PUNCTURE WOUND

Injury Definition

  • Skin is punctured by a narrow sharp object (e.g., a nail, pencil, toothpick).

General Information

  • Needlesticks: Any needlestick from a used or discarded needle should be reported immediately to the doctor. In some cases, medicines should be started to prevent transmission of the HIV (AIDS) virus.
  • Foot Punctures through Athletic Shoes: Puncture wounds into the bottom of the foot have a risk of infection of approximately 4%. This increases to 25% in patients with puncture wounds through athletic (tennis) shoes into the bottom of the foot near the toes. Pain persisting greater than 4-5 days after the injury is suggestive of infection.
  • Pencil Lead Punctures: Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are nontoxic. They will cause a tattoo, however, and should be scrubbed out.

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WHEN TO CALL YOUR DOCTOR FOR PUNCTURE WOUND

Call 911 Now (you may need an ambulance) If:

  • Puncture on the head, neck, chest, back, or abdomen that may go deep

Call Your Doctor Now (night or day) If:

  • You think you have a serious injury
  • Severe pain
  • Puncture on the head, neck, chest, abdomen that isn't deep
  • Puncture overlying a joint
  • Tip of the object is broken off and missing
  • Feels like something is still in the wound
  • Can't stand (bear weight or walk) on punctured foot
  • Needle stick from used or discarded injection needle
  • Sharp object was very dirty (e.g. a barnyard)
  • Setting was dirty and puncture occurred on bare foot
  • No previous tetanus shots
  • Dirt (debris) or pencil lead pigment that can be seen in the wound is not gone after 15 minutes of scrubbing
  • Wound looks infected (redness, red streaks, swollen, tenderness)
  • Fever occurs

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

  • You think you need to be seen
  • Diabetic and puncture wound of foot
  • Last tetanus booster was over 5 years ago

Call Your Doctor During Weekday Office Hours If:

  • You have other questions or concerns
  • Pain has not improved after 3 days

Self Care at Home If:

  • Minor puncture wound and you don't think you need to be seen

HOME CARE ADVICE FOR MINOR PUNCTURE WOUND

  1. Cleansing: Wash the wound with soap and warm water for 15 minutes. For any dirt or debris, scrub the wound back and forth with a washcloth to remove it.
  2. Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.
  3. Antibiotic Ointment: Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Re-soak the area and re-apply an antibiotic ointment every 12 hours for 2 days.
  4. Pain Medication: For pain relief, take acetaminophen every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
    • Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  5. Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
  6. Call Your Doctor If:
    • Dirt in the wound persists after 15 minutes of scrubbing
    • It begins to look infected (redness, red streaks, tenderness, pus, fever)
    • Pain becomes severe
    • You become worse or develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Adult HouseCalls Online. Copyright © 2000-2004 David Thompson, M.D. FACEP

Reviewed 8/2004

Revised 8/2003

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