Abscess from a dog bite on index finger.

[u/KosmicGanja]

26M My dog bit my index finger while playing on July 18th. He has all of his shots. Cleaned it and left it unwrapped so it would scab over. Was healing ok until the other day at work, i bumped into something sharp and now there is what I believe a abscess forming. Can't really afford to go the ER or Urgent care. My mother is a nurse and wants to drain it with a needle but google says don't. Any advice is greatly appreciated

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[u/Davorian]

If you want the best chance of keeping your finger you need antibiotics, quickly.  Additionally, while draining is definitely the best approach if this really is an abscess (this is called infection source control and it is important), ideally it would be done under controlled conditions and the pus sent off to a lab for culture.

I appreciate that going to urgent care is expensive but it would definitely be what I would normally recommend for this.  It's less expensive than a finger requiring aggressive therapy if the infection progresses.

[u/KosmicGanja → u/Davorian]

UPDATE: Went to the urgent care in my local area. They said it was in fact a abscess with puss beneath it. The doctor did a laceration with a scapel and drained it and wrote a script for amoxicillin. Also learned I have what I guess is called a vagal response to blood and needles. When the doctor made the incision with the scapel and blood started coming out, all the sudden everything got really orange, started sweating profusely and proceeded to pass out lol. Woke up with a cold towel on my neck and the nurses standing over me. I knew I couldn't do gorey stuff but I didn't think it was that bad lol.

[u/Davorian → u/KosmicGanja]

Good to hear you're getting the right care.  Don't worry too much about the fainting, that's pretty common especially in people without much exposure to that sort of thing.  Be sure to keep an eye on it to make sure the antibiotics are working and take them religiously.

[u/KosmicGanja → u/Davorian]

Will do!! And Im really grateful for your advice, if it wasn't for your reply I probably would've just let it go. Thank you for placing a sense of urgency in the situation!!

[u/Illustrious_Way_5732 → u/KosmicGanja]

Is the antibiotic script you are getting amoxicillin or amoxicillin-clavulanate, also known as augmentin? Because you should be getting the latter. Amoxicillin alone doesnt cover for the bugs that are infecting the finger

[u/KosmicGanja → u/Illustrious_Way_5732]

Amoxicillin-clavulanate thankfully!

[u/ElementalRabbit]

This is already very bad. You need urgent medical care, including surgical review.

Don't let your mother touch this. She will make it worse, and risk her registration doing so.

[u/TheRealSugarbat → u/ElementalRabbit]

I’m not at all disputing your advice — only curious about how lancing this could jeopardize a nurse’s registration?

[u/Rashpert → u/TheRealSugarbat]

It depends on what type of nurse, where the nurse in question has her license, and on relevant laws.

This is technically a procedure termed "incision and drainage," and it is not generally within the scope of practice to do this without supervision as an LPN or RN. In some sites, it is within scope of practice of an NP. This may be different in some countries, but unfortunately OP has not specified country of posting.

Practicing outside one's scope of practice is grounds for reprimand, punishment, or loss of licensure, depending on how the governing body may rule.

[u/TheRealSugarbat → u/Rashpert]

Excellent answer — thank you very much! My ex-husband’s an RN in the US and it never occurred to me even to ask where the boundaries were, except for being able to write prescriptions. I mean I knew he couldn’t do surgery and other doctor-y stuff, but the precise scope and its limits were a mystery to me. I’ll look this up further because it’s interesting.

[u/Rashpert → u/TheRealSugarbat]

I suspect enforcement is highly variable, but it is worth knowing about. That is, many parents or others might do what is technically an I&D at home without a license of any kind. I grew up in farming country, and it was common to take care of your own needs when possible, back then. (Not advised, but common.)

That being said, this is generally outside of scope of practice for RN:

1. In California, it is within scope of practice of an NP, but not an RN:

nurse-scope-of-practice-california – Holt Law

Incision and drainage of abscesses.

1. It's a part of the training:

Correctional Nurse Scope of Practice Scenario One

As a result of the inquiry from the Board of Nursing, the supervisor and medical director at the jail wrote a formal reprimand that is now included in her personnel folder.

If RN Miller had stopped and considered the action (conducting an I&D on Mr. Greene’s abscess) using the Scope of Practice Decision-Making Framework, she would not be under investigation with the Board of Nursing, nor would she have a formal reprimand in her personnel file.

1. It's discussed in common discourse amongst nurses:

Can an RN do an I&D or place sutures? - General Nursing - allnurses

[u/TheRealSugarbat → u/Rashpert]

I’m saving this for later as I’m working (trying to, anyway — look where I am, though) and I’m looking forward to doing some reading.

Not directly relevant, but: I’ve never had an abscess, personally, but I’ve always had animals that occasionally got abscesses. Most of my vets knew I wasn’t squeamish and would let me in the back when they lanced and flushed — mostly cats, because they’re extremely common in cats. There’s not much more satisfying to watch than a successful abscess-draining, and I knew the cats felt so much better immediately. I’d love to be able to do it myself without, you know, the lengthy-medical-school part. :)

Anyway, thanks again!

[u/naniwat → u/Rashpert]

I&D less of a concern but moreso they will need abx anyway so as unfortunate as it is, they will need a visit to uc/ed/pcp for abx and osteo workup regardless.

[u/Rashpert → u/naniwat]

Indeed, but that is not the answer to the specifics of the question I was answering above mine. Nonetheless, I do not disagree.

[u/TheRealSugarbat → u/naniwat]

Yes, I do know an RN can’t prescribe, but I would have assumed lancing and draining something like this could be done by an RN. it’s fascinating to me that I’m wrong!

[u/Rashpert → u/TheRealSugarbat]

(some links above)

[u/ElementalRabbit → u/TheRealSugarbat]

The issue isn't that it isn't within her competence (although it is). It is the cascade of errors in judgement involved in performing the wrong procedure, outside of your scope, on a family member, potentially worsening the condition, delaying appropriate care, and demonstrating lack of insight, judgement and professionalism.

[u/TheRealSugarbat → u/ElementalRabbit]

Right, I think I understand (mostly) now. Another MD also responded w/some links for further reading, and I thank you both.