How to Treat a Puncture Wound

Medically reviewed by Jonas DeMuro, MD

Last Updated: December 10, 2022 References Approved

Did you know that puncture wounds account for five percent of the admission reasons for children going to emergency centers?^{[1]
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Research source} Puncture wounds occur when a narrow, pointed object such as a nail, tack, sliver or other similar sharp object pierces the skin. These wounds tend to be narrow and can be quite deep if the object was driven into the skin with substantial force. Minor puncture wounds can be treated fairly easily at home, saving you a trip to the emergency room; major puncture wounds, on the other hand, should be treated as soon as possible by a medical professional. Read the following article to learn how to assess and treat minor and more serious puncture wounds.

Part 1

Part 1 of 4:

Assessing the Wound

1
Treat the wound immediately. Provided a puncture wound is attended to quickly, it will usually not become serious. If left unattended, however, infection introduced through the puncture site can become life-threatening for the patient.^{[2]
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2
Reassure the patient. This is especially important for children and for people who don't cope very well with pain. Have him sit or lay down, and help him to remain calm while you treat the wound.

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3
Wash your hands with soap or an antibacterial solution. This will prevent infection.^{[3]
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- Clean any instruments you might use during treatment with rubbing alcohol. These may include tweezers.^{[4]
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  Mayo Clinic
  Educational website from one of the world's leading hospitals
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4
Clean the wound with soap and warm water. Cleanse the wound under warm water for between five and 15 minutes, and then wash the wound with soap and a clean cloth. ^{[6]
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5
Stop the bleeding. Minor puncture wounds usually do not bleed profusely.^{[8]
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Mayo Clinic
Educational website from one of the world's leading hospitals
Go to source} Use a clean cloth to apply gentle, direct pressure on the wound until the bleeding stops.
- A small amount of bleeding may actually help to clean the wound. You can allow small wounds to bleed for about five minutes.^{[9]
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- If the bleeding continues after several minutes of pressure, or the bleeding is severe, ongoing, or alarms you, seek medical attention immediately.^{[11]
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  Mayo Clinic
  Educational website from one of the world's leading hospitals
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6
Assess the wound. Look at the size and depth of the wound, and check for foreign objects embedded in the skin. Larger puncture wounds may require stitches. If you observe any of the following signs, call or visit an emergency medical facility as soon as possible:
- The bleeding won’t stop after five to 10 minutes.
- The wound is a quarter of an inch (0.65 centimeters) or more deep. Even if you can stop the bleeding, larger wounds should be treated by a professional.
- An object is embedded deeply into the skin. If you can’t see anything, but suspect an object remains in the wound, seek medical attention.
- The patient stepped on a nail, or the wound was caused by a rusty fishhook or other rusty object.
- A person or animal has bitten the patient. Bites are prone to infection.
- The affected area is numb or the patient cannot move the body part normally.
- The wound shows signs of infection, including redness and swelling around the affected area, increasing pain or a throbbing sensation, pus or other discharge, or the patient experiences chills or a fever (see Part 4).^{[13]
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Part 2

Part 2 of 4:

Treating a Major Puncture Wound

1
Seek medical assistance immediately. Call emergency services or a close-by emergency medical center. Major puncture wounds should only be treated by a medical professional.
2
Keep pressure on the wound. If the bleeding is severe and you do not have access to a clean cloth or bandage, use your hand.^{[15]
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3
Raise the affected body part. Keep the affected area raised above the patient’s heart, if possible. This will help to bring the bleeding under control.^{[16]
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4
Do not remove objects embedded in the skin. Instead, apply a thick padding of bandages or clean cloth around the foreign object. Make sure there is as little pressure as possible on the embedded object. ^{[17]
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5
Keep the patient in a resting position. To help slow the bleeding, the patient should be kept at total rest for at least 10 minutes. ^{[18]
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6
Monitor the patient. While you wait for medical assistance to arrive, monitor the wound and the patient’s condition.
- Keep pressure on the wound and replace bandages if they become soaked with blood.^{[19]
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- Calm the patient until medical assistance arrives.

