locations on the body make bedside incision and drainage more technically difficult to perform, whether due to the inherent sensitivity of the area (e.g., the palms, soles, and face) or associated complications. Examples of locations that warrant evaluation by surgery due to a high potential for complications include perirectal and periareolar abscesses, which could be complicated by fistula formation. An otolaryngologist should evaluate neck abscesses that could potentially have developed from preexisting cystic lesions. Consider also the need for prophylactic antibiotics in patients with abnormal or artificial heart valves as this may delay the procedure. Additionally, it is prudent to inquire about underlying bleeding disorders and to determine a history of allergy to lidocaine, epinephrine, or latex if using latex gloves. Generally, the following sterile equipment is required for a safe and successful procedure: cleansing agent (typically povidone-iodine or chlorhexidine), a local injectable anesthetic agent (1% or 2% lidocaine, lidocaine with epinephrine, or bupivacaine), 5 to 10 mL syringe with 25 to 40 gauge needle, 4x4 gauze, scalpel blade with a handle, curved hemostat, normal saline solution with large syringe/splash guard/bowl for irrigation, packing material (iodoform or plain gauze), swabs for wound culture (if desired), scissors and tape for dressing the wound.[4] Incision and drainage is a painful procedure that, in addition to local anesthetic, may also require oral or even parenteral analgesia. In certain situations, the presence of support staff may be warranted. In the pediatric population, child life services can play a critical role in facilitating a successful procedure. Child life specialists are professionals whose role is to provide emotional support to children and families in a health care setting. A recent study published in pediatric emergency medicine evaluated the impact of child life on the emotional response of pediatric patients who underwent laceration repair in the emergency department.[5] Comparing children who underwent the procedure without the presence of these specialists with children assisted by child life, those with support were found to have less emotional distress during the procedure. Informed consent from the patient or the patient’s legal guardian must be obtained before the procedure. Risks including bleeding, pain and possible scar formation should be relayed. The verification of tetanus immunization status is also an important step in preparation. The clinician performing the procedure should follow universal precautions that include wearing a gown, gloves, and a facemask or goggles for protection. Although I&D is not considered a sterile procedure (given that the area of interest is already infected), it is prudent to practice sterile precautions. Holding the scalpel with a steady grip, an incision is made directly over the center of the abscess until pus is expressed. The incision should be made parallel to skin tension lines in order to prevent scar tissue formation. A curved hemostat can then be used for blunt dissection to further disrupt loculations within the infected cavity. Manual expression can be used to facilitate drainage as well. After the abscess is drained, the wound should be copiously irrigated with sterile normal saline solution. Wound packing is not recommended for abscesses that are 5 cm or less in diameter, as it has not been shown to affect outcomes and may contribute to increased pain.[6][7] Furthermore, packing has not been shown to reduce the risk of abscess recurrence.[8] The next step is to cover the site with sterile dressing and tape. A follow-up visit is advised 2 to 3 days after the procedure for removal of the packing. Wounds are then left to close by secondary intention. An alternative to I&D is needle aspiration, though this is much less commonly used, given that it is both more invasive and less effective than I&D. In a randomized clinical control trial comparing outcomes with I&D to ultrasound-guided needle aspiration, the overall success of producing purulent drainage with needle aspiration was 26% compared to an 80% success rate in patients who underwent I&D.[9] Another alternative to conventional incision and drainage is the