II. Indications
- Symptomatic, large Subcutaneous Hematoma
III. Contraindications
- Overlying Infection
IV. Complications
V. Approach: Consent
- Most Subcutaneous Hematomas are NOT drained and typically resolve slowly on their own, over weeks to months
- However, some Subcutaneous Hematomas may cause complications
- Local pressure tissue necrosis
- Decreased functional mobility (esp. elderly)
- Infection
- Review complications (as above) of this procedure
- Emphasize that needle method below is only for partial Hematoma evacuation (to decrease symptoms)
- Surgical Consultation may offer alternative options for drainage
- Incision and Drainage with open deloculation
- Counsel the patient on follow-up
- Emergent return for any signs of infection
VI. Technique
- Identify and mark landmarks of Hematoma
- Consider Bedside Ultrasound to identify the breadth and depth of the Hematoma
- Bedside Ultrasound may also be used during needle aspiration to follow its course
- Prepare the skin surface
- Apply antiseptic (e.g. Hibiclens or Povidone Iodine)
- Drape region
- Lidocaine 1% with Epinephrine locally (or other Local Anesthetic) at intended needle insertion sites
- Needle aspiration
- Insert a 16 gauge needle (with a 50 ml syringe) through skin and towards the Hematoma
- Maintain negative pressure on the syringe
- Place a 10 cc syringe between the plunger flange and barrel flange of the 50 cc syringe
- Pass the needle through the Hematoma on various passes and at various angles
- Empty the syringe as it accumulates blood
-
Wound Dressing
- Apply a dressing to the area
- Consider a compression dressing at the area
-
Antibiotics
- Some authors have used 3 days of prophylactic Antibiotics after needle aspiration to prevent Hematoma infection
VII. References
- Warrington (2022) Crit Dec Emerg Med 36(3):24