How to drain a finger paronychia

Improve your in-clinic patient care with this article on draining a finger paronychia, a common finger infection.

Siamak Moayedi, MD

3m read

Editors:Shelley Jacobs, PhD

Peer reviewers:Franz Wiesbauer, MD MPH Internist

Last update19th Nov 2020

What is a finger paronychia?

A paronychia is an infection of the nail root of the fingers or toes. It’s a very common infection and is caused by the introduction of bacteria under the cuticle. This is often from people chewing or ripping a hangnail with their teeth, and is also seen in barbers.

In a wound culture, Staphylococcus is the most common bacteria. But, you can have any kind of bacteria (such as anaerobes) from the mouth.

Physical signs of a finger paronychia

Patients usually seek help after a few days of increasing swelling and pain at the base of a nail. The area is sensitive and pressure from the building pus is painful.

If the infection continues, it can extend to the pulp of the finger and cause a felon, or deep tissue abscess. This requires aggressive procedures and can even lead to loss of function or amputation.

Figure 1. Physical signs of a finger paronychia include swelling at the base of the nail, sensitivity to touch, pain, and pressure from pus build-up. A deep tissue abscess, or felon, can develop if the infection continues.

How do you treat paronychia?

If the infection is caught early when the nail base is a little swollen and red, you can prescribe frequent warm soaks (at least once every two hours), and a short course of antibiotics (e.g., cephalexin). An established infection and pus collection require incision and drainage.

Figure 2. Early paronychia infections can be treated with frequent warm soaks and antibiotics. Established infections require incision and drainage.

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The tools you need to drain a finger paronychia

The first step when performing the incision and drainage technique is to collect the necessary medication and tools:

• Sterilizing solution
• Ice water
• #11 scalpel

Figure 3. Tools for a finger paronychia include sterilizing solution, ice water, and #11 scalpel.

How to drain a finger paronychia

This step-by-step procedure ensures a safe, clean, and (relatively) painless abscess drainage:

1. Place the patient’s finger in a cup of ice water until they can’t stand it anymore to numb the finger. This method is fast, painless, and softens the cuticle. Alternatively, you can perform a digital nerve block.
2. When the finger is numb, clean the cuticle with the sterilizing solution.
3. Stab under the skin parallel to the nail, using your #11 blade.
4. You will immediately see pus come out.

Figure 4. Procedure for draining a finger paronychia. 1) Numb the finger with ice water or a digital nerve block. 2) Clean the cuticle with sterilizing solution. 3) Stab under the skin parallel to the nail with the #11 blade. 4) Pus will escape from the incision.

Post-procedure care for a finger paronychia

Have your patient soak their finger in warm water every two hours for the next two days. Antibiotics are not needed for minor cases of paronychia, but use your judgment depending on the patient’s risk factors.

Figure 5. After draining a finger paronychia, instruct your patient to soak their finger in warm water every two hours for the next two days.

Excellent job! You’re well on your way to mastering the treatment of a finger paronychia.

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Siamak Moayedi, MD

Associate Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.

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How to Drain a Pus-Filled Finger

By : NCampos on : January 8, 2021 comments : (Comments Off on How to Drain a Pus-Filled Finger)

So here’s a new one for me: I woke up yesterday morning with a very sore ring fingernail on my left hand. I felt it as I staggered to the bathroom still ninety percent asleep. I bumped my hand against the wall, “Ow!” What the heck? I rubbed the edge of the nail a few times as I multitasked at the toilet. It really hurt, but I was still sleeping so I stopped paying attention and went back to bed. I woke up and it was even sorer than before. I must have been bitten by a spider, that’s what I actually thought, because I live amongst many, and they have been at war with me and my kids for the last few years (I still like to think I am winning). My finger had that burning feeling, the same way a spider bite feels, itchy and hot. By afternoon, I could barely touch the fingertip or nail. It hurt particularly badly by the thumb-side cuticle. I tried to play guitar; I could barely press down on the frets.

