PUNCTURE WOUND

Injury 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. They will cause a tattoo, however, and should be scrubbed out.

See More Appropriate Topic (instead of this one) If

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

WHEN TO CALL YOUR DOCTOR FOR PUNCTURE WOUND

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 or discarded injection needle
Sharp object was very dirty (e.g. a barnyard)
Setting was dirty and puncture occurred on bare foot
No previous tetanus shots
Dirt (debris) or pencil lead pigment 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
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

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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 every 4-6 hours (e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil, Motrin; adult dosage 400 mg).
- 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.
- 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 or 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.

Reviewed 8/2003

Revised 8/2003

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