Sophia Delgado
If you notice blood pooling under your nail, you may have what is called a subungual hematoma, which is usually caused by a crushing or stubbing injury. Doctors recommend draining subungual hematomas when they cause pain or make up 50% or more of the nail. This procedure, also known as trephination, involves making a small hole in the nail to allow the blood to flow out. It is important to note that drainage is most effective within the first 48 hours after the injury, as the blood begins to clot after this amount of time, making drainage difficult.
| Characteristics | Values |
|---|---|
| When to drain | Drain within the first 48 hours of injury as the blood begins to clot after this amount of time, making drainage difficult. |
| Drainage procedure | Trephination or decompression, where a small hole is made in the nail to allow the blood to flow out. |
| Pain | May cause intense pain or throbbing pain. |
| Symptoms | Darkened discoloration, such as black spots, pressure under the nail, and pain. |
| Treatment | Soak the finger or toe in a warm solution with Epsom salts to help drain fluid and alleviate pain. Take over-the-counter pain relievers like ibuprofen. |
| Regrowth | A new fingernail can regrow in as little as 8 weeks, while a toenail may take 6-18 months. |
| Prevention | Avoid using home methods like heated pins or paper clips to make a hole in the nail, as this may cause infection. |
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What You'll Learn
Drainage methods
If you are experiencing pain, throbbing, or pressure due to a subungual hematoma, it is recommended that you seek medical attention. Drainage can be performed quickly and painlessly by a doctor or at an urgent care center.
Decompression or trephination is a procedure that allows the blood to drain, relieving pressure and pain. Here are some methods that a doctor may use:
- Cautery: A heated wire (electrocautery device) or carbon laser is used to burn a hole in the nail. The heated tip of the wire is cooled by contact with the hematoma, preventing injury to the nail bed.
- Needle: A needle is used to make a hole in the nail. Afterward, the nail will be bandaged, and the finger or toe should be kept elevated and may be wrapped with a cold compress for the first 12 hours. In some cases, a splint may be recommended for up to 3 days.
It is important to note that you should not attempt to drain a hematoma at home as it may cause infection. However, if you choose to do so, you can follow these steps:
- Straighten a paper clip and heat the tip in a flame until it is red-hot.
- Place the tip of the paper clip on the nail and let it melt through.
- Avoid pushing or applying pressure on the paper clip as you could accidentally touch the skin under the nail.
- Reheat the clip as needed, especially for thicker nails.
- Once the hole is complete, blood will escape and relieve the pain.
- Soak the finger in warm, soapy water for 10 minutes, 3 times a day for 2 to 3 days.
After performing the procedure, be sure to watch for signs of infection, such as increased pain, swelling, redness, or warmth around the nail. If the pain does not subside, contact your doctor as you may have a more serious injury.
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When to see a doctor
It is important to know when to see a doctor if you have a subungual haematoma, or blood under your nail. Firstly, you should always see a doctor before attempting to drain blood under your nail. Drainage can be performed quickly and painlessly by a doctor, and you should not attempt to do this at home.
If you have a small subungual haematoma, you may not need to seek medical care. However, if the affected area continues to collect blood, you are in extreme pain, or the injury is at the base of the nail, you should see a doctor. If you have other symptoms such as swelling, an inability to move the finger or toe, or signs of infection, you should also seek medical attention. Signs of infection include increased pain, redness, warmth, red streaks, and pus. If you have broken bones or serious damage to the nail bed or surrounding tissues, you should seek medical attention immediately.
You should see a doctor within 48 hours of the injury, as after this time, the blood will begin to clot, and drainage will be difficult. If you wait too long, your nail may fall off, and it can take 4-6 months for a fingernail and 12-18 months for a toenail to grow back. Nails that grow back may have ridges or other abnormalities.
If you have a darkened area under your nail and haven't had an injury, you should see a doctor to rule out other possible causes.
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Pain relief
Blood under the nail, or subungual haematoma, is a common injury that can be very painful. The pain is caused by the pressure of blood building up under the nail. This pressure can also cause the nail to fall off.
If you are experiencing pain from a subungual haematoma, you should seek medical attention. A doctor or healthcare provider can perform a simple drainage procedure to relieve the pressure and provide pain relief. This procedure can be performed quickly and relatively painlessly in a doctor's office or urgent care centre. It should be done within 48 hours of the injury, as after this time, the blood will start to clot, making it harder to drain. During the procedure, a doctor will administer a digital block (anesthetic) to the affected area. They will then apply gentle pressure to the nail with a heated 18-gauge needle or cautery device to drain the blood. Additional steps may be taken to ensure the continual drainage of blood, such as making the hole 3 to 4 millimetres thick and milking (squeezing) the nail.
