Community Health Network

Puncture Wound
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X-Ray - BB in Left Upper Arm

Puncture Wound - BB Gun

First Aid - Removing a Fishhook

Puncture Wound - With a Foreign Body

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. However, they will cause a tattoo and should be scrubbed out.

If not, see these topics

Animal caused it, see ANIMAL BITE
It looks infected, see WOUND INFECTION
Skin is cut or scraped (not punctured), see SKIN INJURY

Should I
Call?

Care at
Home

When to Call Your Doctor

	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 injection needle, and you were possibly exposed to another person's blood Sharp object was very dirty (e.g., a barnyard) Setting was dirty and puncture occurred on bare foot No previous tetanus shots Dirt (debris) 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 Puncture through shoe (e.g., tennis shoe) and into bottom of foot 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

Symptom
Description

Care at
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HOME CARE ADVICE FOR MINOR PUNCTURE WOUND

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.
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.
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.
Pain Medication:
- For pain relief, take acetaminophen or ibuprofen.
- Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
- Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
- People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
- CAUTION: 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.
- CAUTION: Do not take acetaminophen if you have liver disease.
- Read the package instructions thoroughly on all medications that you take.
Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
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

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

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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.

Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/5/2008

Content Set: Adult HouseCalls Online