Children's Hospital Colorado

Puncture Wound

Urgent or Emergency Care?

If you believe your child needs immediate attention and you have concerns for a life-threatening emergency, call 911. Not sure what counts as urgent and what's an emergency when your child is sick or injured? When it can't wait, know where to take your kids.

Help Me Decide

  • The skin is punctured by a pointed narrow object

Causes of Puncture Wounds

  • Metal: nail, sewing needle, pin, tack
  • Pencil: pencil lead is actually graphite (harmless). It is not poisonous lead. Even colored leads are not toxic.
  • Wood: toothpick

Complications of Puncture Wounds

  • Retained Foreign Object. This happens if part of the sharp object breaks off in the skin. The pain will not go away until it is removed.
  • Wound Infection. This happens in 4% of foot punctures. The main symptom is spreading redness 2 or 3 days after the injury.
  • Bone Infection. If the sharp object also hits a bone, the bone can become infected. Punctures of the ball of the foot are at greatest risk. The main symptoms are increased swelling and pain 2 weeks after the injury.

Call 911 Now

  • Deep puncture on the head, neck, chest, back or stomach
  • You think your child has a life-threatening emergency

Go to ER Now

  • Bleeding that won't stop after 10 minutes of direct pressure
  • Puncture on the head, neck, chest, or stomach that could be deep
  • Tip of the object broke off in the body

Call Doctor or Seek Care Now

  • Puncture into a joint
  • Feels like something is still in the wound
  • Won't stand (bear weight or walk) on punctured foot
  • Needlestick from used needle (may have been exposed to another person's blood)
  • Sharp object or setting was very dirty (such as a playground or dirty water)
  • No past tetanus shots
  • Dirt in the wound is not gone after 15 minutes of scrubbing
  • Severe pain and not better 2 hours after taking pain medicine
  • Wound looks infected (spreading redness, red streaks)
  • Fever occurs
  • You think your child has a serious injury
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Last tetanus shot was more than 5 years ago
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Minor puncture wound

Care Advice for Puncture Wound

  1. What You Should Know About Puncture Wounds:
    • Most puncture wounds do not need to be seen.
    • Here is some care advice that should help.
  2. Cleaning the Wound:
    • First wash off the foot, hand or other punctured skin with soap and water.
    • Then soak the puncture wound in warm soapy water for 15 minutes.
    • For any dirt or debris, gently scrub the wound surface back and forth. Use a wash cloth to remove any dirt.
    • If the wound re-bleeds a little, that may help remove germs.
  3. Antibiotic Ointment:
    • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
    • Then, cover with a bandage (such as Band-Aid). This helps to reduce the risk of infection.
    • Re-wash the wound and put on antibiotic ointment every 12 hours.
    • Do this for 2 days.
  4. Pain Medicine:
    • To help with the pain, give an acetaminophen product (such as Tylenol).
    • Another choice is an ibuprofen product (such as Advil).
    • Use as needed.
  5. What to Expect:
    • Puncture wounds seal over in 1 to 2 hours.
    • Pain should go away within 2 days.
  6. Call Your Doctor If:
    • Dirt in the wound still there after 15 minutes of scrubbing
    • Pain becomes severe
    • Looks infected (redness, red streaks, pus, fever)
    • You think your child needs to be seen
    • Your child becomes worse

Care Advice for Puncture Wound

Puncture Wound - BB Gun

This photo shows a puncture wound from a BB gun in the upper arm. Note the small hole in the arm where the BB struck and entered the skin.

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.


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