Puncture Wounds

Puncture wounds are caused when sharp and pointed objects such as nails, tacks, knife tips, needles, or bullets penetrate the skin. Animal bites are another cause of puncture wounds.

Puncture wounds usually don't bleed very much (unless a major blood vessel is broken). For that reason, they may not look serious. They also may appear to heal very quickly. But because puncture wounds penetrate deeper than simple scrapes and cuts, and don't usually generate enough blood flow to wash away germs, they are particularly prone to infection. Objects such as old nails or tacks that have been exposed to the soil may carry tetanus spores or other bacteria. Saliva is also loaded with bacteria, so bites can easily become infected. That's why it's important to treat these wounds carefully.

What to do

Make sure the object that caused the puncture is intact. If any part of it remains in the wound, seek medical help immediately. Be careful when trying to remove an embedded object without professional help, or you may risk breaking part of it off in the wound. If the puncture wound is in the head, neck, chest, or abdomen, and penetrates deeply enough to affect an internal organ, contact your doctor.

Call your doctor immediately if the puncture wound is the result of an animal or human bite. You may need a tetanus vaccine and, depending on the animal and the circumstances of the bite, rabies shots.

For minor wounds

In the case of an obviously minor puncture wound, encourage a little bleeding to wash out germs by gently pressing on the skin around the wound. Once the bleeding has stopped, clean the wound thoroughly with soap and water. Thorough cleaning can help prevent the risk of tetanus. It's okay to apply an antiseptic solution to help get rid of germs, but the American Red Cross advises against applying an antibiotic ointment because it can close off the puncture and prevent air from getting into the wound. (Tetanus bacteria, for example, are more likely to thrive where there is little oxygen.) However, the Mayo Clinic and the American Academy of Family Physicians advise using antibiotic ointment to help keep out infection and keep the wounded area clean. Apply a sterile gauze bandage to the wound and seek medical help. The American Medical Association warns that all puncture wounds should be seen by a doctor.

For more serious puncture wounds

If the wound won't stop bleeding, press down on the wound firmly with a clean cloth or bandage. Maintain pressure for 15 minutes. If the wound continues to bleed, call 911 or get to an emergency medical facility immediately.

If blood is spurting from the wound, apply pressure to the wound immediately with a clean cloth or bandage, and have someone call 911.

Caring for a puncture wound

Several times a day for four or five days, soak the wound in warm water. Use a bathtub or basin if the wound is on the foot or leg. Soaking helps clean the wound from the inside out.

Monitor carefully for signs of infection. Because puncture wounds go deep, an infection may not become visible for several days after the injury.

When to seek immediate medical help

  • When your tetanus shots are not up-to-date and the puncturing object was dirty.
  • When the wound becomes infected. Signs of infection include pus, increased pain, swelling, redness, tenderness, a sensation of warmth or visible redness radiating from the wound, or a fever of 100 degrees F or more.
  • When the wound involves human or animal bites.
  • When the wound hasn't stopped bleeding after 15 minutes.
  • When blood is spurting from the wound.
  • When the puncture wound is in the eye. Cover both eyes with a protective patch, such as cloth, and apply tape from the forehead to the cheekbone to prevent any pressure on the eyes themselves. Do not try to remove the object. Leaving it in place and covering it with a patch actually prevents further damage to the eye and surrounding area while you seek medical help. The patch should keep the person's eyes closed. If he or she can open them, the cloth isn't thick enough and should be refolded and retaped. Then bring the person to an emergency room immediately.

References

American Academy of Family Physicians. First Aid: Cuts, Scrapes and Stitches. November 2009.

American College of Emergency Physicians, First Aid Manual, 2001.

The American Red Cross First Aid and Safety Handbook.

MayoClinic.com. Puncture Wounds: First Aid. January 2010.

Medical College of Wisconsin. Eye Injury. http://healthlink.mcw.edu/article/923883338.html

University of Michigan Hospitals and Health Centers Emergency Department. Puncture Wound. http://www.med.umich.edu/em/clinops/discharge%20instructions%20adult/puncture%20wound.pdf

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