Subungual Hematoma Evacuation: Procedure Demonstration

00:01 We're here to do the trephination.

00:04 So we're now ready to do the procedure.

00:06 We've already gathered all our supplies.

00:09 The first thing that we need to do is we need to clean the area that we're going to be dealing with. So this is going to be on the second toe.

00:16 As you can see, there's a hematoma underneath the nail.

00:20 We're going to be doing the digital nerve blocks.

00:22 So we want to make sure that we've cleaned that area well.

00:25 So we're going to be doing the dorsal web to be able to do this.

00:28 So we want to make sure we're cleaning here between the toe here.

00:32 And we're going to do the same thing on this side.

00:35 And you're also going to want to make sure you clean the nail bed very well as well here.

00:41 Now you're going to put that in the trash can because remember you always want to keep this clean. Again this is aseptic technique.

00:48 This is not going to be sterile technique.

00:51 So you're going to do the digital block.

00:53 Already have lidocaine without epi, and we're going to be using.

00:58 And so you're going to warn your patient before you do this that they're going to have some discomfort. And it's going to feel like a burning sensation.

01:05 But this is going to help later when we get to the rest of the procedure.

01:09 So again here you're going to go in here between the toes in the webbing area here.

01:16 And you're going to advance your needle.

01:18 You're going to withdraw to make sure that you don't have any blood return.

01:22 And then you can start to administer your lidocaine, and you also want to pull out a little bit and go in the dorsal aspect as well to make sure that we're getting the dorsal nerves.

01:36 And then we're done on that side.

01:38 We're going to let the patient know that we're going to do this one more time. Again, we're going through the webbing.

01:44 We're going to insert our needle.

01:46 We're going to advance. We're going to withdraw to make sure that we're not having any blood return.

01:53 And then we're going to inject as we're slowly moving out.

01:57 And then we want to reposition the needle where we're going in more dorsally.

02:01 And we're going to withdraw again.

02:04 And we're going to inject again to make sure that the patient is anesthetized appropriately.

02:09 Then we're going to remove.

02:11 Then we're going to put this back on our sterile field in case we need it again.

02:16 Because sometimes that's not enough numbing for some people.

02:19 So we're going to leave them for 5 to 10 minutes.

02:22 And then we're going to come back and we're actually going to trephinate the nail.

02:26 So we're taking our 20 gauge needle, and we are actually twisting it into the nail.

02:34 And once we achieve blood coming out, we want to remove the needle.

02:40 And then we're going to use our gauze to wipe away the blood.

02:46 After this is complete then we would bandage the toe.