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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.
Check Your Symptoms
Do you have a puncture wound?
This is a wound caused by a sharp, pointed object going through the skin. Puncture wounds are deeper and narrower than cuts.
Yes
Puncture wound
No
Puncture wound
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
The medical assessment of symptoms is based on the body parts you have.
If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?
"Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps.
Yes
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
No
Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area
Have you been stuck with a used or dirty needle?
Yes
Stuck with used or dirty needle
No
Stuck with used or dirty needle
Is there an object stuck in the wound, and you can't get it out?
You may not be able to remove it because of where or how deep the wound is or because it causes severe pain.
Yes
Object in wound
No
Object in wound
Is the object large or small?
Large means things like a nail or piece of wood that is at least 2 in. (5.1 cm) long and anything bigger than that. Small means things like a pencil tip or a small splinter or sliver.
Large
Large embedded object
Small
Small embedded object
Did you have swelling or bruising within 30 minutes of the injury?
Yes
Swelling or bruising within 30 minutes of injury
No
Swelling or bruising within 30 minutes of injury
Has the swelling or bruising raised a lump that's more than about 1.5 in. (4 cm) across or deep? This would be bigger than a golf ball or Ping-Pong ball.
Yes
Lump bigger than golf ball or Ping-Pong ball
No
Lump bigger than golf ball or Ping-Pong ball
Do you have a puncture wound in your foot?
Yes
Puncture wound in foot
No
Puncture wound in foot
Did the object go through a shoe or boot?
An object that has enough force behind it to go through a shoe can cause serious injury to the foot. Puncture wounds in the sole of the foot also have a high risk of infection.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Increased pain, swelling, warmth, or redness in or around the area.
Red streaks leading from the area.
Pus draining from the area.
A fever.
Pain in adults and older children
Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in adults are:
Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
Long-term alcohol and drug problems.
Steroid medicines, which may be used to treat a variety of conditions.
Chemotherapy and radiation therapy for cancer.
Other medicines used to treat autoimmune disease.
Medicines taken after organ transplant.
Not having a spleen.
With severe bleeding, any of these may be true:
Blood is pumping from the wound.
The bleeding does not stop or slow down with pressure.
Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may be true:
The bleeding slows or stops with pressure but starts again if you remove the pressure.
The blood may soak through a few bandages, but it is not fast or out of control.
With mild bleeding, any of these may be true:
The bleeding stops on its own or with pressure.
The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
Usually found in dirt and soil, tetanus bacteria typically enter the body through a wound. Wounds may include a bite, a cut, a puncture, a burn, a scrape, insect bites, or any injury that may cause broken skin.
You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.
For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
You haven't had a tetanus shot in the past 5 years.
You don't know when your last shot was.
For a clean wound, you may need a shot if:
You have not had a tetanus shot in the past 10 years.
You don't know when your last shot was.
Symptoms of difficulty breathing can range from mild to severe. For example:
You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
You cannot travel safely either by driving yourself or by having someone else drive you.
You are in an area where heavy traffic or other problems may slow you down.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Eye Injuries
Fishhook Injuries
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.
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.
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.
Grasp the end of the splinter with clean tweezers.
If the splinter is embedded in the skin:
Clean a needle with alcohol and make a small hole in the skin over the end of the splinter.
Lift the splinter with the tip of the needle until it can be grasped with the tweezers.
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.
Author: Ignite Healthwise, LLC Staff Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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