Can anyone drain a seroma? Should it only be done by a doctor or licensed person?

Question

after having liposuction procedure, i've continued to have fluid build up and need to be aspirated. Should it only be done or drained by the doctor or a licensed person. Or is this something the office staff should be able to handle as well?

Tommaso Addona, MD · Answer

Thank you for your question.
Seromas, or fluid build ups should ideally be drained by someone with expertise in this area. This can be your surgeon, a PA, a registered nurse, etc. If interventional radiology is necessary, your doctor can refer you to a specialist who can assist you in this procedure.

Fernando Ovalle Jr., MD · Answer

Hello, thank you for your question. Ideally, a post-operative seroma should be evaluated and treated by the surgeon who performed your liposuction procedure as they would have the greatest knowledge of what was done and your anatomy. If for some reason you are not able to see your surgeon due to location/proximity or other reasons, I would advised being seen by either another board certified plastic surgeon, board certified Emergency medicine physician or similar provider with previous experience in draining fluid collections potentially with the use of an ultrasound.

Justin Yovino, MD, FACS · Answer

In my experience a seroma is very unusual after liposuction. If it does occur, and in my opinion, it's best approached by the surgeon who performed the procedure since in theory they are the best prepared to enter the previously liposuctioned space. This is not to say that other medical professionals cannot be successful in the drainage of a seroma. It is a relatively easy procedure if the needle is placed in the right spot.

Daniel Barrett, MD · Answer

Dear curiousjw,
any invasive procedure should be done by a doctor. I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Zoran Potparic, MD · Answer

Evacuation of seroma should be primarely done by your surgeon. Registered nurse who may have been trained to do so is another option. radiologyst, using ultrasound imaging, is also a good safe options. I am not sure that "office staff" should be a choice.

Farhad Rafizadeh, MD · Answer

In my practice I take care of all aspects of the patient care especially if we are dealing with a complication.

Connie Hiers, MD, FACS · Answer

Trained office staff like nurses or medical assistants can also drain a seroma with the surgeon's approval.

Camille Cash, MD · Answer

If you have developed a seroma as a result of a plastic surgery procedure your surgeon is the one to typically address this.  This may be done with ultrasound guidance and drained via aspiration.  Often a seroma will require multiple aspiration treatments before complete resolution.

Darryl J. Blinski, MD · Answer

This question opens a wide avenue of ethical issues! Did you have surgery out of town? Why not return to see your chosen operative surgeon??? Most Plastic surgeons locally do not accept other surgeons postoperative complications, which a post op seroma is one. The treatment options are: Needle aspiration via an 18-14 gauge spinal needle, in multiple sessions with aggressive compression. Or Surgical exploration. Both should only be preformed by a medically licensed surgeon, not by office staff! There will be a fee associated also.

Mats Hagstrom, MD (license on probation) · Answer

The most important aspect of managing a postoperative seroma is to begin aggressive treatment as soon as it’s identified. this means eliminating all the fluid as frequently as possible. Preferably on a daily basis. One alternative to draining is placement of a drain which some surgeons feel comfortable doing. If the surgeon can’t or doesn’t want to place a drain in the patient can be sent to interventional radiology where the drain can be placed.
If there is fluid in the seroma cavity then the surfaces cannot remain in contact and the space will never heal. this is why it needs to be drained on a daily basis and minimize the amount of time the space has a fluid accumulation.
Draining them on an interval like once a week will never create resolution and will inevitably lead to an encapsulated Chronic seroma. Once the seroma is chronic it can no longer be successfully treated by draining using any technique including sclerosing. once encapsulated the only successful treatment is typically direct surgical excision with placement of a drain. The seroma capsule has to be removed for this to be successful.
Surgeons delegate certain responsibility to other staff members and this varies from provider to provider. I always treated these myself and would not have someone with less experience doing it because they’re not easy to drain. I found the best way to successfully drain a seroma cavity is to use my smallest Liposuction cannula and connected to a vacuum pump. That works far better than doing it with needles and a syringe.
If a plastic surgeon has staff members who have done it before and I really talented then they can delegate those tasks if they want to. Personally I am very hands-on and believe in giving my patience the highest level of care and I’ve never delegated anything out. I take out my own stitches do my own bandages drain seromas and do all of those things myself.
The most important thing to recognize is that there is an opportunity to get resolution and have the seroma be eliminated early but doing that requires having a drained on a regular basis. most people both patients and surgeons don’t commit to the frequency of draining necessary to have this become successful and because of that a lot of people end up with chronic seromas. Some thing else I find a bit perplexing is how rare it is for plastic surgeons to ask for help from their colleagues in the radiology department. Interventional radiologist are in ideal provider to help out in a situation like this and most of the time it’s covered by medical insurance.
Draining as a Rama is technically a surgical procedure so based on that it needs to be someone who has the licensing to practice medicine. This could be a nurse practitioner or physician assistant. I do not believe it’s in the scope of practice of a nurse to drain a fluid collection.
I’m not a specialist on nursing scope of practice but that at least is my best guess.
Rules, regulations and standard of care also varies from state to state.
The most important aspect is getting them drained completely and frequently unless a drain is placed
Good luck,
Mats Hagstrom MD

Can anyone drain a seroma? Should it only be done by a doctor or licensed person?

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