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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

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
No
Puncture wound
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Do you have an eye injury?
Yes
Eye injury
No
Eye injury
Do you have an injury caused by a fishhook?
Yes
Fishhook injury
No
Fishhook injury
Is the wound bleeding?
Yes
Bleeding wound
No
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
No
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
No
Difficulty breathing more than a stuffy nose
Is there any pain?
Yes
Pain
No
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
No
Pain for more than 8 hours
Is the pain getting worse?
Yes
Pain is getting worse
No
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
No
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
No
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
No
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
No
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
No
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
No
Numbness, tingling, or loss of feeling around or below an arm or leg injury
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
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
No
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
No
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
No
Object in wound
Is the object large or small?
Large means things like a nail or piece of wood that is at least 2 in. (5.1 cm) 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
No
Swelling or bruising within 30 minutes of injury
Has the swelling or bruising raised a lump that's more than about 1.5 in. (4 cm) 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
No
Lump bigger than golf ball or Ping-Pong ball
Do you have a puncture wound in your foot?
Yes
Puncture wound in foot
No
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
No
Object went through a shoe or boot
Do you think you may need a tetanus shot?
Yes
May need tetanus shot
No
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, herbal remedies, and supplements 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.
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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.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

  • For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
    • You haven't had a tetanus shot in the past 5 years.
    • You don't know when your last shot was.
  • For a clean wound, you may need a shot if:
    • You have not had a tetanus shot in the past 10 years.
    • You don't know when your last shot was.

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.
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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.
HomeTreatment
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Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

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.

Eye Injuries
Fishhook Injuries

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 mild fever may occur. Home treatment can help reduce the discomfort.

Pain relief

Elevate the injured area on pillows 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

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

ByHealthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
H. Michael O'Connor, MD, MMEd, FRCPC - Emergency Medicine
Martin J. Gabica, MD - Family Medicine

Current as ofNovember 20, 2017

Current as of: November 20, 2017

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & H. Michael O'Connor, MD, MMEd, FRCPC - Emergency Medicine & Martin J. Gabica, MD - Family Medicine