What are the steps to remove a splinter under a fingernail?

Steps to Remove a Splinter Under a Fingernail

The most effective approach to remove a splinter under a fingernail is to cut a V-shaped piece of the nail with the point of the V at the proximal tip of the splinter, then grasp and remove the splinter with forceps, taking care not to push it further into the nail bed. 1

Preparation

• Perform proper hand hygiene by washing hands with warm water and antimicrobial soap for at least 15 seconds, covering all surfaces of hands and fingers 2
• Dry hands with a disposable towel and use the towel to turn off the faucet 2
• Wear gloves if there is potential contact with blood or body fluids 2

Removal Procedure

1. For subungual splinters (under the nail):

   • Administer local anesthesia for pain control before the procedure 3
   • Cut out a V-shaped piece of the nail with the point of the V at the proximal tip of the splinter 1
   • Grasp the exposed splinter with forceps and remove it, being careful not to push it further into the nail bed 1

2. For superficial horizontal splinters:

   • Expose the splinter completely by incising the skin over the length of the long axis of the splinter 1
   • Lift the splinter out with forceps 1

3. For difficult-to-locate splinters:

   • Consider using imaging modalities like ultrasound (POCUS waterbath-technique) to locate elusive splinters 4
   • Once located, remove under local anesthesia 4

Post-Removal Care

• Clean the area thoroughly after splinter removal 3
• Perform antiseptic soaks with dilute vinegar (50:50 dilution) or 2% povidone-iodine for 10-15 minutes twice daily to prevent infection 5
• Apply mid to high potency topical steroid ointment to nail folds twice daily if inflammation is present 5
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge) 5
• If infection is suspected, obtain cultures and initiate appropriate antibiotics with coverage against Staphylococcus aureus 3

Special Considerations

• Deeper splinters near important structures (nerves, tendons, blood vessels) should be referred for specialist removal 1
• Reactive materials like wood, thorns, and vegetative material should be removed immediately before inflammation or infection occurs 1
• Regular nail trimming may be necessary until the nail plate grows reattached 3
• Watch for granulation tissue formation, which may require silver nitrate application 3

When to Seek Professional Help

• If the splinter is deeply embedded or near important anatomical structures 1
• If signs of infection develop (increasing pain, redness, swelling, purulent drainage) 3
• If you're unable to remove the entire splinter 4
• If the patient experiences persistent pain after attempted removal 5