Indications Painful subungual splinter To prevent infection or a foreign-body reaction to a splinter in the nail bed Complications Bleeding Infection Procedure The key to successfully completing this procedure is adequate anesthesia With all but the most superficial splinters/foreign bodies, a digital block should be performed to achieve anesthesia Restrain the child’s hand with the fingers extended ( Fig 130.40 A) If the splinter end is visible, it may be possible to pull it out directly with tweezers or a hemostat Otherwise, scissors can be inserted and spread under the distal tip of the nail to lift the nail from the bed allowing for improved access to the splinter/foreign body, or a no 11 scalpel blade can be used to scrape the nail down to the nail bed to uncover enough of the splinter/foreign body to remove it The latter technique is likely to be associated with less pain after the anesthetic wears off Hold the blade perpendicular to the direction of the splinter and at 90 degrees from the horizontal, as in Figure 130.40B Scrape the nail off in a proximal to distal fashion, applying pressure gently to minimize discomfort from squeezing the nail onto the splinter The shape of the nail removed is similar to that of a “U.” With small tweezers or forceps, grasp the splinter/foreign body once it is exposed and tug it gently to remove it from the nail bed ( Fig 130.40C ) Irrigate the area with sterile saline after removal and dress with antibiotic ointment and a bandage FIGURE 130.40 Removal of a subungual splinter or foreign body Large splinters or those embedded deeply under the nail are best removed by excision of a portion of the nail after a digital block