A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair?
Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.
Pediatric Trick of the Trade: Finger Immobilization Technique
- Distract child by utilizing parents, TV, cell phone, and/or child life specialists.
- Utilize pediatric calming techniques.
- For anxious children, consider intranasal midazolam (0.2 mg/kg).
- Use a large chuck or sheet to block the patient’s view of yourself and his/her hand.
- Attach an adult size IV arm board (approximately the length of the patient’s forearm) with tape around the wrist and forearm. Be careful not to restrict blood flow.
- Leave some extra distal arm board length to use as a handle.
- Tape all finger joints (except those requiring evaluation or repair) to the arm board.
- Administer a digital block for anesthesia.
- Apply a tourniquet for hemostasis, as needed.
This technique allows for isolation of the area of interest, reduces patient movement, and conceals the procedure from the child’s view.
For tips on how to repair nail bed lacerations, see Trick of the Trade: Finger nail bed laceration repair.