Sophia Delgado
Blood under the nail, also known as a subungual hematoma, is a common injury that occurs when blood vessels under the nail break and blood pools underneath. This can cause throbbing pain and pressure. While small hematomas may heal without treatment, larger hematomas may require a procedure called nail trephination to drain the blood and relieve pain and pressure. This involves making a small hole in the nail to allow the blood to flow out. This procedure is generally safe and can be performed quickly in a doctor's office or urgent care center.
| Characteristics | Values |
|---|---|
| Procedure Name | Trephination |
| Who Can Perform It? | A healthcare provider or doctor |
| When to Perform It? | Within the first 48 hours after injury; when the hematoma causes pain or makes up 50% or more of the nail |
| What Does It Involve? | Making a small hole in the nail with a needle, electrocautery device, or a specialized tool; applying gentle pressure to the nail; ensuring the hole is 3 to 4 millimeters thick; milking the nail to help blood flow out; bandaging the area |
| Risks | Infection; further injury to the nail bed |
| Aftercare | Keep the area dry and clean; keep the affected area bandaged and elevated; use cold compresses during the first 12 hours |
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What You'll Learn
Trephination: a quick procedure to drain blood from under the nail
Blood pooling under the nail is called a subungual haematoma. This usually occurs when the nail gets crushed in an injury, causing blood vessels to break and blood to collect under the nail. Symptoms include severe pain and throbbing due to the pressure of the blood collecting between the nail and the nail bed.
Trephination is a quick and common procedure to drain blood from under the nail. It is performed by a healthcare provider in a variety of settings, including emergency rooms and urgent care clinics. The procedure involves the following steps:
- The nail and the surrounding area are cleaned with soap and water to remove any dirt or debris. A wound-cleansing solution, such as chlorhexidine, is then applied.
- A small hole is made in the hard part of the nail (nail plate) using a needle, an electrocautery device, or a special tool designed for trephination. The device is positioned over the middle of the bruise and gentle pressure is applied to create a hole just deep enough to release blood. The hole is typically 3 to 4 millimetres thick to allow for continuous drainage.
- The collected blood drains out of the hole. Additional holes may be necessary for large haematomas.
- The nail may be "milked" or squeezed to help the blood flow out.
- The wound is then covered with a dry bandage or dressing, and the patient is instructed to keep the area clean and dry while it heals.
Trephination is a safe and effective way to relieve pain and pressure caused by a subungual haematoma. It rarely leads to complications, but there is a small risk of infection or minor injury to the nail bed. Most patients experience immediate relief after the procedure.
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Administering a digital block to numb pain
A subungual hematoma is the medical term for blood pooling under the nail bed's surface, usually caused by a crushing or stubbing injury. The blood may turn dark over time, and the pressure may cause the nail to come off. To relieve the pain and pressure, a doctor may recommend draining the hematoma. This procedure, called trephination, involves making a small hole in the nail to allow the blood to flow out. Drainage can be performed quickly and relatively painlessly.
Before performing trephination, doctors may administer a digital block to numb pain. A digital block is a simple procedure that provides immediate anaesthesia for injuries and procedures affecting the fingers and toes. It is one of the most commonly performed nerve blocks in primary care and emergency departments due to its efficacy and wide variety of uses. It is also considered superior to local anaesthetic injections for digital injuries as it has a rapid anaesthetic effect, decreased risk of direct trauma to blood vessels and nerves, and requires a lower volume of anaesthetic solution.
To administer a digital block, the patient's hand is placed on a sterile field with the palm down. The syringe is held perpendicular to the digit, and the needle is inserted into the web space, just distal to the metacarpophalangeal (MP) joint. The anaesthetic is slowly injected into the dorsal aspect of the web space, and the needle is slowly advanced toward the volar aspect, infiltrating the surrounding tissues. The needle should not pierce the volar aspect of the web space. The procedure can be repeated on the other web space of the involved digit.
When only the distal part of the digit is involved, such as in a nail injury, a wing block procedure can be used instead of a digital block. The extremity is positioned with the volar/plantar side down. The needle is held perpendicular to the long axis of the digit and at a 45-degree angle to the plane of the sterile field. The needle is inserted 3 mm proximal to an imaginary point where the linear extension of the lateral and proximal nail folds would intersect. The anaesthetic is injected along the proximal nail fold, and the needle is slowly withdrawn and redirected toward the lateral nail fold. This step may be repeated on the opposite side of the nail if necessary.
