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How To Drain Your Subungual Hematoma (blood pocket under finger-nail) with a Drill Bit

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Picture of How To Drain Your Subungual Hematoma  (blood pocket under finger-nail) with a Drill Bit
Have you ever smashed your finger in something and immediately get a black finger nail?  Well along with that sweet Hot Topic look comes a throbbing pain that, even for those with high pain thresholds, can be unbearable. It's hard to even sleep with this kind of pain! So, the best thing to do is drain the blood pocket under the nail and relieve the pressure build-up.

Some use the heated pin method. But that can lead to a little more pain than necessary. Also, there is hardly any pain associated with the drill bit method except for the slight pressure you are applying. Fingernails don't have nerve endings, and by moving very slowly with a drill bit, you can reach the blood pocket without touching your nail bed!

finally, you get a satisfying eruption of crimson that, if performed soon after the injury, has a geyser effect. it's quite nice.


Step 1: Smash Finger

Picture of Smash Finger
I happened to accidentally crush my finger with a welding tank.

 
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medicman3 years ago
Hi, I too am a "health care professional", a physician. While by the book ethics would prevent me from telling anyone it's OK to do this at home, I really can't find much wrong with the theory behind this home brew trephination procedure. The only thing I would add is that the procedure should be performed in a room with little air flow (avoid open windows or fans that might kick bacteria around); and most importantly, the nail needs to be disinfected BEFORE the procedure as well as after. That way you wont be pushing surface bacteria into the newly made wound. Also. be sure and twist the drill bit by hand as the author of this 'ible did. I have seen wounds where people thought they could use a drill but the drill ended up pulling the bit itself into the nail and making a far worse wound than what was started with. Last, the best way to sterilize the drill bit is rubbing alcohol and heat. Dip the bit in the alcohol, and light it on fire and let the alcohol burn away.

In this economy it's just not possible for everyone to have health insurance. It's a shame, but it is the way it is. If people will be trying to relieve pain themselves it's definitely better to have access to the right info than to guess at it. Any other "health professionals" are welcome to chime in, but it's better in my opinion to put knowledge out there than to criticize others for doing the same.
I believe you are doing your duty as a physician in recommending safe practices for performing this procedure. Would you agree that draining a SH will probably prevent the nail from falling off?

I've smashed my finger before and gotten little hematomas under the nail, but nothing severe enough to warrant draining. Those hurt like hell; I can't even imagine one like the one pictured.
No, draining the nail will increase the chances that your nail will stay on. Whether or not the nail falls off is depends only on the initial trauma. If the trauma sufficiently destroys the connection between the nail and nail bed then the nail will eventually fall off, drained or not. The only benefit to draining is the relief of pain. When the injury first occurs, the blood flowing to the area has no where to go and creates pressure by being caught between the nail and nail bed. This pressure can cause a lot of pain, but will not be sufficient to further traumatize the nail plate/nail bed connection. If the subungual hematoma is not drained After 24 hours, the pain should subside naturally as the pressure will be normalized by then. If the trephination procedure has not been performed within 24 hours of the initial trauma, then performing it after that will not reduce pain, since at that point any pain is from the trauma itself and not from the pressure of blood under the nail. So essentially, if this procedure is not performed within 24 hours of the injury, there can only be negative consequences to the procedure (possible infection, further trauma, etc). In fact the hospital I work at will not perform this procedure on injuries more than a day old.
andyp4 medicman4 months ago

I am curious about the 24 hour cut-off. My recent thumb injury was hurting more and more as time went by, and after about a day it suddenly seemed like an _excellent_ idea to drill a hole in myself.

The result was instant relief of the throbbing pain that had kept me awake all night and showed every sign of keeping me awake the next night too.

I will suggest that anyone who thinks that drilling a hole in yourself is inconceivable has never injured themselves in this way.

Agreed. I just performed this on myself. Injured myself about 36 hours ago, thumb in a car door. It was literally throbbing all night, could not sleep at all. I went to the docs and they offered to do this for me, but I'd have to come back later in the afternoon as the doc had a waiting room full of people and was already running late by the time they had got to me. Right after I got home, I looked up this tutorial and some youtube vids and just decided to do it myself, I needed the relief! Needless to say, it was INSTANT relief! Also, natural pinkish color is now showing again through where black spots are under my nail! It's still bleeding a bit, but I'm nursing it with anti-septic and paper towels. Better than it throbbing though!

So i am screwed?? A cabinet fell on my toe sunday morning, it is now Tuesday and i just now seen this option of drilling. I can no longer do this?
Thank you for backing up exactly what I was saying earlier.
Sincerely, The Crazy Female ER nurse. ;)
djimdy ebowman13 years ago
And if you have to go to a hospital, dig out your cash and negotiate, I say. Do your best to cut out the unholy scourge that is "Health Insurance," as if there is such a thing as insuring one's health.
Gymnast2151 month ago
Yea idk what to do it's really really not good
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cnemartinez238 made it!1 month ago
Its still coming out. Had to poke the cuticle though, as nothing came out the hole in nail.
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blakehx1 month ago
I usually use the flaming needle technique! I blast the nail with an upside down air duster can to freeze it, then immediately press a red-hot needle into the nail until I see blood start flowing! Once it stops running, put a cotton ball on it and a bandage! When the oozing stops, you can seal it up with a drop of super glue if you want!
PhilipB41 month ago

so, uh... cant you also sterilize it with the bourbon? :)

LutherR12 months ago

Painless more or less, besides 5 min spent applying pressure to the toe. Not every drill bit would do, regular wasn't getting a purchase had to use one for drilling stainless steel.

hintss2 months ago

no "after" photo of the fingernail with a hole and no blood?

klynnh6214 months ago
But how long would it take for the hole you drill to heal?

