From the Guidelines
Access drainage is contraindicated in several situations that could lead to complications or treatment failure, including uncorrected coagulopathy, lack of safe access route to the collection, and inability to identify the fluid collection on imaging, as noted in studies such as 1 and 1. Absolute contraindications for access drainage include:
- Uncorrected coagulopathy
- Lack of safe access route to the collection
- Inability to identify the fluid collection on imaging Relative contraindications include:
- Thrombocytopenia (platelet count <50,000/μL)
- Anticoagulation therapy that cannot be temporarily discontinued
- Collections that are inaccessible due to intervening vital structures like major blood vessels or bowel loops Drainage should also be avoided in patients with severe hemodynamic instability until they are stabilized, as the procedure could worsen their condition. For infected collections, drainage should not be performed without appropriate antibiotic coverage, typically broad-spectrum antibiotics started before the procedure, as recommended by 1. The presence of multiple small collections rather than a single drainable abscess may also limit the effectiveness of drainage procedures. These contraindications exist because drainage procedures carry risks of bleeding, infection spread, organ injury, and procedural failure that could harm patients in these circumstances. A thorough pre-procedure assessment including coagulation studies, complete blood count, and appropriate imaging is essential to identify these contraindications, as highlighted in studies such as 1 and 1.
From the Research
Contraindications for Access Drainage
There are no direct contraindications for access drainage mentioned in the provided studies. However, some studies mention potential complications and considerations for drainage:
- The use of drains can be contentious, and their selection, use, and duration should be practiced with prudence 2.
- Drains are not innocuous, especially when poorly selected, wrongly used, and left in situ for too long 2.
- Coagulopathy can be a concern in patients undergoing surgery, and the use of fresh frozen plasma infusions may be necessary to correct coagulopathy 3, 4, 5.
- Vitamin K deficiency can cause coagulopathy, and patients who have not eaten for a few days and have been administered antibiotics with an N-methyl-thiotetrazole (NMTT) side chain may be at risk 4.
- The timing of fresh frozen plasma administration can be crucial in rapidly correcting coagulopathy in warfarin-related intracerebral hemorrhage 5.
Considerations for Drainage
Some considerations for drainage include:
- Understanding the benefits and applications of surgical drains and tissue responses to constituent material 2.
- Correct assessment of clinical indications to reduce unnecessary usage of drains 6.
- The use of closed vacuum drains can apply negative suction in a sealed environment, producing apposition of tissues and promoting healing 6.