Subungual Hematoma Drainage

1.Prepare the finger with Betadine

2.Using the preferred tool for nail penetration, make a hole at the base of the nail or in the center of the hematoma. This hole must be large enough for the hematoma to drain.

3.If using an 18-ga needle, twirl the needle between the thumb and index finger with slight downward pressure until no resistance is felt and dark blood return is seen from the hole.

4.If using a paper clip, first heat the end of the paper clip in open flame to sterilize it. Apply the hot tip to the nail until resistance is no longer felt and blood return is seen.

If using a sterile cautery tool, activate cautery until the tip is hot. Apply the tool to the nail as with a heated paper clip.

5.Allow the hematoma to drain. Gentle squeezing at the tip of the finger may facilitate hematoma drainage.


6.Apply antibacterial ointment (eg, bacitracin) over the trephination site and dress the wound with gauze or an adhesive bandage.


Pearls
1.When appropriate, take a radiograph of the finger to rule out an underlying fracture that may require splinting.

2.Always check for the presence of an associated extensor tendon injury.

3.Hematomas that are larger than 50% of the nail do not necessarily require nail removal and exploration.

4.The nail may fall off during the week following hematoma drainage but should regrow as long as the germinal matrix is intact.

5.Multiple holes may be necessary to facilitate adequate drainage.
Drainage of the subungual hematoma does not accelerate healing or prevent infection.
If the heat of an electrocautery device is painful for the patient (which is not typical), an 18-ga needle should instead be used for trephination.

Source:http://emedicine.medscape.com/article/82926-overview#a15