Thanks for the tips works Good , was wondering at first kind of weird, but tried it no pain and relief the pressure .

WendyA35 months ago

I got this done at the clinic because I couldn't bare the pain, even after 2 days later - the pain got worse.

I didn't bleed out fast though. Just been oozing bits of blood for the past couple of days. Not sure how to stop the bleeding. Been following instructions with using triple antibiotic ointmnet (or neosporin) and keeping a band-aid over it.

Literally just did this at work because the pain was unbearable. you are a life saver & now all the mechanics think im a bad ass. My finger feels soooooooooo much better

Wow no all u have to do is heat up a needle with a lighter and poke it through your nail until it bleeds you went to far
holly-g1 year ago
@ ebowman1-
nosocomial ring a bell?
holly-g1 year ago
@salazam
touché sir! Live on!! hehehe.
holly-g1 year ago
Draining the nail most definitely dictates how well the nail will fall off; or possibly aiding in saving the nail!!! Some of the "medical personnel" here appear to provide misstated opinions, possibly? Follow the guide or possibly create your own ; but this one is tried and true. Best regards, Author!
holly-g1 year ago
@ medicman you should know rubbing alcohol will not sterilize anything, ethyl alcohol is what you need, not isopropyl. Consult any sanitizer bottle or reference it. Good try though.
msawtell1 year ago
This will work but, you run the risk of excessive damage. I am a nurse and a mom who has had to relieve the pressure from under one of my kid's fingernail. This works quickly and painlessly.The finger nail is hurting so bad from the pressure it doesn't feel much of anything else.
Clean hands well before and after. Heat a large sewing needle in a flame until it is glowing cherry red. touch it firmly to the center of the bruised area of the nail. Press with firm but gentle pressure. Reheat needle and repeat if necessary. Cover with bandaid when finished.
lakazdi2 years ago
this seems quite irresponsible. all I see is the potential for a mistake and the comment "but I saw how to do it on the internet"
schaude3 years ago
if you do this you could close the hole later on, after desinfecting it, with super glue (sekundenkleber). just polish it after drying and be lucky with your "like new"-nail!

by the way, super glue is what surgeons use nowadays closing flesh wounds.
rjr162 schaude3 years ago
Very tue, but the Medical grade uses 2-Octyl cyanoacrylate vs your standard Super Glue (which use Methyl, Ethyl or n-butyl and can be more prone to cause irritation and/or reactions)
Klesa3 years ago
LMFAO!!! Oh god... Lol. I cant help but laugh at all the comments. But being as a "physician" has spoke on the page and thoroughly explained that it's ok but doesn't recommended it should "NAIL" it. :D Happy poking. :P
mseba3 years ago
this is stupid you can get many viruses even std-s in good conditions by drilling holes in your body ,
lukeyj15 mseba3 years ago
STDs? I don't know how one would contract an STD from drilling a hole into one's fingernail. The only way I foresee that happening is if one were to classify AIDS as an STD, didn't sterilise the drill bit, and let someone else use the drill bit before them that had AIDS, without them cleaning the drill bit. Using a completely new drill bit out of the packet that is sterilised with alcohol and then a flame will guarantee that you will not get AIDS or an STD from this procedure.
byoung123 years ago
HAHAHA the shadow of the bit makes it look like a horror film. How the blood is flowing fresh and the bit is still stuck in there :) lol.
The drill bit has a series of concentric flutes running up the shaft to remove swarf while drilling. The flutes perform the same function for the blood.
The first time I saw this ible I thought "Eww gross, I hope I never have to do that!" Well what do you know, I injured my toenail today and it is starting to bleed under the nail. I might have to do this procedure in the near future.
lime3D3 years ago
I just read through the first 40 comments, and can't believe all the folks that are saying NOT to do this.

I think this is a fantastic instructable, and now that I've read it, I'll know exactly what to do if the next time I need to.

Thanks for publishing this.

To all those people that are freaking out about drilling holes... haven't you ever heard about body piercing? C'mon.

I don't know about using superglue, but it seams to me that a dab of anti-bacterial ointment and a band-aid should do the trick.

Thanks for publishing this.
SWEEEEET
mrwolfe3 years ago
Thanks for writing this up. I've been performing the same procedure for years - whenever I happen to be clumsier than usual!

I initially used a heated paperclip and a sewing needle, but started using a 0.5mm or 1mm drill bit, mainly because I usually have one handy in the workshop. Sterilisation is a good idea, although I never thought of sterilising the drill bit and so far I have never had an infection.
C1337us3 years ago
Smashed my thumb in a car door and it turned alll black and I couldn't sleep that night once. Great instructable!
flamekiller3 years ago
... or is the bourbon for steadying your hands?
grannyjones3 years ago
sure beats the heck out of a 4 hour, $600 visit to the ER
mstar3 years ago
It's amazing how many people got so freaked out over this suggestion. Years ago I smashed a thumbnail removing a truck bearing and the guy I was working for gave me a brand new 1/16" drill bit and told me how to do it. I put it off for a few hours, being somewhat squemish, but when the trobbing started up in earnest, I did the deed. You spin the drill bit between your fingers to make the hole and it only takes a few seconds. You can feel it grab just before it breaks through and the blood pocket on the other side keeps it from ever touching flesh. The relief is instantaneous.
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