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Subject: Subungual Hematoma Drainage
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Fine-tipped battery cautery units
Needle, 19 gauge
A suggested surgical tray that can be used for laceration repair is listed in Appendix G
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F
Severe pain with a subungual hematoma after acute traumatic injury
Patient is no longer experiencing pain at rest (after 48 to 72 hours)
Subungual ecchymosis (pain resolves after 30 minutes; only mild bleeding occurs)
Blood collection without trauma (tumors such as glomus tumors, keratoacanthomas, and Kaposi sarcoma may manifest initially as a subungual hematoma)
Subungual band of pigmentation (most likely represents nontraumatic benign or malignant pigmentation)
PITFALL: As the nail plate is traversed, blood may spurt upward as the pressure is released. The provider should wear personal protective gear and make sure he or she is not directly over the device, where the risk of contamination is greatest.
Pearl: Create a hole large enough for continued drainage, which can occur for 1 to 2 days after the injury.
PITFALL: Avoid heating coated paper clips, which can produce a malodorous plume and burns from the molten coating. Avoid copper paper clips, which can melt.
PITFALL: Be careful to stop drilling as soon as blood starts draining to prevent the needle from contacting the nail bed.
Nail deformity (often nail splitting)
Fine-tipped battery cautery units are available from Aaron Medical (high-temperature cautery AA01, http://www.hospitalnetwork.com) or from Advanced Meditech International (thermal cautery CH-HI, about $35 each; phone: 1-800-635-2452; http://www.ameditech.com).