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Puncture Wounds

Topic Overview

Causes of puncture wounds

A 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 Symptoms

Home Treatment

Minor 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 object

  • Make 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 bleeding

  • Allow 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 wound

Clean 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 bandage

Most 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.

Tetanus

  • Determine 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 fever of up to 100°F (37.8°C) may occur. Home treatment can help reduce the discomfort.

Pain relief

An ice or cold pack may help reduce swelling and bruising. Never apply ice directly to a wound or the skin. This could cause tissue damage.

Elevate the injured area on pillows while applying ice and 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 treatment

Call your doctor if any of the following occur during home treatment:

  • Signs of infection
  • Signs of loss of function
  • Signs of decreased blood flow
  • Pain gets worse.
  • Symptoms become more severe or more frequent.

Prevention

To 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 Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Questions to prepare for your appointment

You 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?

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Revised June 6, 2012

Last Revised: June 6, 2012

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & H. Michael O'Connor, MD - Emergency Medicine

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