How to Treat a Puncture Wound

Sharp objects such as nails or fishhooks cause puncture wounds when they penetrate the skin. Puncture wounds require special attention because bleeding is usually minimal and the risk of infection high, and because the penetrating object may have punctured organs and arteries inside.

Instructions

Difficulty: Easy

Things You’ll Need:

• Mild Soap Such As Dishwashing Liquid
• Disinfected water
• Rubber Or Latex Gloves
• Povidone-iodine
• Tweezers

Preparation

1. Scrub hands thoroughly with soap and disinfected water.
2. Put on latex gloves to prevent the spread of infectious disease.
3. Prepare a disinfectant solution of 1 oz. povidone-iodine and 1 liter disinfected water. See "How to Disinfect Water." Set the disinfectant solution aside for about five minutes.

Irrigation and Scrubbing

4. Do not remove the object that caused the puncture if it is still impaled in the wound. See "How to Treat a Wound With an Impaled Object."
5. If there is little bleeding, encourage bleeding by pressing lightly on the tissue on either side of the wound with a gloved hand.
6. Scrub the area around the wound using a nailbrush and disinfectant solution. Scrubbing may be painful to the injured person, but it is important that all debris is removed.
7. Rinse a pair of tweezers thoroughly with disinfectant solution to sterilize them.
8. Remove all large pieces of dirt, debris, dead skin and flakes of clotted blood from the wound.
9. Draw the disinfectant solution into an irrigation syringe.
10. Hold the syringe perpendicular to the wound, about 2 to 3 inches above it. Angle the syringe and tilt the wound so that the solution will flood the wound and drain away from the opening.
11. Press down on the plunger to emit a forceful stream of solution.
12. Repeat the irrigation process, rinsing the wound for at least three to five minutes. Puncture wounds are very difficult to clean, so repeat the irrigation process as many times as possible to give the wound a thorough cleaning.
13. Rinse the wound liberally with disinfected water, because the disinfectant solution may cause irritation to the skin if left on.
14. Check the clothing and area around the injured person to make sure his or her skin won't be exposed to disinfectant solution for a prolonged period of time, because this may cause burning.
15. Bandage the wound immediately after it has been thoroughly cleansed of all debris. See "How to Bandage a Wound During First Aid."

Continued Care

16. Change the dressing and bandage, and monitor the wound daily for infection. See "How to Evaluate a Wound for Infection."
17. If there are any signs of infection, place a small piece of gauze inside the wound to prevent it from sealing and to allow pus to drain. See "How to Treat an Infected Wound."

Tips & Warnings

• You will need to have at least 1 liter of disinfectant solution on hand for this procedure.
• Use a clear plastic bottle with measurements on the side, such as a Nalgene bottle, for easy measurement when mixing the disinfectant solution. These bottles include measurements in milliliters and ounces.
• If povidone-iodine solution is not available, use disinfected water to cleanse the wound.
• Infectious diseases such as AIDS and hepatitis are transmitted via the exchange of bodily fluids. Protect yourself by wearing latex gloves. Wear goggles or glasses to protect against spurting blood or fluids. Wear a surgical mask to prevent the spread of other diseases. If you don't have gloves, a surgical mask and goggles, improvise by placing your hand in a plastic bag, wearing sunglasses, and covering your mouth with a bandanna.
• "Irrigation syringes" are also called "pressure irrigators." If an irrigation syringe is not available, improvise by puncturing a plastic bag with a small hole, drilling or burning a hole into the top of a water bottle, or using a sports bottle with a squirting top. The idea here is to create a high-pressure flow of water that will remove debris without damaging the tissue.
• Do not use alcohol, iodine or mercurial solutions to cleanse a wound, as these can damage the tissue.
• If the infection seems to be spreading and the injured person is more than 24 hours from medical care, immediately begin oral antibiotic treatment. Give high doses of antibiotics for at least five days. If you anticipate being in a remote area, consult a physician before you leave about bringing a broad-spectrum antibiotic with you for the treatment of skin infections. Make sure you bring all the instructions for usage and information about complications of the antibiotic with you into the backcountry.
• Tetanus is a serious complication that may occur with puncture wounds. Tetanus boosters should be given every 10 years, and shots should be up-to-date before heading into a remote area. Evacuate if the injured person has not received a tetanus booster.
• Evacuate immediately for any of the following conditions: blood flow cannot be stopped; a tourniquet has been applied; the wound is large or gaping widely; the wound involves a joint, foot, hand or face; the wound involves an embedded object; skin or parts of the body have been partially or completely severed away; the wound is showing signs of infection; or an organ or artery appears to have been punctured.
• This information is not intended as a substitute for professional medical advice or treatment.