I thought, “That’s it.” I must have cut my finger and the guitar strings have enough migrated skin bacteria that it got into my wound, which I didn’t actually see, but since I was making stuff up… Anyway, I decided to look it up: Are infections common in guitar players? Blam! Up come articles and posting boards all about infected guitar-finger; many had pictures. Yup that looks just like my finger does, so I started reading. All the rocker-posters said the same thing, “I get these often and repeatedly.” Interestingly, I have never gotten an infected finger from playing guitar. I couldn’t even recognize the type of pain I had originally thought was a spider bite. It was that unfamiliar to me, but I guessed that’s what it had to be because I had no recollection of cutting myself and that was the only way I could fathom I had an infection.

An infected finger close to the nail is called a paronychia. The symptoms are a red, swollen, hot finger – pain to the touch. And there can be pus. I had pus. Upon reading the causes of paronychia, it hit me – I had a hangnail on that finger exactly where it hurt most, which I chewed off. It hurt as a hangnail, it hurt when I yanked it off with my teeth, and it hurt for several days afterward. But then the pain went away for several days. It was only when I bumped my hand into the wall on my way to the bathroom did I have pain again in that finger, and boy was it a doozy.

I tried some of the home remedies I found on the web. First was soak in warm water. It had me thinking, “Horsesh*t,” because I do not equate heat with inflammation relief. But to my surprise, it gave me minimal relief. Very minimal, mind you, but it was something. Then I cleaned it with alcohol (reasonable enough), and put Neosporin (not a huge fan but have some lying about) around the infected cuticle. I took ibuprofen. My finger pain eased substantially, and my hope was that maybe (just maybe) the finger would feel better in the morning.

It didn’t. In fact, it hurt even worse the next day. I couldn’t even put my hand in my pocket without wincing. I contacted my surgeon friend thinking I might need antibiotics. He told me to pop by and he could check it out, probably drain it.

Okay, I was happy to take care of my finger right away. I always say we don’t realize how much we use a body part until we have an injury, then we are reminded how much each body part is integral to our sensing and acting within the world. I went for an adjustment first, because I also had a bit of back pain and sciatica, but that’s another story. After my adjustment, I was feeling fine, I headed over to my friend’s place in West Hollywood. It was pretty obvious at this point it was infected. The pus-filled cuticle was expanding and my finger was red and hard. He took a lance and opened it from the top of the infected cuticle. I didn’t feel a thing, nada. Then he put down the lance and took my ring finger with his right hand and used the left to squeeze out the pus. This I felt – it wasn’t pleasant, but seeing the pus ooze out made it less painful in some way. There was an ample amount of pus, not loads, but maybe the size of a ladybug. However, when there was no more to come out, the squeezing hurt. The finger was so swollen that he had to sort of work the entire area, sort of knead it toward the lanced opening. Once that clear fluid (exudate) started to squeeze out, I knew he had gotten everything. And then, of course, it is followed by blood. A quick cleanup and a bandage with a little antibiotic salve, and voilà, my finger felt better and was now on the mend. No antibiotics needed.

This is what it looks like as I write this. Today I have no pain whatsoever in the finger tip, so I was able to play the guitar. I am typing freely now, while the previous night I still had to improvise. There is still a moderately red band around the joint just beneath the cuticle, and the side which was pus-filled, where the original hangnail was, is still a bit sore. However, my friend told me it would be likely cleared up in a few days. Bravo!

It is amazing to me how one hangnail could have such a huge impact, but it’s a good reminder for me (and you!) to not use our mouths to chew on nails, fingers, hangnails, whatever. The bacteria in our saliva do not belong in our wounds. Further, once you open a wound, even with something as small as a hangnail, anything really can infect it, even your own hands, so practice diligent hygiene. I am not suggesting to be a germophobe, but wounds of every sort warrant a little extra caution, that’s just a fact of life. So if you find yourself with a paronychia, from a cut, hangnail, or chomping at your fingernails, you will need it drained. If you can do it yourself with a sterile lance, have at it. But be clean above all – alcohol, antibacterial salve (Neosporin), and a bandage – and you can probably correct the problem yourself. Just be certain if it doesn’t get significantly better almost immediately (like 24 hrs), go to an Urgent Care. If it gets worse, go to the emergency room (ER) immediately.