After the procedure, you should keep the wound clean and dry while it heals. You may need to elevate the hand or foot. Relief from pain and pressure may be immediate after trephination. Any pain should ease on its own within a few days or right away after drainage.
It is important to note that you should not attempt to drain a subungual haematoma at home. Using home methods such as a heated pin or paper clip to make a hole in the nail may cause infection from bacteria entering the wound. Infections can cause much more damage than the initial injury. Always seek medical attention for proper diagnosis and treatment.
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Healing time
The healing time for a subungual hematoma depends on several factors, including the size of the hematoma and whether or not the nail has fallen off. If the injury is small, it may not need to be drained at all and can heal on its own without much issue. However, if the hematoma is large and causing pain, pressure, or other symptoms, drainage may be necessary for healing.
Drainage of a subungual hematoma is most effective when performed within the first 48 hours after the injury, as the blood begins to clot after this amount of time, making drainage difficult. It is recommended to see a doctor within this time frame to decide on the best course of treatment. The drainage procedure itself is relatively quick and painless and can be performed in a doctor's office or urgent care center.
After drainage, it may take a day or two for the blood to stop oozing from the nail, and the hole should be covered with sterile gauze during this time. It is important to watch for signs of infection, such as increased pain, swelling, redness, or warmth around the nail, and to seek medical attention if these occur.
If the nail falls off due to the injury or is removed as part of treatment, the wound should heal within a few weeks. However, it may take longer for the nail to grow back completely. A new fingernail can regrow in as little as 8 weeks, but it may take up to 6 months for the nail to fully grow back, and even longer if there was damage to the nail bed or surrounding tissues. Toenails may take even longer to regrow, ranging from 12 to 18 months.
In summary, the healing time for a subungual hematoma can vary depending on the severity of the injury and the treatment required. While small injuries may heal on their own within a few months, larger injuries may require drainage and take several months or more for the nail to fully regrow, with proper care and follow-up being crucial throughout the healing process.
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Potential complications
Draining blood from under a nail, also known as trephination, is generally considered a safe procedure when performed correctly and within the first 48 hours of the injury. However, there are still potential complications that individuals should be aware of.
One of the main complications is the risk of infection. If proper sterile techniques are not followed, bacteria can enter the wound, leading to an infection. Infections can often cause more damage than the initial injury and may require medical attention. It is important to watch for signs of infection, such as increased pain, swelling, redness, warmth around the nail, red streaks leading from the nail, or pus draining from the nail.
Another complication is the possibility of incomplete pain relief. Even after successful drainage, the pain and pressure may build up again in a few days. If the pain persists or worsens, it could indicate a more serious underlying injury, and individuals should consult a doctor.
In some cases, there is also a risk of damaging the nail bed or surrounding tissues during the drainage procedure. This could affect the regrowth of the nail, leading to abnormalities in the shape or appearance of the nail. In rare cases, if the nail matrix is damaged, the nail may not grow back at all.
Additionally, there is a small chance that the drainage procedure may not be effective in relieving pain and pressure, especially if the hematoma is large or covers a significant portion of the nail. In such cases, a doctor may recommend alternative treatments, including removing the nail completely.
It is important to note that attempting to drain the blood at home, using methods like a heated paper clip, is not recommended due to the increased risk of infection and accidental injury to the skin under the nail. Individuals should always seek medical advice and, if drainage is required, have it performed by a healthcare professional.
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Frequently asked questions
Subungual hematoma is the medical term for bleeding under a fingernail or toenail, usually caused by a crushing or stubbing injury.
It is recommended to see a doctor within 48 hours of the injury as the blood begins to clot after this time, making drainage difficult.
If left untreated, the blood under your nail may turn dark, and the pressure may cause your nail to come off completely. Small hematomas may heal on their own without any issues.
Doctors may perform a procedure called trephination, which involves creating a small hole in the nail to allow the blood to flow out. This can be done using a heated wire, electrocautery device, carbon laser, or a large-bore needle.
No, it is not recommended to drain blood under your nail at home as it may cause infection. Always seek medical attention and let a professional perform the procedure.
