Puncture Wound

First aid for a puncture wound

1. Wash your hands and put on gloves if available.
2. Stop the bleeding: apply firm pressure with a clean cloth for a few minutes. Small punctures often bleed little, which can help clear dirt.
3. Rinse thoroughly: hold the wound under clean running water for 5 to 10 minutes. Wash the surrounding skin with soap. Avoid scrubbing inside the wound.
4. Remove small visible debris with tweezers cleaned in rubbing alcohol. Do not dig for deep objects.
5. Apply antibiotic ointment or petroleum jelly to keep the wound moist.
6. Cover with a clean bandage and change it daily or when it gets wet or dirty.
7. Ease pain with acetaminophen (paracetamol) or ibuprofen at the label dose.

Do not use hydrogen peroxide or iodine repeatedly inside the wound, as they can damage tissue and slow healing. Puncture wounds are usually left open rather than stitched, so that infection can drain.

Tetanus shot after a puncture wound

Tetanus bacteria live in soil, dust and animal waste. Puncture wounds are ideal for them because they are deep and low in oxygen. Rust itself does not cause tetanus. The dirt on a rusty object does.

Get the booster within a few days of the injury, ideally as soon as possible. Adults usually receive Tdap or Td.

Special types of puncture wound

Stepping on a nail

Punctures through the sole of a shoe can carry pieces of rubber and sock into the foot. A small proportion lead to deep infections. Pseudomonas bacteria, which live in the foam of sneakers, can infect the bone or cartilage, causing osteomyelitis, typically with pain that gets worse after a few days of improving. Any puncture through a shoe, especially in someone with diabetes, should be checked by a doctor. An X-ray or ultrasound may look for a retained object.

Bites

Animal and human bites are puncture wounds with a high infection risk, especially cat bites, which inject bacteria deep into tissue and joints. Bites to the hand are particularly risky. Doctors often give preventive antibiotics, and rabies risk is assessed for animal bites. See animal bite and human bite.

Needlestick injuries

A puncture from a used needle can transmit hepatitis B, hepatitis C and HIV. Wash the area with soap and water and seek care immediately. HIV post-exposure prophylaxis works best when started within hours and must start within 72 hours. Hepatitis B vaccination or immune globulin may also be given.

High-pressure injection injuries

Paint, grease or hydraulic fluid injected under pressure can look like a pinprick but spread widely through tissue and cause severe damage. These are surgical emergencies.

Splinters and thorns

Small splinters near the surface can be removed with clean tweezers. Deep, large, glass or wooden fragments that break apart should be removed by a clinician. Thorn and rose injuries occasionally cause a fungal infection called sporotrichosis, with a chain of lumps forming up the arm weeks later.

Signs of an infected puncture wound

Infection usually shows within 1 to 5 days:

• increasing pain, rather than gradual improvement
• redness spreading from the wound, or red streaks up the limb
• swelling and warmth
• pus or cloudy drainage
• fever or chills
• swollen glands in the armpit or groin

These suggest wound infection or cellulitis, which need antibiotics. A painful, fluctuant lump suggests an abscess that needs draining.

What a doctor will do

• examine the depth, location and nearby nerves, tendons, blood vessels and joints
• clean and sometimes slightly widen the wound to remove debris
• order an X-ray or ultrasound to look for glass, metal, wood or rubber
• give a tetanus booster if needed
• prescribe antibiotics for bites, contaminated or high-risk wounds, or infection. Routine antibiotics are not needed for most clean, minor punctures
• arrange follow-up in 2 to 3 days for higher-risk wounds

Healing time

Most minor puncture wounds close within a few days and heal fully in 1 to 2 weeks. Deeper wounds, foot punctures and infected wounds take longer. Keep the wound clean and covered, avoid soaking it in pools or baths until it has closed, and take weight off a punctured foot for a day or two.

Frequently asked questions

Do I need a tetanus shot after stepping on a nail?

You need a booster if your last tetanus shot was more than 5 years ago, because a nail puncture counts as a dirty wound. If you have never had the full vaccine series or do not know, you need a booster and possibly tetanus immune globulin. Get it within a few days of the injury.

How do I clean a puncture wound?

Wash your hands, stop any bleeding with pressure, then rinse the wound under clean running water for 5 to 10 minutes and wash around it with soap. Remove only visible, shallow debris. Apply antibiotic ointment and a clean bandage, and change it daily.

How can I tell if a puncture wound is infected?

Signs include pain that gets worse after the first day or two, spreading redness or red streaks, swelling, warmth, pus and fever. Infection usually appears 1 to 5 days after the injury. See a doctor promptly if you notice any of these signs.

Should a puncture wound be covered or left open?

Cover it with a clean bandage over a thin layer of antibiotic ointment or petroleum jelly. This keeps out dirt and keeps the wound moist, which helps healing. Change the dressing daily. Puncture wounds are usually not stitched closed, so any infection can drain.

When is a puncture wound serious?

It is serious if it is deep, bleeding heavily, in the chest, belly, neck, head, eye or a joint, from a bite or used needle, through a shoe, or if an object is still embedded. People with diabetes or weak immunity should have even small punctures checked.