Removing a Subungual Splinter in an 8-Year-Old
For a splinter lodged under the fingernail, cut out a V-shaped wedge of nail with the point of the V at the proximal (closest) tip of the splinter, then grasp and remove the splinter with forceps, taking care not to push it deeper into the nail bed. 1
Preparation and Anesthesia
Apply topical anesthetic or perform a digital nerve block before attempting removal, as subungual splinters are particularly painful in children and adequate pain control is essential for cooperation and successful removal. 1
Gather necessary equipment: fine-tipped forceps, small scissors or nail clippers, magnification if available, and good lighting. 1
Removal Technique
Visualize the splinter completely by inspecting the nail to identify the proximal (closest to cuticle) end of the splinter, which is your target for grasping. 1
Cut a V-shaped notch in the nail with the point of the V positioned directly over the proximal tip of the splinter—this exposes the end you need to grasp. 1
Grasp the exposed proximal end with forceps and pull the splinter out along its long axis, being extremely careful not to push it deeper into the nail bed during manipulation. 1
When to Remove Immediately vs. Refer
Remove reactive materials (wood, thorns, vegetative matter) immediately before inflammation or infection develops, as these materials cause significant tissue reaction. 1
Refer to a specialist if the splinter is deeply embedded near important structures (tendons, nerves, blood vessels), cannot be visualized or palpated, or if you are unsuccessful after initial attempt. 1
If the splinter is not easily palpable or visible, consider using ultrasound with a water bath technique to localize it before attempting removal. 2
Critical Pitfalls to Avoid
Never push the splinter deeper during removal attempts—this is the most common complication and makes subsequent removal much more difficult. 1
Do not attempt removal without adequate anesthesia in a child, as pain will cause movement and increase risk of complications. 1
Avoid multiple blind attempts at removal; if unsuccessful on first try with proper visualization, refer rather than causing additional trauma. 1