Puncture Wounds

Overview

A puncture wound is a forceful injury caused by a sharp, pointed object that goes into the skin. A puncture wound is usually narrower and deeper than a cut or scrape. Many people get puncture wounds by accident from household items, work items, or yard tools or when operating machinery. Most puncture wounds are minor, and home treatment is usually all that is needed.

Sharp objects, such as nails, tacks, ice picks, knives, teeth, and needles, can cause puncture wounds. These wounds raise your risk of infection because they are hard to clean and they provide a warm, moist place for bacteria to grow. The bacteria Pseudomonas are a common cause of infection when a person's foot gets punctured through the sole of an athletic shoe.

Some punctures are done for health reasons. For example, a needle puncture may be used by a doctor to draw blood or to put fluid or medicines into a vein (intravenous, or I.V.).

Health professionals have a higher risk for needle-stick injuries. A puncture from a used needle increases the risk of infection. It also increases the risk of getting a disease that is passed (transmitted) through blood, such as hepatitis or HIV. But for puncture wounds from clean needles, home treatment may be all that is needed.

Self-Care

Minor puncture wounds can be treated effectively at home. Home treatment can prevent infection and promote healing.

Try these tips for treating a puncture wound.

• Remove the object.
  • Make sure the object that caused the wound is not still in the wound. Check to see if the object is whole. Be sure that a piece has not broken off in the wound.
  • Try to remove the object that caused the wound if it is small and you can see it. If you have a splinter, try using cellophane tape before using clean tweezers or a needle. Simply put the tape over the splinter, then pull the tape off. The splinter usually sticks to the tape and is removed easily and without pain. Be careful, and don't push the object farther into the wound. Don't wet the splinter.
• Stop the bleeding.
  • Allow the wound to bleed freely for up to 5 minutes to clean itself out, unless there has been a lot of blood loss or blood is squirting out of the wound.
  • Apply direct pressure to the wound.
• Clean the wound as soon as you can.

  This lowers the chance of infection, scarring, and tattooing of the skin from dirt left in the wound. (If dirt or other debris is not removed from a puncture wound, the new skin will heal over it. The dirt can then be seen through the skin and may look like a tattoo.)

  • Wash the wound for 5 minutes with large amounts of cool water and soap. Mild dishwashing soap, such as Ivory, works well. Some nonprescription products for wound cleaning can numb the area so cleaning doesn't hurt as much. Be sure to read the product label for correct use.
  • Don't use rubbing alcohol, hydrogen peroxide, iodine, or Mercurochrome. They can harm the tissue and slow healing.
• Check to see if other tissues have been injured.

  These tissues include blood vessels, nerves, tendons, ligaments, joints, bones, and internal organs.

• Apply a bandage, if needed.

  Most puncture wounds heal well and don't need a bandage.

  You may need to protect the puncture wound from dirt and irritation. Be sure to clean the wound thoroughly before bandaging it. Cleaning reduces the chance that you'll get an infection under the bandage.

• Treat pain and swelling.

  Prop up the injured area on a pillow anytime you sit or lie down. Try to keep the area at or above the level of your heart to reduce swelling.

If you are concerned that the injury is more serious, you may need to be checked by a doctor to see if you need stitches or a tetanus shot.

Removing a splinter

Before using tweezers or a needle to remove a splinter, try using cellophane tape to remove it. Simply put the tape over the splinter, then pull the tape off. The tape will stick to the splinter and remove it painlessly.

If tape doesn't work, try these steps.

1. Wash your hands well with soap and water.

   Do not wet or soak the splinter because it will be harder to remove in one piece.

2. Grasp the end of the splinter with clean tweezers.

   If the splinter is embedded in the skin:

   1. Clean a needle with alcohol and make a small hole in the skin over the end of the splinter.
   2. Lift the splinter with the tip of the needle until it can be grasped with the tweezers.
3. Gently pull the splinter out.
4. Clean the wound.
5. Watch for any signs of infection.

You may need medical care if the splinter:

• Cannot be easily removed.
• Broke off and part of it remains in the wound or if you are uncertain that the splinter has been removed.
• Is very large.
• Is deeply embedded in the skin.
• Is in the eye.

Need for a tetanus shot

To decide if you need a tetanus shot after a wound, first decide if the object that caused the wound was dirty or clean. An object is dirty if it has dirt, soil, spit, or feces on it. A clean object does not have dirt, soil, spit, or feces on it.

You will need a tetanus shot if:

• Your wound was caused by something that was clean and your last tetanus shot was longer than 10 years ago.
• Your wound was caused by something that was dirty and your last tetanus shot was longer than 5 years ago.
• You are not sure if your wound was caused by something clean or dirty and your last tetanus shot was longer than 5 years ago.
• You are not sure when you had your last tetanus shot.
• You did not get the first series of tetanus shots (primary vaccination series).

If you need a tetanus shot, call your doctor to arrange for a shot.

Some people may need tetanus immunoglobulin (IG) for a wound that is at high risk for developing tetanus. The immunoglobulin is usually only needed if you have not (or do not know if you have) completed the tetanus primary vaccination series.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
• New loss of function near the wound.
• Decreased blood flow, such as cool, pale skin near the wound.
• Pain gets worse.
• Symptoms occur more often or are more severe.

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