BackTable / VI / Podcast / Episode #243

Better Abscess Drainage

with Dr. John Pavlus

In this episode, our hosts Drs. Michael Barraza and Aaron Fritts interview Dr. John Pavlus about his methods of drain placement, monitoring, and removal, as well as his vision to design an ideal drainage system.

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Medtronic Abre Venous Stent
Better Abscess Drainage with Dr. John Pavlus on the BackTable VI Podcast)
Ep 243 Better Abscess Drainage with Dr. John Pavlus
00:00 / 01:04

BackTable, LLC (Producer). (2022, September 16). Ep. 243 – Better Abscess Drainage [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. John Pavlus discusses Better Abscess Drainage on the BackTable 243 Podcast

Dr. John Pavlus

Dr. John Pavlus is the chief of interventional radiology at Brooke Army Medical Center in San Antonio, Texas.

Dr. Michael Barraza discusses Better Abscess Drainage on the BackTable 243 Podcast

Dr. Michael Barraza

Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.

Dr. Aaron Fritts discusses Better Abscess Drainage on the BackTable 243 Podcast

Dr. Aaron Fritts

Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, TX.

Show Notes

In this episode, our hosts Drs. Michael Barraza and Aaron Fritts interview Dr. John Pavlus about his methods of drain placement, monitoring, and removal, as well as his vision to design an ideal drainage system.

Dr. Pavlus became interested in abscess drains when he noticed that across different institutions had very different indications, types, and methods of putting in drains. Dr. Pavlus prefers to place drains under ultrasound guidance, and he will also obtain a CT image afterwards to ensure the drain is in place. The doctors discuss their favorite guidewires to use: Dr. Pavlus prefers the Coons wire and Dr. Barraza prefers the Amplatz wire.

For deep pelvic cul-de-sac abscesses, Dr. Pavlus describes how he obtains transgluteal access and uses a Hawkins needle. Liver abscesses can be challenging, due to their variety of drainage contents (hematoma, bile, necrotic material), and increased time of drainage. We also discuss the debate between suction bulbs and gravity drainage bags, noting that research studies and personal experiences have not shown significant differences in the rate of fistula formation with either method. One exception is post-operative spinal drainage, where using suction could confer the risk of removing CSF.

To assess when a drain needs to be removed, Dr. Pavlus monitors the output and obtains a CT. He prefers to take ownership of drain care and remove drains that he originally placed, but if needed, he also collaborates with trauma surgeons to ensure that drains and sutures are removed properly. Dr. Pavlus also recognizes the need to standardize follow up care for drains. Dr. Barraza describes a workflow for drain checks at his fellowship site, which included daily rounds and a standardized checklist for each patient.

Finally, Dr. Pavlus speaks about his ongoing mission to design an ideal drainage system for various dwell times, viscosity of contents, and catheter sizes.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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