II. Indications

  1. Symptomatic, large Subcutaneous Hematoma

III. Contraindications

  1. Overlying Infection

IV. Complications

  1. Incomplete Hematoma evacuation
    1. Procedure described below is only a partial Hematoma evacuation
  2. Hematoma Infection
  3. Bleeding
    1. Expanding Hematoma
    2. New Hematoma
  4. Scarring
    1. Less likely with syringe method than with Incision and Drainage

V. Approach: Consent

  1. Most Subcutaneous Hematomas are NOT drained and typically resolve slowly on their own, over weeks to months
  2. However, some Subcutaneous Hematomas may cause complications
    1. Local pressure tissue necrosis
    2. Decreased functional mobility (esp. elderly)
    3. Infection
  3. Review complications (as above) of this procedure
    1. Emphasize that needle method below is only for partial Hematoma evacuation (to decrease symptoms)
  4. Surgical Consultation may offer alternative options for drainage
    1. Incision and Drainage with open deloculation
  5. Counsel the patient on follow-up
    1. Emergent return for any signs of infection

VI. Technique

  1. Identify and mark landmarks of Hematoma
    1. Consider Bedside Ultrasound to identify the breadth and depth of the Hematoma
    2. Bedside Ultrasound may also be used during needle aspiration to follow its course
  2. Prepare the skin surface
    1. Apply antiseptic (e.g. Hibiclens or Povidone Iodine)
    2. Drape region
    3. Lidocaine 1% with Epinephrine locally (or other Local Anesthetic) at intended needle insertion sites
  3. Needle aspiration
    1. Insert a 16 gauge needle (with a 50 ml syringe) through skin and towards the Hematoma
    2. Maintain negative pressure on the syringe
      1. Place a 10 cc syringe between the plunger flange and barrel flange of the 50 cc syringe
    3. Pass the needle through the Hematoma on various passes and at various angles
      1. Empty the syringe as it accumulates blood
  4. Wound Dressing
    1. Apply a dressing to the area
    2. Consider a compression dressing at the area
  5. Antibiotics
    1. Some authors have used 3 days of prophylactic antibiotics after needle aspiration to prevent Hematoma infection

VII. References

  1. Warrington (2022) Crit Dec Emerg Med 36(3):24

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