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Puncture Wounds

Overview

A puncture wound is a forceful injury caused by a sharp, pointed object that goes into the skin. A puncture wound is usually narrower and deeper than a cut or scrape. Many people get puncture wounds from household items, work items, or 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 cause puncture wounds. These wounds raise your risk of infection because they are hard to clean and they provide a warm, moist place for bacteria to grow. The bacteria Pseudomonas are a common cause of infection when a person's foot gets punctured through the sole of an athletic shoe.

Some punctures are done for health reasons. For example, a needle puncture may be used by a doctor to draw blood or to put fluid or medicines into a vein (intravenous, or I.V.).

Health professionals have a higher risk for needle-stick injuries. A puncture from a used needle increases the risk of infection. It also increases the risk of getting a disease that is passed (transmitted) through blood, such as hepatitis or HIV. But for puncture wounds from clean needles, home treatment may be all that is needed.

Check Your Symptoms

Do 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.

Yes

Puncture wound

How old are you?

Less than 12 years

12 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Do you have an eye injury?

Yes

Eye injury

Do you have an injury caused by a fish hook?

Yes

Fish hook injury

Is the wound bleeding?

Yes

Bleeding wound

Would you describe the bleeding as severe, moderate, or mild?

Severe

Severe bleeding

Moderate

Moderate bleeding

Mild

Mild bleeding

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 belly

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

Is there any pain?

Yes

Pain

How 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?

Signs of pain in an adult or child are different than signs of pain in a baby or toddler.

8 to 10: Severe pain

Severe pain

5 to 7: Moderate pain

Moderate pain

1 to 4: Mild pain

Mild pain

Has the pain lasted for more than 8 hours?

Yes

Pain for more than 8 hours

Is the pain getting worse?

Yes

Pain is getting worse

Have you been injected with something under high pressure, like oil or paint from a sprayer?

Yes

Injection under high pressure

Is there a deep puncture in or over a joint?

A puncture that goes into a joint can be serious.

Yes

Deep puncture in joint area

Do you have a wound on your arm, leg, hand, or foot that is more than just a scratch?

Yes

Wound on extremity

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 injury

Can you move the area below the injury normally, even though it may hurt?

Yes

Able to move limb normally below injury

Unable to move limb normally below injury

For 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 injury

Are there any symptoms of infection?

Yes

Symptoms of infection

Do you think you may have a fever?

Yes

Possible fever

Are there red streaks leading away from the area or pus draining from it?

Yes

Red streaks or pus

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 area

Have you been stuck with a used or dirty needle?

Yes

Stuck with used or dirty needle

Is 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.

Yes

Object in wound

Is the object large or small?

Large means things like a nail or piece of wood that is at least 5.1 cm (2 in.) long and anything bigger than that. Small means things like a pencil tip or a small splinter or sliver.

Large

Large embedded object

Small

Small embedded object

Did you have swelling or bruising within 30 minutes of the injury?

Yes

Swelling or bruising within 30 minutes of injury

Has the swelling or bruising raised a lump that's more than about 4 cm (1.5 in.) across or deep? This would be bigger than a golf ball or Ping-Pong ball.

Yes

Lump bigger than golf ball or Ping-Pong ball

Do you have a puncture wound in your foot?

Yes

Puncture wound in foot

Did 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 boot

Do you think you may need a tetanus shot?

Yes

May need tetanus shot

Many 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, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products 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 Treatment

You 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.

HomeTreatment

RelatedInformation

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.

Usually found in dirt and soil, tetanus bacteria typically enter the body through a wound. Wounds may include a bite, a cut, a puncture, a burn, a scrape, insect bites, or any injury that may cause broken skin. Tetanus can also happen with other infections, like dental infections. It can happen during a surgery or pregnancy and delivery.

A wound can be so small, you may not notice you have one. Or a skin blister could break and become an open wound. If there is any delay in finding or cleaning a wound, there is an increased risk for skin infection and a chance for tetanus to get in the wound. A tetanus infection can start 3 to 21 days after the bacteria enter the wound. Be especially careful about wounds on your fingers and toes.

