Puncture Wound

Injury Definition

  • The skin is punctured by a narrow, sharp object (e.g. a nail, pencil, toothpick)
  • Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are not toxic. They will cause a tattoo, however, and should be scrubbed out

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Call 911 Now (your child may need an ambulance) If

  • Puncture on the head, neck, chest or abdomen that may be deep

Call Your Doctor Now (night or day) If

  • You think your child has a serious injury
  • Puncture on the head, neck, chest, abdomen that isn’t deep
  • Puncture overlying a joint
  • Tip of the object is broken off and missing
  • Won’t stand (bear weight or walk) on punctured foot
  • Needle stick from used or discarded injection needle
  • Sharp object was very dirty (e.g. a rusty nail)
  • Setting was dirty and occurs on bare foot
  • No previous tetanus shots
  • Dirt (debris) or pencil lead pigment that can be seen in the wound is not gone after 15 minutes of scrubbing
  • Severe pain
  • Wound looks infected (redness, red streaks, swollen, tenderness)
  • Fever occurs

Call Your Doctor Within 24 Hours (between 9 and 4) If

  • You think your child needs to be seen
  • Last tetanus booster was over 5 years ago

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Parent Care at Home If

  • Minor puncture wound and you don’t think your child needs to be seen

Home Care Advice for Puncture Wound

  1. Cleansing: Wash with soap and warm water for 15 minutes. For any dirt or debris, scrub the wound surface back and forth with a wash cloth to remove it. If the wound rebleeds a little, that may help remove germs.
  2. Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.
  3. Antibiotic Ointment: Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Re-soak the area and re-apply an antibiotic ointment every 12 hours for 2 days.
  4. Pain Medicine: Give acetaminophen or ibuprofen for any pain.
  5. Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
  6. Call Your Doctor If
    • Dirt in the wound persists after 15 minutes of scrubbing
    • Pain becomes severe
    • It begins to look infected (redness, red streaks, tenderness, pus, fever)
    • Your child becomes worse or develops any of the “Call Your Doctor Now” symptoms