What is the proper treatment for a splinter in the hand?

Treatment of a Splinter in the Hand

Remove the entire splinter immediately, irrigate the wound thoroughly with clean water, and cover with a clean dressing to prevent infection. 1

Immediate Removal Technique

The most effective approach is complete splinter removal as soon as possible, before inflammation or infection develops. 1, 2

For Superficial Horizontal Splinters

• Incise the skin over the entire length of the splinter's long axis to expose it completely 2
• Lift the splinter out using forceps once fully exposed 2
• Ensure the entire splinter is removed in one piece to prevent retained foreign material 1

For Subungual (Under the Nail) Splinters

• Cut a V-shaped piece of nail with the point at the proximal tip of the splinter 2
• Grasp and remove the splinter carefully, avoiding pushing it deeper into the nail bed 2

For Deep or Elusive Splinters

• Consider ultrasound (POCUS waterbath technique) to localize the splinter if not easily visible or palpable 3
• Remove under local anesthesia if needed for patient comfort 3
• Refer splinters near important structures (nerves, tendons, blood vessels) for specialist removal 2

Post-Removal Wound Care

Immediate Cleaning

• Irrigate the wound thoroughly with clean water after splinter removal 1
• This step is critical to prevent infection from any residual contamination 1

Wound Protection

• Apply a clean dressing to cover the wound and prevent further contamination 4, 1
• This reduces infection risk in the open wound 4

Critical Safety Considerations

Avoid These Pitfalls

• Never use unsterilized instruments, as this introduces infection risk 1
• Remove reactive materials (wood, thorns, vegetative matter) immediately before inflammation occurs 2
• Do not delay removal, as retained organic material significantly increases infection risk 2

Monitor for Infection Signs

Watch for these warning signs requiring medical attention:

• Increasing pain 1
• Redness spreading from the wound 1
• Swelling 1
• Warmth around the area 1
• Purulent discharge 1

When to Refer

Refer immediately for specialist removal if: 2

• The splinter is deep and near nerves, tendons, or blood vessels
• Multiple attempts at removal have failed
• The splinter cannot be adequately visualized or localized
• Signs of infection are already present