Part 3

Part 3 of 4:

Treating a Minor Puncture Wound

1
Remove the object (or objects) if it is not large. Small splinters and other sharp objects can be removed with disinfected tweezers. If you find a large object, or one that is embedded deeply into the flesh, seek medical attention.^{[20]
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Clean dirt and other small particles from the surface of the wound. Rub the wound with a clean cloth and/or remove the particles with disinfected tweezers.^{[21]
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Educational website from one of the world's leading hospitals
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- All manner of foreign objects can become embedded in a puncture wound, including wood, cloth, rubber, dirt and other materials; these may be difficult or impossible to see when treating the wound at home. However, do not poke or dig around in the wound; if you believe there are still foreign objects in the wound, seek medical attention. ^{[23]
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3
Treat and bandage the wound. If the puncture is free of debris and sharp objects, apply an antibacterial ointment or cream and cover with a bandage. ^{[24]
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- Because minor puncture wounds do not tend to be very large in size and are not prone to excessive bleeding, you may not need a bandage. However, puncture wounds to the feet or other places that get dirty may require a bandage to prevent debris from entering the wound.
- Topical antibiotic ointments like Neosporin and Polysporin are effective, and don’t require a prescription. Apply every 12 hours for 2 days. ^{[25]
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  Mayo Clinic
  Educational website from one of the world's leading hospitals
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- Use a porous adhesive dressing or bandage that won’t stick to the wound. Change daily, to ensure that the wound stays healthy and dry. ^{[27]
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Part 4

Part 4 of 4:

Recovering from a Puncture Wound

1
Treat the affected area with care. The following steps are recommended for the first 48 to 72 hours after treating a minor puncture:
- Keep the affected area elevated, above the heart if possible.
- Change the bandages if they get dirty or wet.
- Keep the affected area dry for 24 to 48 hours.
- After 24 to 48 hours, clean the wound with soap and water twice a day. You can reapply antibiotic ointment or cream, but avoid the use of rubbing alcohol or hydrogen peroxide.
- Avoid activities that may place a strain on the affected area and could re-open the wound. ^{[29]
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2
Monitor the puncture for infection. Minor puncture wounds should heal in less than two weeks. If you notice any of the following symptoms, seek medical assistance immediately:
- Throbbing or increasing pain in the affected area.
- Redness or swelling of the wound. In particular, look for red streaks around or moving away from the wound.
- Pus or other discharge.
- An unpleasant smell coming from the wound.
- Chills, or a fever of 100.4°F (38°C).
- Swelling in the neck, armpits or groin glands. ^{[30]
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3
Get a tetanus shot if needed. A wound that has come into contact with soil, manure or dirt may pose a risk of a tetanus infection. Use the following guidelines to determine if the patient needs a tetanus shot (and consult your doctor for advice):
- If more than 10 years have passed since the patient last had a tetanus shot.
- If the object causing the injury was dirty (or you are not sure whether or not it was dirty), or the wound is severe, and more than 5 years have passed since the patient last had a tetanus shot.
- The patient is not sure when the last shot was.
- The patient has never received a tetanus shot.^{[31]
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Expert Q&A

Question

What kind of antibiotic cream should I use?

Jonas DeMuro, MD
Board Certified Critical Care Surgeon
Dr. DeMuro is a board certified Pediatric Critical Care Surgeon in New York. He received his MD from Stony Brook University School of Medicine in 1996. He completed his fellowship in Surgical Critical Care at North Shore-Long Island Jewish Health System and was a previous American College of Surgeons (ACS) Fellow.

Jonas DeMuro, MD

Board Certified Critical Care Surgeon

Expert Answer

Triple antibiotic cream is a good choice. Discuss this with your doctor for a more specific recommendation based on your medical history and any allergies.
Question

Is it normal for there to be hardness and tenderness around the wound?

Jonas DeMuro, MD
Board Certified Critical Care Surgeon
Dr. DeMuro is a board certified Pediatric Critical Care Surgeon in New York. He received his MD from Stony Brook University School of Medicine in 1996. He completed his fellowship in Surgical Critical Care at North Shore-Long Island Jewish Health System and was a previous American College of Surgeons (ACS) Fellow.

Jonas DeMuro, MD

Board Certified Critical Care Surgeon

Expert Answer

If the area of the wound is hard and tender it may indicate a retained foreign body, or an infection that may have progressed into an abscess. In either case, it needs to be examined by a physician for a possible procedure and antibiotics.

Warnings

Be sure to watch for signs of infection around the wound site until it heals. Symptoms such as redness, swelling, throbbing, red streaks or pus may indicate an infection.

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