Health Library Puncture WoundsFrom Healthwise

A puncture wound is a forceful injury caused by a sharp, pointed object that penetrates the skin. A puncture wound is usually narrower and deeper than a cut or scrape. Many people accidentally get puncture wounds with household or work items, 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 all cause puncture wounds. Puncture wounds increase your risk for infection because they are difficult to clean and provide a warm, moist place for bacteria to grow.

Some punctures are done for health reasons. For example, a puncture may be used by a health professional to draw blood or to give fluid or medications directly into a vein ( intravenous, or IV).

Health professionals have an increased risk for needle-stick injuries. A puncture from a used needle increases the risk of infection or for transmitting a blood-borne disease, such as hepatitis or human immunodeficiency virus (HIV). Home treatment may be all that is needed for puncture wounds from clean needles.

When you have a puncture wound:

• Determine whether any part of the object that caused the wound is still in the wound, such as a splinter or lead (graphite) from a pencil.
• Determine whether underlying tissues, such as blood vessels, nerves, tendons, ligaments, bones, joints, or internal organs, have been injured by the object.
• Clean the wound and remove any dirt or debris to prevent infections, both bacterial skin infections and tetanus ("lockjaw").
• Determine whether you need a tetanus shot.

Review the Emergencies and Check Your Symptoms sections of this topic to determine if and when you need to see a health professional.

• Signs of shock occur:
  • In children.
  • In adults and older children.
• Severe bleeding does not slow during the first 15 minutes of applying steady, direct pressure.
• Moderate to severe difficulty breathing occurs with a puncture wound to the neck or chest:
  • In children.
  • In adults and older children.
• Moderate to severe pain occurs with a puncture wound to the belly.
• A puncture wound to the eyeball occurs.
• A puncture wound is caused by the injection of a substance under high pressure into the skin, such as paint from a high-pressure paint sprayer or industrial lubricant for machinery.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you any of the have the following symptoms, evaluate those symptoms first.

• A cut that may need stitches, staples, or skin adhesives: Go to the topic Cuts.
• Puncture wound caused by a bite: Go to the topic Animal and Human Bites.

	Yes	Do you have a puncture wound in your head, neck, chest, or belly?
When to See a Doctor See significance of puncture wounds in the head, neck, chest, or belly if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have a puncture wound in your head, neck, chest, or belly (more than a superficial wound)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a puncture wound that is bleeding?
When to See a Doctor See significance of bleeding if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: For more information, see how to stop bleeding. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have moderate bleeding that has slowed but not stopped after applying steady, direct pressure for 15 minutes? Call your health professional today if you answer "Yes" to the following question. Yes Do you have mild bleeding that has slowed but not stopped after applying direct pressure 3 times for 15 minutes each (45 minutes total)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to remove an object from the wound?
When to See a Doctor See significance of inability to remove an object if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Are you unable to remove an object from a wound? Note: You may be unable to remove an object because: Of the location and depth of the wound. You are not sure about the depth of the wound. Removing the object will cause severe pain. Call your health professional today if you answer "Yes" to the following question. Yes Do you think an object is still in the wound and you are unable to remove it? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have signs of decreased blood flow at or near a puncture wound?
When to See a Doctor See significance of signs of decreased blood flow if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is the skin below the puncture wound pale and cold to the touch? Yes Do you have tingling, burning, numbness, or a "pins-and-needles" feeling below a puncture wound? Yes Do you have severe pain below a puncture wound that is not part of the wound? Yes Do you have decreased blood flow below a puncture wound based on the pinch test? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have any loss of function at or near the puncture wound?
When to See a Doctor See significance of loss of function if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Are you unable to move your limb normally (not because of pain) below the puncture wound? Yes Do you have tingling, numbness, or loss of feeling below the puncture wound, not just at the site of the wound? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you unable to adequately clean a puncture wound using home treatment?
When to See a Doctor See significance of puncture wound that cannot be adequately cleaned if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: For more information, see how to clean a skin wound. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Is the wound too large or too deep to clean? Yes Does cleaning a wound cause too much pain? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a puncture wound in your foot?
When to See a Doctor See significance of a puncture wound in the foot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a puncture wound that occurred when an object went through the sole of your shoe? Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take medicine that causes problems with your immune system? Yes Do you have any other health risks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have an infection?
When to See a Doctor See significance of an infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have increased swelling, redness, or warmth around a deep wound? Yes Do you have increased swelling, redness, or warmth around a wound over a joint? Yes Do you have a puncture over a joint and increased pain with movement of the joint? Yes Do you have red streaks extending from a wound over a joint? Yes Is a wound over a joint tender to the touch? Yes Do you have any drainage of pus from a wound over a joint? Yes Do you have swollen lymph nodes near a wound over a joint? Yes Do you have a wound over a joint and think you may have a fever? Yes Do you have diabetes? Yes Do you have peripheral arterial disease and a puncture wound on your leg or foot? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around the wound? Yes Is the area around your puncture wound increasingly tender to the touch? Yes Do you have red streaks extending from the wound? Yes Do you have pus in or around the wound? Yes Do you think you may have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a wound for 48 hours or longer? Yes Have you had swollen lymph nodes near a wound longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have swelling and bruising at or near a puncture wound?
When to See a Doctor See significance of swelling and bruising if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe swelling or bruising? Yes Do you have increased swelling, redness, or warmth around a wound over a joint? Call your health professional today if you answer "Yes" to any of the following questions. Yes Did a lot of swelling and bruising begin within 30 minutes after the puncture wound? Yes Did swelling begin after a puncture wound to a joint area? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has swelling from a puncture wound (not over a joint) increased over the past 24 hours despite home treatment? Yes Have you had a moderate amount of swelling from a puncture wound for 2 to 3 days, but it does not interfere with normal function? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

