From the Guidelines
Percutaneous drainage catheters for iliopsoas abscesses should be removed when clinical improvement is evident, drainage output decreases to minimal amounts, and imaging confirms significant reduction in abscess size, as supported by recent guidelines and studies, such as the 2020 study published in the Journal of the American College of Radiology 1. The removal of a percutaneous drain for an iliopsoas abscess is a critical step in the management of this condition, and it should be guided by clinical judgment and evidence-based practices.
- Key factors to consider when deciding to remove the drain include:
- Clinical improvement, such as resolution of systemic symptoms like fever and leukocytosis
- Decrease in drainage output to minimal amounts, typically less than 10-20 mL per day for 2-3 consecutive days
- Imaging confirmation of significant reduction in abscess size
- Individualization of the decision based on the patient's response to treatment and the underlying cause of the abscess The timing of drain removal can vary depending on the complexity of the case, but it typically occurs after 7-14 days of drainage, as suggested by the study 1.
- It is essential to weigh the risks of premature removal, which can lead to recurrence, against the risks of prolonged catheter placement, which can increase the risk of infection and patient discomfort. Before removing the drain, some clinicians may perform a sinogram to ensure there is no persistent collection or fistulous communication, as part of a comprehensive approach to management 1.
- After drain removal, patients should continue appropriate antibiotic therapy, typically completing a total 2-4 week course, depending on the causative organism and clinical response, to minimize the risk of recurrence and promote optimal outcomes.
From the Research
Percutaneous Drain Removal for Iliopsoas Abscess
- The removal of a percutaneous drain for an iliopsoas abscess is typically considered when the abscess has resolved and the patient's clinical symptoms have improved 2, 3.
- In one study, the drain was removed on the 21st day after drainage, when ultrasonography and CT scans showed that the abscess was no longer present 2.
- The decision to remove the drain is often based on clinical and imaging findings, such as improved laboratory results, resolution of symptoms, and reduction in abscess size 3, 4.
- The timing of drain removal may vary depending on the individual patient's response to treatment and the underlying cause of the abscess 5, 6.
- In general, the goal of treatment is to achieve complete drainage and resolution of the abscess, and to prevent complications such as sepsis or recurrent infection 5, 4.