How to Aspirate a Peritonsillar Abscess?

Abscess Site

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.

Some instructions