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Draining blood using a heated needle or cautery device
Draining blood from under a nail, also known as trephination, is a procedure that should be performed by a doctor or healthcare professional. It involves creating a small hole in the nail to allow the blood to flow out and relieve the pain and pressure caused by the buildup of blood, known as a subungual hematoma.
Trephination should be performed within the first 48 hours of the injury, as the blood begins to clot after this time, making drainage difficult. It is important to note that small hematomas may not require drainage at all, and a doctor should be consulted before making any decisions regarding treatment.
One method of trephination involves using a heated needle or cautery device to drain the blood. Here is a step-by-step guide to the procedure:
- Administer a digital block, which is a form of pain relief or anesthetic. This step may be skipped if the injury is not causing pain.
- Apply gentle pressure to the nail with a heated 18-gauge needle or cautery device. A "pop" sound may be heard when the needle reaches the blood under the nail.
- Ensure that the hole created by the needle is 3 to 4 millimeters thick to allow for continuous drainage. Additional holes may be necessary for large hematomas.
- Milk or squeeze the nail to help the blood flow out of the hole. Then elevate the affected hand or foot.
- Cover the area with a dry bandage or dressing, and keep the wound clean and dry while it heals.
It is important to note that attempting to drain a hematoma at home using non-sterile methods, such as a heated paper clip, can cause infection. Infections can often cause more damage than the initial injury. Therefore, it is recommended to seek medical help for trephination.
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Covering the nail with a dry bandage
The bandage should be applied immediately after the trephination procedure to protect the wound and keep it clean and dry while it heals. It is important to follow your doctor's instructions for changing the bandage. The wound should be kept elevated to reduce swelling and promote healing.
In the first 12 hours after the procedure, you may also need to use cold compresses to reduce pain and swelling. In some cases, your doctor may recommend that you use a splint for up to 3 days until the tenderness subsides.
It is important to note that nail trephination should only be performed by a healthcare professional. Attempting to drain the hematoma at home can lead to infection or further injury to the nail bed.
Overall, covering the nail with a dry bandage is an important step in the aftercare for nail trephination, helping to protect the wound and promote healing.
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Potential complications: infection and nail bed injury
Blood under the nail, also known as a subungual haematoma, is usually caused by a crushing or stubbing injury. The injury causes blood vessels in the nail bed to leak, which builds up underneath the nail plate, causing pain and discoloration.
Infection is a potential complication of a subungual haematoma. Bacterial infections can develop in the injured area, especially if the injury is severe or involves bone damage. Signs of infection include red or discolored skin around the nail, swelling, pus, and fever. If an infection is suspected, it is important to seek medical attention immediately.
Nail bed injury can also occur as a complication of a subungual haematoma. The pressure from the pooled blood can cause the nail plate to separate from the nail bed, resulting in nail loss. This is more likely to occur if there is damage to the nail matrix, which is the area responsible for nail regrowth. In some cases, the nail may not grow back, or it may grow back with a different shape or abnormalities.
To reduce the risk of infection and nail bed injury, it is important to seek medical attention within 48 hours of the injury. After this time, the blood begins to clot, making drainage more difficult. Drainage of the haematoma can be performed by a healthcare professional using a heated needle, cautery device, or laser to create a small hole in the nail for the blood to drain. This procedure, known as trephination, is typically performed under local anesthesia to minimize pain.
Following the procedure, it is important to keep the area clean and dry, and to follow the healthcare provider's instructions for changing bandages and caring for the affected area. Most subungual haematomas heal well without any lasting effects, but it is always advisable to monitor the area for any signs of infection or other complications.
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Frequently asked questions
A subungual hematoma is when blood pools under the nail bed's surface, usually caused by a crushing or stubbing injury.
The procedure to remove blood from under the nail is called trephination. It involves making a small hole in the nail to allow the blood to flow out and relieve the pressure and pain.
Trephination is a quick, outpatient procedure that can be performed in a doctor's office, urgent care center, or emergency room.
Yes, there is a small risk of infection or further injury to the nail bed. It is important to keep the area clean and dry while it heals and follow the doctor's instructions for changing bandages.