Caring for Your Jackson-Pratt Drain

This information will help you learn how to care for your Jackson-Pratt Drain after you leave the hospital. You will also benefit from watching the following video.

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About the Jackson-Pratt Drain System

Figure 1. Jackson-Pratt Drain System

The Jackson-Pratt Drain System consists of a flexible tube attached to a soft plastic vessel with a stopper (see Figure 1). The drainage end of the tube (flat white part) is inserted into the surgical field through the insertion site. The insertion site is a small opening next to the incision.

The drain end of the tube is secured with suture material. The rest of the tube protrudes from your body and is attached to a vessel.

When you compress (squeeze) a vessel with a closed stopper, a uniform, low suction pressure is created. The vessel should always be in a compressed state, in addition to the moment when you empty the drain.

It is not the same for everyone. Some people have a large amount of fluid released through the drain, some do not. Record the amount of fluid released in the drainage log at the end of this resource. Bring the journal to your doctor’s appointments for follow-up.

The length of time you use your Jackson-Pratt drain depends on your surgery and the amount of fluid coming out of the drain. Call your healthcare provider if the amount of fluid coming out of the drain does not exceed 30 milliliters (mL) in 24 hours. Your surgeon may remove the Jackson-Pratt drainage system or leave it on for a longer period for certain procedures

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How to Maintain Your Jackson-Pratt 9 Drain System0005

After you leave the hospital, you will care for your Jackson-Pratt drainage system as follows:

• clean the tube by squeezing it to remove clots;
• empty the drainage system twice a day – once in the morning and once in the evening. Record the amount of fluid released through the drain in the Jackson-Pratt Drainage Log at the end of this resource. If there are multiple drains, measure and record the amount of fluid for each one separately. Do not summarize readings.
• take care of the place where the tube is inserted into the skin;
• check for problems.

Clean tubing

The following steps will help clear clots from the tubing and restore flow through the drain system. Clean the tubing before emptying the system and measuring the amount of fluid being released. Also, clean the tubing if you notice fluid leaking around the insertion site.

Prepare everything you need before starting. You will need:

• measuring container given to you by a nurse;
• 1 alcohol wipe;
• Jackson-Pratt Drainage Journal, pen or pencil.

1. Wash your hands. If you wash your hands with soap, wet them and lather. Rub your hands together for 20 seconds, then rinse off the soap. Dry your hands with a disposable towel. Turn off the faucet with the same towel.
   If using an alcohol-based hand rub, apply it to your hands. Then rub your hands together until they are dry.

2. Look at the tube in the mirror. This will help you figure out where your hands should be.
3. Pinch the tube between the thumb and forefinger of one hand as close as possible to the insertion site. To make it easier for your fingers to slide through the tube, you can use alcohol wipes. Continue to hold the tube in this manner while cleaning it. This ensures that you do not pull on the skin causing pain.
4. With the thumb and forefinger of the other hand, squeeze the tube directly under the fingers of the first hand. Continuing to squeeze your fingers, slide them down the tube, moving the clots towards the vessel.

Repeat steps 3 and 4 as many times as necessary to allow clots to drain from the tube into the vessel. If the clots cannot be drained into the vessel, or if there is little or no fluid coming out, tell your healthcare provider.

Emptying the Jackson-Pratt Drain

Once all the clots are in the vessel, it can be emptied. Prepare a clean work surface. You can use the bathroom or other room where there is a dry, uncluttered surface.

First, remove the drainage vessel from the postoperative bra or bandage, if you are wearing them.

