Attention
- Always better to keep nail in place if possible. Can be used to splint injury by taping
back onto nail bed
- Try not to damage nail base, so nail will grow back evenly
- If diabetes — medical consult before proceeding
Letting out blood from under nail (subungual haematoma)
Attention
- Use if blood is not clotted (fluid) and covers only part of area under nail
- If blood fills whole area underneath nail — nail may need to be removed, or lifted to suture underneath
- Hot end of needle or paperclip should go just under nail surface and not touch nail
bed. Painless if done properly
- Tell person discoloured part of nail will usually grow out over 4–6 months. If enough
of nail bed injured — nail will drop off, new nail grows in over 4–6 months
What you need
- 19-21G needle
- OR ordinary paperclip and hot flame source (eg lighter, candle, spirit lamp)
- Sterile dressing pack
- Normal saline
- Sterile gloves
- Dressing, if needed
What you do
- Wash hands and put on sterile gloves
- Pierce nail — use gentle rotating motion with needle to make 1 or 2 holes in nail
- OR as per local health guidelines — unfold 1 end of paperclip and hold over flame until red hot — Figure 7.15
- Quickly move paperclip to nail. Hold at 90° (right angle) and press down lightly into
haematoma (centre of blood)
- Don’t push too hard, let paperclip burn through nail. You will feel it give way, blood
will ooze out, pain will lessen — Figure 7.16
- Gently squeeze nail area to get all the blood out
- Lay out dressing pack and equipment
- Clean site with normal saline and dress if needed
Letting out pus from paronychia (next to or under nail)
Attention
- All procedures following need ring block anaesthetic
- Soak finger or toe in warm water for 10 minutes to soften tissue around nail
What you need
AND
- Sterile scalpel blade and handle (for procedure A)
- Sterile gauze soaked with normal saline (for procedure A)
- Sterile fine artery forceps (for procedures B, C)
- Sterile small metal retractor (for procedure C)
- Sterile pair of sharp scissors (for procedure C)
- Vas gauze (for procedure C)
What you do
- Lay out dressing pack and equipment
- Wash hands and put on sterile gloves
- Clean site and drape with sterile towels
- If trained and competent — give ring block
Pus beside nail (procedure A)
- Cut with scalpel over area of pus — Figure 7.17
- Clean out pus from wound
- If deep — pack with normal saline soaked gauze ribbon
- Dress wound and keep dry
Pus at bottom of nail (procedure B)
- Lift eponychial fold with artery forceps to release pus — Figure 7.18
- Dress wound and keep dry
Pus under nail itself (procedure C)
- Pierce nail using hot paperclip method — not over nail base. Pus will flow out and
nail can stay in place
- May need to repeat several times to keep hole open
OR
- Push eponychial fold back until you can see nail base, hold in place with retractor.
You may need helper
- Lift nail base away from nail bed — cut off small area to let pus out if needed —
Figure 7.19
- Dress with vas gauze, keep dry