A hematoma of the nail bed is relieved by making a hole in the nail (trephination) Restrain the child and digit on a table Cleanse the fingertip with antiseptic solution A high temperature, single use electrocautery pen can be used to melt a hole through the nail This technique is rapid and often less painful than making a hole with other methods ( Fig 130.36A ) If electrocautery is not readily available, options include heating the tip of a paper clip held with a hemostat used in a manner similar to electrocautery or the use of an 18-gauge needle or no 11 scalpel in a rotary motion to bore a hole through the nail Enter perpendicular to the nail in the center of the hematoma If using an 18-gauge needle, apply gentle downward pressure and rotary motion by rolling the hub of the needle back and forth between your fingertips to eventually create a hole in the nail, as shown in Figure 130.36B (needle/scalpel) and Figure 130.36C (heated paper clip) Apply gentle pressure to the nail bed for several minutes after the hole has been made to facilitate drainage, and then cover with a sterile dressing