When emptying the Jackson-Pratt drain system, follow the instructions below:

Figure 2 Emptying the Vessel

1. Remove the stopper from the top of the vessel. Due to this, the vessel will straighten. Do not touch the inside of the stopper or the inside of the vessel opening.

2. Turn the vessel upside down and squeeze it slightly. Pour the liquid into a measuring container (see figure 2).

3. Turn the vessel with the correct hole up. Squeeze the vessel so that the fingers of your hand touch the palm of your hand. All air must come out of the vessel.
4. Continuing to squeeze the vessel, insert the cork into place. Make sure the vessel remains fully compressed to ensure even low suction. For the drainage system to work, the plug must be closed.
5. Attach the drainage vessel to your postoperative bra or bandage if you are wearing one. Use a plastic loop or Velcro®. Do not let the drainage system hang freely. You may find it convenient to carry your drainage system in a fanny pack or pouch.
6. Check the amount and color of the liquid in the measuring container. In the first couple of days after surgery, the liquid may have a dark red tint. This is fine. As the wound heals, the fluid may turn pink or pale yellow.
7. Record the amount (in ml) and color of fluid coming out of the drain in the Jackson-Pratt Drain Log.
8. Flush the liquid down the toilet and rinse the measuring container with water.
9. At the end of each day, calculate the total amount of fluid excreted during the day. Record the amount of fluid in the last column of the drainage log. If there is more than 1 drainage system, take measurements and keep records for each one separately. Do not summarize readings.

How to care for the injection site

Watch for signs of infection

Wash your hands again after emptying the drainage system. Examine the area around the insertion site for signs of infection, such as:

• sensitivity;
• edema;
• discharge of pus;
• temperature increase;
• more pronounced than usual redness. Sometimes a dime-sized redness develops at the insertion site of the drain. This is fine.

If you have any of these signs or symptoms, or if you have a temperature of 101°F (38.3°C) or higher, call your healthcare provider. He may advise you to apply a bandage to the insertion site.

Keep the skin around the drain site clean and dry

Keep the drain site clean and dry by washing with soap and water, then pat dry with a towel.

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Common Drainage Problems Jackson-Pratt

The first time, a nurse will watch you empty your drain to make sure you’re doing it right. Once you learn how to care for a Jackson-Pratt drainage system, you will be doing it yourself. Even after you start taking care of the system yourself, you can always ask for help. Call your healthcare provider if you have problems caring for your Jackson-Pratt drainage system.

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How to care for your skin after the drain is removed

Your healthcare provider will remove the drain and cover the insertion site with a bandage. It is important to keep the injection site and adjacent skin clean and dry. This will speed up the healing process and help prevent infection.

If you have undergone reconstructive surgery, skin care after the removal of the drainage system will be different.

Skin care in cases where reconstructive surgery has not been performed

If you had surgery without reconstruction, after removing the drainage system, follow these recommendations:

• Remove the bandage after 24 hours.

• The incision site should not be wetted until it is completely healed and the drainage system is removed. After removing the bandage, you can take a shower, but do not take a bath or swim in the pool.

• Wash the incision site gently with soap and water, rinse with warm water, and pat dry with a towel.
• Examine the incision site, use a mirror if necessary. It is considered normal if you experience:
  • slight redness;
  • mild swelling;
  • sensitivity;
  • a small amount of clear or bloody liquid on a gauze swab.

Skin Care After Reconstructive Surgery

If you have undergone reconstructive surgery, follow these guidelines after removing the drainage system.

• Change dressings every 12 hours if necessary.
• Your surgeon will tell you when you can shower after the drain has been removed.

• • Do not wet the incision site for 4-6 weeks after reconstructive surgery. Do not take a bath or swim in the pool. For more information, watch the video How to Maintain Your Jackson-Pratt Drainage System.
• Wash the area gently with soap and rinse with warm water. Pat dry with a towel.
• Examine the incision site, use a mirror if necessary. It is considered normal if you experience:
  • slight redness;
  • mild swelling;
  • sensitivity;
  • a small amount of clear or bloody liquid on a gauze swab.

