Puncture Wound

Symptoms

DEFINITION

• The skin is punctured by a narrow, pointed object

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Causes

• Commonly caused by a nail, sewing needle, pencil, toothpick
• Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are not toxic.

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See More Appropriate Topic (instead of this one) If

• Animal caused it, see ANIMAL OR HUMAN BITE
• Looks infected, see WOUND INFECTION
• Skin is cut or scraped (not punctured), see SKIN INJURY
• Foreign body (e.g., sliver) remains in the skin, see SKIN FOREIGN BODY

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

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

Call Your Doctor Now (night or day) If

• You think your child has a serious injury 
• Bleeding that won't stop after 10 minutes of direct pressure
• 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 still in the wound
• Won't stand (bear weight or walk) on punctured foot
• Needle stick from used or discarded injection needle
• Sharp object or setting was very dirty (e.g., a barnyard)
• No previous tetanus shots
• Dirt (debris) or pencil lead pigment is not gone after 15 minutes of scrubbing
• Severe pain
• 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 your child needs to be seen
• Last tetanus shot over 5 years ago

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Parent Care at Home If

• Minor puncture wound and you don't think your child needs to be seen

Care at Home

HOME CARE ADVICE FOR PUNCTURE WOUND

1. Cleansing:
   • Wash the wound with soap and warm water for 15 minutes.
   • For any dirt or debris, scrub the wound surface back and forth with a wash cloth to remove it.
   • If the wound re-bleeds a little, that may help remove germs.
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-wash the area and re-apply an antibiotic ointment every 12 hours for 2 days.
4. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for any pain.
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
   • Pain becomes severe
   • It begins to look infected (redness, red streaks, tenderness, pus, fever)
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Photo Example

X-Ray - BB in Left Upper Arm

This X-Ray shows BB in the left upper arm.

Puncture Wound - BB Gun

This photo shows a puncture wound from a BB gun in left upper arm. Note the small hole in the arm where the BB struck and entered the skin.

First Aid - Removing a Splinter

You can remove splinters, larger slivers, and thorns with a needle and tweezers. Check the tweezers beforehand to be certain the ends (pickups) meet exactly. (If they do not, bend them.) Sterilize the tools with rubbing alcohol or a flame.

Clean the skin surrounding the sliver briefly with rubbing alcohol before trying to remove it. Be careful not to push the splinter in deeper. If you don't have rubbing alcohol, use soap and water, but don't soak the area if FB is wood (Reason: can cause swelling of the splinter).

Remove the splinter:

• Step 1: Use the needle to completely expose the large end of the sliver. Use good lighting. A magnifying glass may help.
• Step 2: Then grasp the end firmly with the tweezers and pull it out at the same angle that it went in. Getting a good grip the first time is especially important with slivers that go in perpendicular to the skin or those trapped under the fingernail.

 

Puncture Wound - With a Foreign Body

There is a small metal splinter (foreign body) embedded in the palm of the hand.

This patient went to the emergency department and had the splinter removed.