Puncture Wound

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Puncture Wound Facts

  • A puncture wound is caused by an object piercing the skin and creating a small hole. Some punctures are just on the surface. Others can be very deep, depending on the source and cause.
  • A puncture wound does not usually result in excessive bleeding. Usually, these wounds close fairly quickly without any intervention.
  • Treatment may be necessary to prevent infection in some wounds. A puncture wound from a cause such as stepping on a nail can become infected because the object that caused the wound may carry bacteria or spores Clostridium spp that cause tetanus into the skin and tissue.
  • The subject of puncture wounds discussed here is meant to cover only the non-life-threatening wounds, and is not an article that covers deep organ penetrating wounds seen with guns, large knives, lances or other similar objects.

Puncture Wound Causes

Common causes of puncture wounds are wood splinters, pins, nails, and glass. Puncture wounds may also be caused by objects such as scissors and knives. Almost any sharp object can potentially cause a puncture wound.

Puncture Wound Symptoms

  • Puncture wounds usually cause pain and mild bleeding at the site of the puncture. It is usually fairly obvious if a person is cut. However, small pieces of glass may cause puncture wounds that a person may not notice at first.
  • Infection may cause redness, swelling, pus, or watery discharge from a puncture wound that is not noticed or not treated properly.

When to Seek Medical Care

When to call the doctor

  • If the wound will not stop bleeding after 5 minutes of direct pressure or is spurting blood, call a doctor or go to an Emergency Department.
  • If the wound was caused by a nail, pen, or pencil, call a doctor to see if the person needs immediate care or close follow-up.
  • If the person is not sure when they had their last tetanus shot, check with the doctor's office. Individuals will need a tetanus shot if it has been more than 10 years since their last shot or if their last tetanus shot was more than 5 years ago, and the wound has been contaminated with dirt. This is done since immunity to tetanus may wane over time.
  • If the person knows or suspects part of the object remains in the wound, contact a doctor. The individual may need urgent care to detect and remove the object.

When to go to the hospital

Seek emergency medical attention in any of the following situations:

  • If the wound is in the head, chest, or abdomen, unless it is very small, but it is better to be sure. If there is any concern, see a doctor.
  • If there is loss of feeling, numbness, or inability to move an arm or leg below the wound
  • If the wound is more than 24 hours old and the person develops signs of infection, such as redness at the area of the wound, swelling, pus drainage, fever over 100 F (37.3 C), or red streaks coming away from the wound
  • If the wound does not stop bleeding after pressure is applied for 5 minutes
  • If the wound has part of an object remaining in it, such as a pencil tip, nail, or piece of glass
  • If a lot of dirt remains in the wound
  • If the wound is gaping or there is white tissue (fatty tissue) or muscle visible
  • If the person has a chronic medical condition, such as diabetes, or takes steroids
  • If the wound is close to or in an eye

Puncture Wound Diagnosis

The evaluation is based on a thorough history of what caused the puncture wound and the circumstances surrounding the event. The doctor will ask about the time from injury to evaluation, type of object that caused the injury, an estimate of the depth of penetration, inspection of the object if available, and whether or not footwear was worn if the injury is to the foot.

  • Patients will be asked about the date of their last tetanus shot.
  • X-rays may be taken as needed, to look for any possibility of an object left behind in the puncture wound or to assess any damage to the underlying bone.
  • Ultrasound may also be performed.

Puncture Wound Home Remedies

  • First, check to see that nothing is left in the wound.
  • Check to see if the object that caused the wound is intact. If a piece is missing, it may be stuck in the wound.
  • Allow the wound to bleed freely, but if bleeding is heavy or squirting out, apply pressure until it stops.
  • If bleeding won't stop, the patient will need emergency care.
  • The basics of wound care
    • Stop the bleeding: Minor puncture wounds and cuts usually stop bleeding without any treatment. If not, apply gentle pressure with a clean cloth or bandage. If the blood spurts or continues after several minutes of pressure, emergency care is necessary.
    • Clean the wound: The person that cleans the wound needs first to wash their hands; ideally, the person should wear sterile gloves. People may spread bacteria into the wound if their hands are not clean. Cleanse the wound; wash with water. People can use a mild soap such as Ivory if the wound is very dirty. If dirt or debris remains in the wound, clean a pair of tweezers with alcohol and remove the dirt. If a person cannot get the dirt or debris out, the patient's doctor should be notified or they should go to an urgent care or emergency center.
    • Protect the wound: An antibiotic ointment such as Neosporin or Polysporin can be used. Apply a thin layer over the wound. This will help coat and protect the wound. Large amounts of ointment are not helpful because they can attract bacteria. Apply the ointment with a clean swab or gauze. Do not apply directly from the tube in order to avoid contamination of the tube. Ointments can be applied up to 3 times a day, but individuals should always clean the wound before applying ointment.

Puncture Wound Treatment

The wound will be thoroughly cleansed. The doctor may use instruments to look for objects in the wound. The patient may be given a tetanus shot. Antibiotics may be given to people with diabetes, peripheral vascular disease, contaminated wounds, or deep wounds to the foot. Most healthy people without signs of infection do not require antibiotics.

Puncture Wound Follow-up

The patient will be given instructions for general wound care and specifically for puncture wounds. If the patient has other concerns or he or she thinks they see signs of infection (such as redness, warmth, pus draining from the wound) or develop a fever, they should call a doctor.

Puncture Wound Prevention

The following suggestions are listed to reduce the risk of puncture wounds.

  • Use sharp objects only for their intended purpose and handle with care. Keep out of reach of children.
  • Do not run with sharp objects or glass in your hands.
  • Always sweep up broken glass promptly and carefully avoid picking up pieces with bare hands.
  • Remove nails from boards and dispose of them properly.
  • Keep play and work areas free of trash and glass bottles or objects.

Puncture Wound Prognosis

Most puncture wounds heal well on their own. Patients will be given thorough instructions emphasizing wound care and cleansing and monitoring for infection. Overall prognosis from most puncture wounds (except puncture wounds from guns, long knives or deep wounds that puncture the intestines, lungs, brain or other organs, which are not the subjects of this article) is good.

Reviewed on 11/17/2017

Medically reviewed by Joseph Palermo, DO; American Osteopathic Board Certified Internal Medicine

REFERENCES:

"Overview of puncture wounds"
UptoDate.com

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