Essential Guide to Safely Draining a Peritonsillar Abscess (Quinsy) for Healthcare Professionals

In today's post, we're diving deep into the medical procedure for draining a peritonsillar abscess, commonly known as a quinsy. This is a critical procedure that can significantly alleviate a patient's discomfort and prevent further complications. Drawing from my personal experience and the video content, we'll cover everything you need to perform this procedure safely and effectively. Remember, this is intended for trained and licensed healthcare professionals—do not attempt this at home. If you're a patient suspecting a quinsy, please consult a healthcare professional immediately.

First things first, before even considering the procedure, ensure you've taken a detailed history and thoroughly examined the patient. High clinical suspicion of a quinsy is essential. Sometimes, examining the mouth can be challenging due to significant trismus (inability to open the mouth fully). If this is the case, admit the patient, administer IV treatment, and re-examine them later. Initial treatment can often improve your view.

When admitting a patient with suspected quinsy, IV access is crucial. Take blood for a full blood count, U&Es, LFTs, and a glandular fever screen (e.g., Monospot). Pain relief is also essential—administer paracetamol orally if the patient can swallow; otherwise, use IV analgesia. Topical analgesic sprays like benzodiamine can also be beneficial. Additionally, IV fluids such as Hartmann's solution or sodium chloride are necessary as these patients are often dehydrated. A single dose of IV steroid, typically dexamethasone 6.6 mg, can make the patient feel significantly better.

Ultimately, the definitive treatment for a quinsy is drainage. There are two primary techniques: needle aspiration and incision and drainage. Let's break down each method.

**Needle Aspiration**

1. **Preparation**: Explain the procedure to the patient and obtain written consent. Discuss potential complications such as bleeding, infection, pain, and the risk of puncturing the carotid artery.
2. **Equipment**: You'll need local anesthetic spray (1% lidocaine with epinephrine), topical anesthetic spray (4% lidocaine), a 25 and 20-22 gauge needle, a 5 ml syringe, a metal or wooden tongue depressor, a head torch, a scalpel, blunt tip forceps, a sick bowl, a Yankauer sucker, and appropriate PPE.
3. **Anatomy**: Understand the relevant anatomy. The tonsils are between the anterior and posterior pillars of the throat. The peritonsillar abscess is between the tonsillar capsule and the palatopharyngeus muscle. Importantly, the internal carotid artery lies about 2.5 cm posterolateral to the tonsil, so avoid directing the needle towards it.
4. **Procedure**: Position the patient upright with head support. Spray the back of the throat with topical anesthetic and wait a few minutes. Use a tongue depressor to push the tongue aside and identify the most prominent part of the abscess. Inject 2-3 ml of anesthetic into the mucosa using a 25-gauge needle. The mucosa should blanch, indicating correct depth. For aspiration, use a 10 ml syringe with an 18 or 20-gauge needle. Apply continuous suction and direct the needle anterior to posterior. Aspirate the most prominent area first, typically the superior pole. If no pus is obtained, try the middle and inferior poles. Avoid aspirating the tonsil itself. Collect the pus for culture.

**Incision and Drainage**

1. **Preparation**: Again, explain the procedure and obtain consent.
2. **Equipment**: Similar to needle aspiration, but ensure you have a scalpel with the blade covered except for the last half centimeter.
3. **Procedure**: Warn the patient that pus will flow and must be spat out. Make a small incision over the most prominent area with the scalpel. Use a suction catheter to remove pus and blood. Expect some bleeding. Open the incised area with blunt forceps to drain as much pus as possible. Have the patient rinse and gargle with saline or a diluted peroxide saline solution.

**Aftercare**

1. **Observation**: Monitor the patient for about an hour for complications such as bleeding and ensure they can tolerate fluids.
2. **Discharge**: Provide antibiotics as per your trust guidelines, warm saline rinses, and follow-up instructions. Ideally, follow up within 24 hours. Supply written advice and safety netting information.
3. **Further Management**: Patients with excessive bleeding, aspiration, or inability to take oral antibiotics may require prolonged observation or hospitalization. Multiple abscesses may necessitate elective tonsillectomy after 4-6 weeks. Consider imaging and other diagnoses for recurrent quinsy or immunocompromised patients.

If you found this guide useful, please like and subscribe to the channel. For those looking to scale their medical brand on YouTube or interested in sponsoring our videos with your products, feel free to book a consultation. Until next time, keep learning and stay safe.