>What's wrong with a white needle?
--> Nothing! And, as Goat says, he has no problems with it... But that's
most likely because of his experience and care. Most trephining I have seen
is done by nurses and, occasionally juniors and only some of them are as
skilled.
The problem is that our needles are not drills. You cannot "drill" with them
- you can twirl one in with pressure, but it is mainly the pressure that
gets through and pressure is what hurts (especially in adults who have
tougher nails than young kids). Of course, if you are careful, you CAN do it
without much pressure, but, as I said, most people who do these are not
careful enough.
If you must use needles, try to use the hub-end of a vacutainer or other
short-bevel needles, which are less likely to triger nail-bed haemorrhage by
going too deep.
As for other issues - I do not find that red-hot tips bother the patients
much to look at because I would make sure they DO NOT observe the job as it
is done. Some distraction or just plain blockage of view does the trick.
It also helps if they have had good analgesia at triage (I wouldn't normally
advocate a ring-block, just oral stuff if there is enough time between
traige and having it done). Best results are with ICE applied to the digit
and I leave it on around the digit as I do the procedure (except for over
the nail).
The red hot tip goes through in seconds, without pressure, especially if you
use the electric instruments. No pressure is required and this is obvious
even to inexperienced users.
Then there is the problem of re-occlusion. To prevent that, if you are not
using hot-tips, you may well use a sclapel blade (large one). This works
best on very curved nails (and also great for making a hole over an thorn FB
which is under thre middle of a nail but not protruding throughh the edge.
You just keep "shaving" the nail down tangentially (no pressure) until you
have a hole and a BIG one).
But this is where hot tips beat manual techniques hands-down. You don't make
a hole; you don't make 2 holes; you make a wide slit. Then you can have a
hot water soak and wave the digit about in it to get the clotted blood
out...
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