| Puncture Wounds
		
			| Topic OverviewCauses of puncture woundsA
		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 of infection because they
		are hard to clean and provide a warm, moist place for bacteria to
		grow. The bacteria Pseudomonas are a common cause of infections when a puncture wound occurs through the sole of an athletic shoe. Some punctures are done for
		health reasons. For example, a puncture may be used by
		a doctor to draw blood or to give fluid or medicines directly into a vein
		(intravenous, or IV). Health professionals
		have an increased risk of 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. What to do if you get a puncture wound?When
		you have a puncture wound: Determine if any part of the object that
		  caused the wound is still in the wound, such as a splinter or
		  lead (graphite) from a pencil. A pencil
		lead puncture wound is less worrisome, so it is not
		necessary to check blood levels for lead or worry about lead toxicity or
		poisoning.Determine
		  if 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.
 Check your symptoms to decide if and when you
		should see a doctor.Check Your SymptomsDo 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.How old are you? Less than 12 years Less than 12 years12 years or older 12 years or olderDo you have an eye injury?Do you have an injury caused by a fishhook?Do you have a deep wound in your head, neck, chest, or belly? A deep puncture wound in any of these areas could damage the internal organs. Yes Deep puncture wound to head, neck, chest, or bellyNo Deep puncture wound to head, neck, chest, or bellyAre you having trouble breathing  (more than a stuffy nose)?Yes Difficulty breathing more than a stuffy noseNo Difficulty breathing more than a stuffy noseHow bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine? 8 to 10: Severe pain Severe pain5 to 7: Moderate pain Moderate pain1 to 4: Mild pain Mild painHas the pain lasted for more than 8 hours? Yes Pain for more than 8 hoursNo Pain for more than 8 hoursIs the pain getting worse?Have you been injected with something under high pressure, like oil or paint from a sprayer? Yes Injection under high pressureNo Injection under high pressureIs there a deep puncture in or over a joint? A puncture that goes into a joint can be serious. Yes Deep puncture in joint areaNo Deep puncture in joint areaDo you have a wound on your arm, leg, hand, or foot that is more than just a scratch?For an arm or leg wound, is the skin below the wound (farther down the limb) blue, pale, or cold to the touch and different from the other arm or leg? This may mean that a major blood vessel was damaged and that blood is not reaching the rest of the arm or leg.  Yes Skin is blue, pale, or cold below an arm or leg injuryNo Skin is blue, pale, or cold below an arm or leg injuryCan you move the area below the injury normally, even though it may hurt? Yes Able to move limb normally below injuryNo Unable to move limb normally below injuryFor an arm or leg wound, is there any numbness, tingling, or loss of feeling around the wound or below the wound (farther down the arm or leg)? This may mean that a nerve was damaged.  Yes Numbness, tingling, or loss of feeling around or below an arm or leg injuryNo Numbness, tingling, or loss of feeling around or below an arm or leg injuryDo you think you may have a fever?Are there red streaks leading away from the area or pus draining from it?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 areaNo Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected areaHave you been stuck with a used or dirty needle?  Yes Stuck with used or dirty needleNo Stuck with used or dirty needleIs 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.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 objectSmall Small embedded objectDid you have swelling or bruising within 30 minutes of the injury? Yes Swelling or bruising within 30 minutes of injuryNo Swelling or bruising within 30 minutes of injuryHas 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 ballNo Lump bigger than golf ball or Ping-Pong ballDo you have a puncture wound in your foot? Yes Puncture wound in footDid 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. Yes Object went through a shoe or bootNo Object went through a shoe or bootMany 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, herbal remedies, and 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 TreatmentYou 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.
Symptoms of infection may
	 include: 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.
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 TodayBased 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.If the symptoms get worse, seek care
		  sooner.
Seek Care NowBased 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  NowBased on your answers, you need
		emergency care.Call911or other emergency services now.Call  911  NowBased on your answers, you need
		emergency care. Call911or other emergency services now.Put direct, steady pressure on the
		wound until help arrives. Keep the area raised if you can.Eye Injuries Fishhook InjuriesHome TreatmentMinor puncture wounds can be
		treated effectively at home. If you do not have an increased risk of
		infection, you do not have other injuries, and you do not need a tetanus shot or treatment by a
		doctor, you can treat a puncture wound at home. Home
		treatment can prevent infection and promote healing. The American Red Cross recommends that everyone use blood and body fluid precautions with first aid treatment. Remove objectMake 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. Do not wet the splinter.
 Stop the bleedingAllow 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.
 After you have stopped the bleeding, check your
		  symptoms to determine if and when you need to see your
		  doctor. Clean the woundClean 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). Some nonprescription products are available for wound
			 cleaning that numb the area so cleaning doesn't 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.
 Consider applying a bandageMost 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 to reduce the risk of infection occurring under the bandage. Puncture wounds are less likely than cuts to need stitches, staples or skin adhesives. TetanusDetermine 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 mild fever may occur. Home
			 treatment can help reduce the discomfort. 
				
 Pain reliefElevate the injured area on pillows anytime you are sitting or lying down. Try to keep the
		  area at or above the level of your heart to reduce swelling. Medicine you can buy without a prescription| Try a nonprescription
				medicine to help treat your fever or pain: | 
|---|
 | Talk to your child's doctor before switching back and
				  forth between doses of acetaminophen and ibuprofen. When you switch between two
				  medicines, there is a chance your child will get too much medicine. |  Safety tips| Be sure to follow
				  these safety tips when you use a nonprescription medicine: | 
|---|
 | Carefully read and follow all
						directions on the medicine bottle and box.Do not take more than
						the recommended dose.Do not take a medicine if you have had an
						allergic reaction to it in the past.If
						you have been told to avoid a medicine, call your doctor before you take
						it.If you are or could be pregnant, do not take any medicine other
						than acetaminophen unless your doctor has told you to.Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.
 |  Symptoms to watch for during home treatmentCall  your doctor if any of the following occur during home
		  treatment: Signs of infectionSigns of
			 loss of functionSigns of decreased blood flowPain
			 gets worse.Symptoms become
			 more severe or more frequent.
PreventionTo prevent puncture wounds, be sure 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.
 Be sure to have a tetanus shot every 10 years.Preparing For Your AppointmentTo prepare for your appointment, see the topic Making the Most of Your Appointment. Questions to prepare for your appointmentYou can help your
		doctor 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?What nonprescription medicines have you tried? Did they
		  help?What prescription and nonprescription medicine do you
		  take?Were drugs or alcohol involved in your
		  injury?When was your last
		  tetanus shot?Do you have any
		  health risks?
CreditsByHealthwise StaffPrimary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
 Specialist Medical ReviewerH. Michael O'Connor, MD - Emergency Medicine
 Martin J. Gabica, MD - Family Medicine
Current as ofMarch 20, 2017Current as of:
                March 20, 2017 Last modified on: 8 September 2017  |  |