NOTE: If you have a puncture wound from a needle and you don't know if the needle was clean or dirty, be sure to call your doctor for instructions on follow-up care.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Minor puncture wounds can be treated effectively at home. If you do not have an increased high risk of infection, do not have other injuries, and do not need treatment by a health professional or a tetanus shot, you can treat a puncture wound at home. Home treatment can prevent infection and promote healing.

Remove object

• Make sure the object causing the wound is not still in the wound. Check to see if the object is intact and 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 painlessly and easily. Be careful, and do not push the object farther into the wound. For splinter removal, see removing splinters. Do not 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.
• Stop the bleeding with direct pressure to the wound. For more information, see how to stop bleeding.
  • Mild bleeding can almost always be stopped within 15 minutes by applying direct pressure to the wound.
  • Moderate bleeding can usually be slowed or stopped by applying steady, direct pressure to the wound for 15 minutes.
  • Severe bleeding cannot be slowed or stopped by applying steady, direct pressure to the wound for 15 minutes.

After you have stopped the bleeding, use the Check Your Symptoms section of this topic to determine if and when you need to see your health professional.

Clean the wound

Clean the wound as soon as possible to reduce 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). For more information, see how to clean a wound. Some nonprescription products are available for wound cleaning that numb the area so cleaning does not hurt as much. Be sure to read the product label for correct use.
• Do not use rubbing alcohol, hydrogen peroxide, iodine, or mercurochrome, which can harm the tissue and slow healing.
• Soak the wound in warm water for 20 minutes, 2 to 4 times a day, for the next 4 to 5 days. The warmth from the water will increase the blood flow to the area, which helps reduce the risk of infection.

Consider applying a bandage

Most puncture wounds heal well and do not need a bandage. You may need to protect the puncture wound from dirt and irritation. It is important to clean the wound thoroughly before bandaging it to reduce the risk of infection occurring under the bandage. For more information, see how to bandage a wound.

Tetanus

• Determine whether you need a tetanus shot.
• You may have a localized reaction to a tetanus shot. Symptoms include warmth, swelling, and redness at the injection site. A fever of up to 100 °F (37.8 °C) may occur. Home treatment can help reduce the discomfort.
  • Apply an ice pack to the injection site for 20 minutes, 3 or 4 times a day for the first 24 to 48 hours. After 48 hours, heat may feel better.
  • Take a nonprescription medication for pain and fever.

Pain relief

An ice or cold pack may help reduce swelling and bruising. See ice and cold packs. Never apply ice directly to a wound or the skin. This could cause tissue damage.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section of this topic to evaluate your symptoms if any of the following occur during home treatment.

• Signs of infection.
• Signs of loss of function.
• Signs of decreased blood flow.
• Pain gets worse.
• The wound does not heal.
• Symptoms become more severe or more frequent.

To prevent puncture wounds, it is important to practice safety when using blunt or sharp objects.

• Pay close attention to what you are doing.
• If you become distracted, set the object aside until you can pay attention to what you are doing.
• Know how to use the object properly.
• Have good lighting so you can see what you are doing.
• Wear gloves whenever possible to protect your hands.
• Wear other safety gear, such as glasses or boots, as appropriate.
• Hold a sharp object away from your body while using it.
• Carry the object with the dangerous end away from you.
• Shut the power off and use safety locks on your power tools when you are not using them.
• Be very careful when using high-pressure equipment, such as staple guns or paint sprayers. Make sure your work area is clear of people and hazards that could interfere with the safe operation of the equipment.
• Store dangerous objects in secure places away from children.
• Teach children about safety, and be a good role model.
• Do not use alcohol or drugs when you are handling sharp objects.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms? How long have you had your symptoms?
• How and when did the puncture wound occur? Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
• What object caused the puncture wound? Was there or is there an object in the puncture wound? Was the object removed in one piece? Did the injury occur under high pressure?
• What home treatment measures have you tried? Did they help? Be sure to include any nonprescription medications you have taken or used. Did they help?
• When was your last tetanus shot?
• Do you have any health risks?

• Animal and Human Bites
• Arm Injuries
• Cuts
• Eye Injuries
• Finger, Hand, and Wrist Injuries
• Scrapes
• Shock
• Snake and Lizard Bites
• Toe, Foot, and Ankle Injuries

Author:	Sydney Youngerman-Cole, RN, BSN, RNC	Last Updated: June 30, 2006
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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