. Establish a clean work surface covered with a clean towel to reduce contamination. If pets or children are present, move them to another area to maintain a focused environment.
The packing material often needs to be moistened with sterile saline solution in a clean bowl. Gently squeeze the material to ensure it is damp but not dripping wet, as excess moisture can cause skin breakdown. Pre-cut strips of tape should be set aside for easy access once the new dressing is applied.
Step-by-Step Technique for Wound Packing
The first step is to safely remove the old dressing and packing material. Gently peel away the outer dressing and carefully pull out the existing packing strip, placing contaminated materials immediately into a plastic waste bag. Inspect the removed packing for color, odor, and drainage amount, as this provides information about the wound’s healing progress.
Next, thoroughly clean the wound cavity, typically using a sterile saline solution. This irrigation process flushes out any remaining debris, exudate, or loose tissue. Irrigation should be done gently with a syringe or by carefully washing the wound as directed by your provider.
Once the wound is clean, the new packing material is ready for insertion. The goal is to loosely fill the dead space, ensuring a single continuous strip is used to prevent pieces from being left behind. Using sterile gloves and sterile forceps, gently guide the damp packing strip into the entire cavity.
Avoid jamming the material in tightly, which can cause pressure, pain, and impede blood circulation. The packing should conform to the base and sides of the wound, allowing for drainage while keeping the edges separated. Leave a small “tail” (one to two centimeters) visibly outside the wound opening for easy removal.
Finally, cover the packed wound with a fresh, sterile outer dressing. This dressing absorbs drainage and protects the cavity from the external environment. Secure the outer dressing firmly with the pre-cut pieces of medical tape until the next scheduled change.
Follow-Up Care and Signs of Complication
The typical frequency for changing the abscess packing is once or twice daily, or as prescribed by the healthcare provider. To remove the old packing safely, moisten the area with saline or perform the removal in the shower to loosen the material and reduce discomfort. Pull the old packing out smoothly and efficiently to minimize pain.
The wound heals by gradually filling in from the bottom, meaning the amount of packing material needed will decrease over time. If the packing material no longer fits or the wound appears to be healing completely, this is a positive sign. Packing is temporary and is usually discontinued once the cavity has granulated enough to prevent premature closure of the skin surface.
Monitor the wound closely for signs that may indicate a worsening infection or complication. Seek immediate medical attention if you develop systemic symptoms such as a fever or chills.
Locally, signs of trouble warranting immediate contact with a healthcare professional include:
- Increasing pain that is not relieved by medication.
- The appearance of red streaking on the skin spreading away from the wound.
- A foul odor emanating from the drainage.
- Significant increase in redness, warmth, or swelling around the abscess site.
- The inability to locate the packing material’s tail.