Many people may not know when they got their last tetanus shot. So it's a good idea to call your doctor to see if you need one.

Make sure to stay up to date on your tetanus shots. A tetanus shot is recommended:

For a dirty wound that has things like dirt, saliva, or feces in it, if you haven't had a tetanus shot in the past 5 years.
For a clean wound, if you haven't had a tetanus shot in the past 10 years.

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 Today

Based 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.

HomeTreatment

RelatedInformation

Seek Care Now

Based 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 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Eye Injuries

Fish Hook Injuries

Self-Care

Minor puncture wounds can be treated effectively at home. Home treatment can prevent infection and promote healing.

Try these tips for treating a puncture wound.

Remove the object.
- Make sure the object that caused the wound is not still in the wound. Check to see if the object is whole. Be sure that 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 easily and without pain. Be careful, and don't push the object farther into the wound. Don't 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.
- Apply direct pressure to the wound.
Clean the wound as soon as you can.
This lowers 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 non-prescription products for wound cleaning can numb the area so cleaning doesn't hurt as much. Be sure to read the product label for correct use.
- Don't use rubbing alcohol, hydrogen peroxide, iodine, or Mercurochrome. They can harm the tissue and slow healing.
Check to see if other tissues have been injured.
These tissues include blood vessels, nerves, tendons, ligaments, joints, bones, and internal organs.
Apply a bandage, if needed.
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. Cleaning reduces the chance that you'll get an infection under the bandage.
Treat pain and swelling.
Prop up the injured area on a pillow anytime you sit or lie down. Try to keep the area at or above the level of your heart to reduce swelling.

If you are concerned that the injury is more serious, you may need to be checked by a doctor to see if you need stitches or a tetanus shot.

Removing a splinter

Before using tweezers or a needle to remove a splinter, try using cellophane tape to remove it. Simply put the tape over the splinter, then pull the tape off. The tape will stick to the splinter and remove it painlessly.

If tape doesn't work, try these steps.

Wash your hands well with soap and water.
Do not wet or soak the splinter because it will be harder to remove in one piece.
Grasp the end of the splinter with clean tweezers.
If the splinter is embedded in the skin:
1. Clean a needle with alcohol and make a small hole in the skin over the end of the splinter.
2. Lift the splinter with the tip of the needle until it can be grasped with the tweezers.
Gently pull the splinter out.
Clean the wound.
Watch for any signs of infection.

You may need medical care if the splinter:

Cannot be easily removed.
Broke off and part of it remains in the wound or if you are uncertain that the splinter has been removed.
Is very large.
Is deeply embedded in the skin.
Is in the eye.

Need for a tetanus shot

To decide if you need a tetanus shot after a wound, first decide if the object that caused the wound was dirty or clean. An object is dirty if it has dirt, soil, spit, or feces on it. A clean object does not have dirt, soil, spit, or feces on it.

You will need a tetanus shot if:

Your wound was caused by something that was clean and your last tetanus shot was longer than 10 years ago.
Your wound was caused by something that was dirty and your last tetanus shot was longer than 5 years ago.
You are not sure if your wound was caused by something clean or dirty and your last tetanus shot was longer than 5 years ago.
You are not sure when you had your last tetanus shot.
You did not get the first series of tetanus shots (primary vaccination series).

If you need a tetanus shot, call your doctor to arrange for a shot.

Some people may need tetanus immunoglobulin (IG) for a wound that is at high risk for developing tetanus. The immunoglobulin is usually only needed if you have not (or do not know if you have) completed the tetanus primary vaccination series.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

New or worse signs of infection, such as redness, warmth, swelling, pus, or a fever.
New loss of function near the wound.
Decreased blood flow, such as cool, pale skin near the wound.
Pain gets worse.
Symptoms occur more often or are more severe.

Learn more

Over-the-counter medicines

More self-care

Care for a Skin Wound

Preparing For Your Appointment

You can help your doctor diagnose and treat your condition by being prepared for your appointment.

Making the Most of Your Appointment

Related Information

Credits

Current as of: July 10, 2023

Author: Healthwise Staff
Clinical Review Board
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