From the Research
To drain a subungual hematoma, the most effective method is to use a sterile 18-gauge needle, electrocautery device, or handheld cautery pen heated until red-hot to create a small hole through the nail plate directly over the hematoma, as this approach has been shown to provide immediate pain relief and prevent potential complications, as reported in a recent case study 1. The procedure for draining a subungual hematoma involves several key steps:
- Cleaning the affected nail with antiseptic solution such as povidone-iodine or alcohol
- Using a sterile instrument to create a small hole through the nail plate directly over the hematoma
- Applying gentle pressure to facilitate blood drainage
- Applying antibiotic ointment like bacitracin or polysporin and covering with a sterile bandage after the procedure This approach is supported by the most recent and highest quality study available, which highlights the importance of prompt and effective treatment to prevent prolonged pain, potential nail loss, and possible infection 1. The indications for draining a subungual hematoma include:
- Hematoma covering more than 25-50% of the nail
- Significant pain
- Recent trauma (within 48 hours) It is essential to note that no anesthesia is typically required, as the nail plate lacks nerve endings, although the underlying nail bed is sensitive 2. After the procedure, patients should keep the area clean and dry for 48 hours and watch for signs of infection, such as increasing pain, redness, or purulent drainage, as reported in previous studies 3, 4.