How to place a catheter into a Bartholin abscess?

Placement of a Word Catheter for Bartholin Abscess

The Word catheter is the most effective and preferred technique for management of Bartholin gland abscesses, offering low recurrence rates and high patient satisfaction when properly placed and maintained for the full treatment duration. 1

Procedure for Word Catheter Placement

Materials Needed

• Word catheter
• Local anesthetic (1% lidocaine with epinephrine)
• Povidone-iodine or chlorhexidine for skin preparation
• #11 scalpel blade
• Sterile gloves
• Gauze pads
• Syringe for inflation
• Sterile water or saline

Step-by-Step Technique

1. Patient Positioning

   • Position patient in dorsal lithotomy position
   • Ensure adequate lighting

2. Preparation

   • Clean the area with antiseptic solution (70% alcohol, chlorhexidine, or povidone-iodine) 2
   • Administer local anesthetic (1% lidocaine with epinephrine) at the planned incision site

3. Incision and Drainage

   • Make a small (5-10 mm) incision at the mucosal surface of the abscess, as close as possible to the hymenal ring
   • The incision should be kept as close as possible to the anal verge to minimize the length of potential fistula formation 2
   • Allow the purulent material to drain completely
   • Send specimen for culture if clinically indicated

4. Word Catheter Insertion

   • Insert the deflated Word catheter into the abscess cavity
   • Inflate the balloon with 2-3 mL of sterile water or saline
   • Tuck the external end of the catheter into the vagina

5. Post-Procedure Care

   • The catheter should remain in place for 4-6 weeks to allow epithelialization of the tract
   • Advise patient that the catheter may be in place during this period
   • Prescribe appropriate antibiotics if signs of infection are present

Clinical Evidence and Outcomes

Word catheter placement has shown excellent results with:

• 97% abscess resolution rate 3
• Low recurrence rates of approximately 12% 4
• High patient satisfaction, with 89% of women reporting they would choose the same treatment again 3

Potential Complications and Management

Catheter Dislodgement

• Occurs in approximately 20% of cases 3
• Most commonly happens within the first week
• If dislodgement occurs before epithelialization (usually within 2-3 weeks), reinsertion may be necessary

Recurrence

• If recurrence occurs, repeat the procedure or consider alternative treatments such as marsupialization
• Some studies suggest marsupialization may have slightly lower recurrence rates (8.3% vs 18.8%) 5

Alternative Techniques

If a Word catheter is unavailable, a simple technique using a small loop of plastic tubing can be employed:

• Create a loop of tubing
• Secure it to prevent expulsion
• This allows for drainage until epithelialization occurs 1

Follow-up Recommendations

• Review patient after 1 week to ensure catheter is still in place
• Remove catheter after 4 weeks
• Assess for complete resolution and absence of recurrence

The Word catheter technique offers several advantages over surgical alternatives including:

• Can be performed under local anesthesia
• Shorter procedure time (approximately 1 hour vs 4 hours for marsupialization) 4
• Reduced need for analgesics (33% vs 74% for marsupialization) 4
• Can be performed in outpatient settings without hospitalization 6

This minimally invasive approach promotes therapeutic de-escalation, has high patient acceptance, improves clinical outcomes, and reduces healthcare costs 6.