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When to call your health care provider

Call your health care provider right away if you have:

• secreted bright red liquid;
• body temperature 101°F (38.3°C) or higher;
• at the injection site of the drainage, redness, sensitivity, swelling, a feeling of pressure increase, or pus is released;
• the skin around the surgical site is hot to the touch;
• you cannot remove the clot into the vessel or the amount of fluid secreted is negligible or it is absent.

Call your healthcare provider Monday through Friday from 9:00 to 17:00 if:

• the amount of fluid released through the drain suddenly decreased or increased by 100 ml in the last 24 hours;
• the amount of fluid released through the drainage does not exceed 30 milliliters (ml) in 24 hours;
• the tube falls out of the insertion site;
• you cannot shrink the vessel;
• Are you having trouble maintaining your Jackson-Pratt drainage system?

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Total anomalous pulmonary venous drainage

The word “anomalous” means “wrong”. With this defect, the pulmonary veins (and there are four of them), which should flow into the left atrium , do not flow into it, i.e. do not connect with him. There are a lot of options for their wrong confluence.

There is a “partial” anomalous drainage – this is when one or two of the four veins flow into the right atrium (the most common variant), and in the vast majority of cases it is combined with atrial septal defects, and we talked about this in the chapter on ASD.

Total or total anomalous pulmonary venous drainage (TAPD) is different. With this defect, all four pulmonary veins from both lungs are connected into one wide vessel-collector. This collector of arterial blood oxidized in the lungs does not fuse with the left atrium, as it should, but connects to the body’s venous system, usually through a large vein. Arterial blood, thus, bypassing the heart, enters the large veins and into the right atrium. Only here, having passed through the defect of the interatrial septum, it will be where it should be initially – in the left atrium, and then it makes the usual path through the systemic circulation. It’s hard to imagine what it could be like at all. But children with this defect are born full-term, and the heart copes with such a situation for some time. However, this time can be very short.

Firstly, the life of a child depends on the size of the interatrial communication – the smaller it is, the more difficult it is for the arterial blood to reach its destination in the left half of the heart.

Secondly, in this left half of the heart, a significant part of the blood is simply venous, i.e. unoxidized, and it will again be forced into a large circle. In a child, thus, partially venous blood begins to circulate in the arteries, and he becomes “blue”, i.e. the color of the skin, and especially the tips of the fingers and mucous membranes (lips, mouth) is cyanotic. This is cyanosis, and we will talk about its causes, manifestations and consequences later.

With complete anomalous drainage, cyanosis may not be very pronounced, but it is present and is usually noticeable shortly after birth.

In most cases, the condition of children with complete anomalous pulmonary venous drainage is “critical” from the very beginning of life. If nothing is done, they will die in a few days or months.

Surgical treatment exists, and the results today are quite encouraging. The operation is quite complicated, it is performed on the open heart and consists in the fact that the common pulmonary vein collector is sutured to the left atrium, and the hole in the atrial septum is closed with a patch. Thus, after the operation, normal blood circulation is restored in two separated circles.

Sometimes an emergency option is also acceptable – the expansion of the defect during probing as the first, life-saving stage, which allows you to somewhat delay the main intervention.

We will not touch here on many details related to various types of vice and methods of correcting it. But we only want to emphasize that children with this defect need immediate specialized assistance, which is absolutely real today.

The long-term results of the operation are quite good, because the main defect has been eliminated. However, children should be under the supervision of cardiologists because complications are possible in the form of rhythm disturbances or narrowing of the pulmonary veins at the sites of suturing (this is due to the fact that the heart that has undergone such a major operation continues to grow). And again we want to emphasize: this child is not disabled. He must lead an absolutely normal life, and the sooner the operation is done, the sooner everything will be forgotten.