How to remove a splinter from under a fingernail?

How to Remove a Wood Splinter from Under the Fingernail

To remove a wood splinter from under the fingernail, first soak the affected finger in warm water to soften the nail, then expose the splinter by cutting a V-shaped piece of the nail with the point of the V at the proximal tip of the splinter, and carefully remove the splinter with sterile tweezers without pushing it further into the nail bed. 1

Initial Assessment and Preparation

• Assess the location and depth of the splinter under the fingernail to determine the appropriate removal technique 1
• Thoroughly wash hands with soap and water to minimize infection risk 2
• Prepare the following materials:
  • Clean tweezers or forceps
  • Small scissors or nail clippers
  • Antiseptic solution (povidone-iodine or diluted vinegar)
  • Local anesthetic (if available and needed)
  • Good lighting source 1, 2

Step-by-Step Removal Technique

For Visible Superficial Splinters:

• Soak the affected finger in warm water with antiseptic solution (50:50 diluted vinegar or 2% povidone-iodine) for 10-15 minutes to soften the nail 2
• For a subungual splinter (under the nail):
  • Cut a V-shaped notch in the nail with the point of the V directly over the proximal end of the splinter 1
  • This exposes the splinter for easier grasping with tweezers 1
  • Take particular care not to push the splinter further into the nail bed during removal 1

For Deeper or Difficult-to-See Splinters:

• Consider using the POCUS (Point-of-Care Ultrasound) waterbath technique to locate the splinter if it's not easily visible 3
• For deeper splinters near important structures (nerves, blood vessels, tendons), seek professional medical assistance 1

Post-Removal Care

• After successful removal, clean the area thoroughly with antiseptic solution 2
• Apply antiseptic ointment and cover with a clean bandage if there is any break in the skin 2
• Continue daily antiseptic soaks for 2-3 days if there was significant trauma to the nail or surrounding tissue 2
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge) which would require medical attention 2, 4

When to Seek Medical Help

• If the splinter is deeply embedded and not easily accessible 1
• If the splinter is near important structures like nerves or blood vessels 1
• If signs of infection develop after attempted removal 2, 4
• If the splinter cannot be completely removed 1
• If the splinter is reactive material (certain types of wood or plant material) and has been embedded for some time 1

Prevention of Complications

• Avoid manipulating the nail folds or cuticles during the healing process 2
• Keep the affected area clean and dry 2
• Wear protective gloves when working with wood or other materials that could cause splinters 2
• Regular trimming of nails, ensuring they are cut straight across and not too short, can prevent future injuries 2

Wood splinters should be removed promptly to prevent inflammation or infection, particularly as wood is a reactive material that can cause significant tissue reaction if left in place 1.