11740 Evacuation of subungual hematoma

Name of the Procedure:

Evacuation of Subungual Hematoma (Nail Drainage)

Summary:

Evacuation of a subungual hematoma is a procedure that involves draining blood trapped under a fingernail or toenail. This is typically done to relieve pain and pressure caused by the hematoma.

Purpose:

This procedure addresses the condition of a subungual hematoma, which is usually caused by injury or trauma to the nail. The goals are to alleviate pain, prevent nail loss, and reduce the risk of infection.

Indications:

• Severe pain and pressure under the nail due to trapped blood
• Noticeable discoloration (dark red or black) under the nail
• Nail injury resulting from trauma such as heavy object impact or crushing

Preparation:

• No significant preparation is usually required.
• The area should be cleaned.
• Inform the healthcare professional of any allergies, especially to local anesthetics if used.

Procedure Description:

1. Cleaning: The affected finger or toe is cleaned with an antiseptic solution.
2. Anesthesia: Local anesthesia may be applied to numb the area.
3. Drainage: A small hole is made in the nail using a heated needle, cautery device, or a small drill to allow the trapped blood to escape.
4. Aftercare: The area is cleaned and dressed. Antibiotic ointment might be applied to prevent infection.

Duration:

The procedure typically takes about 10-15 minutes.

Setting:

This procedure is usually performed in an outpatient clinic or a doctor’s office.

Personnel:

• General or family physician
• Nurse or medical assistant for support and aftercare

Risks and Complications:

• Infection at the puncture site
• Pain following the procedure
• Nail deformity or loss
• Incomplete drainage requiring additional intervention

Benefits:

• Immediate pain relief
• Reduced pressure under the nail
• Prevention of further nail damage
• Quick recovery time

Recovery:

• Keep the area clean and dry.
• Apply antibiotic ointment and a clean bandage daily.
• Monitor for signs of infection such as increased redness, swelling, or discharge.
• Follow-up appointments if necessary.
• Most patients return to normal activities within a few days.

Alternatives:

• Conservative management with pain relief and watchful waiting.
• Partial or total nail removal in severe or recurrent cases.
• Each alternative approach may carry its own pros and cons, particularly in terms of pain relief speed and recovery time.

Patient Experience:

• The procedure usually causes minimal discomfort if anesthesia is used.
• A brief sensation of pressure or heat may be felt during the drainage.
• Pain and pressure relief are typically immediate post-procedure.
• Mild tenderness and swelling might be present for a few days.
• Over-the-counter pain relievers can be used to manage discomfort.

By providing these details, patients can better understand the procedure, what to expect, and how to prepare and care for themselves before and after the evacuation of a subungual hematoma.