Management of Finger Splinter in the Emergency Department
Immediate Removal and Wound Care
Remove the entire splinter immediately, followed by thorough wound irrigation with clean water, and apply a clean dressing to prevent infection. 1
Removal Technique Based on Splinter Type
Superficial horizontal splinters:
- Incise the skin over the entire length of the splinter's long axis and lift it out with forceps 2
- These splinters are generally visible on inspection or easily palpated 2
Subungual splinters (under the nail):
- Cut out a V-shaped piece of nail with the point at the proximal tip of the splinter 2
- Grasp and remove the splinter carefully to avoid pushing it deeper into the nail bed 2
Deep or elusive splinters:
- Consider ultrasound using the POCUS waterbath technique for localization 3
- Refer splinters near nerves, tendons, blood vessels, or vital organs for specialist removal 2
Critical Principles
Remove reactive materials (wood, thorns, spines, vegetative matter) immediately before inflammation or infection develops. 2
Post-Removal Wound Management
Irrigation and cleaning:
- Thoroughly irrigate the wound with clean water after splinter removal 1
- Cleaning must always precede any disinfection procedures 4, 5, 6
Dressing application:
- Cover the wound with a clean dressing to prevent contamination 1
Topical antibiotic (optional):
- For patients ≥2 years: apply a small amount of bacitracin (fingertip-sized) 1-3 times daily, may cover with sterile bandage 7
- For children <2 years: consult physician before topical antibiotic use 7
Infection Prevention
Use only sterilized instruments for removal to prevent introducing infection. 1
Critical items that contact sterile tissue (such as surgical instruments used for splinter removal) require sterilization 4, 5, 6
Discharge Instructions and Follow-Up
Monitor for infection signs:
Instruct patients to return immediately if any of these signs develop.
Common Pitfalls to Avoid
- Never use unsterilized instruments as this introduces infection risk 1
- Do not delay removal of wood or vegetative material, as these reactive materials cause rapid inflammation 2
- Avoid pushing subungual splinters deeper during nail manipulation 2
- Do not attempt removal of deep splinters near vital structures without appropriate expertise or imaging guidance 2