How is subungual hematoma drainage performed?

Updated: Aug 25, 2020
  • Author: Oliver Mayorga, MD, MS, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Prepare the finger with povidone-iodine solution (Betadine). See the video below.

Preparation of finger.

Using the preferred tool for nail penetration, make a hole at the base of the nail or in the center of the hematoma. This hole must be large enough for the hematoma to drain.

If using an 18-ga needle, twirl the needle between the thumb and index finger with slight downward pressure until no resistance is felt and dark blood return is seen from the hole. See the video below.

Trephination with needle.

If using a paper clip, first heat the end of the paper clip in open flame. Apply the hot tip to the nail until resistance is no longer felt and blood return is seen.

If using a sterile cautery tool, activate cautery until the tip is hot. Apply the tool to the nail as with a heated paper clip.

Allow the hematoma to drain. Gentle squeezing at the tip of the finger may facilitate hematoma drainage.

Apply antibacterial ointment (eg, bacitracin) over the trephination site and dress the wound with gauze or an adhesive bandage. See the video below.

Posttrephination care.

Apply a finger splint for additional comfort. Instruct the patient to avoid soaking the finger and to keep the finger dry for 2 days.

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