Overview

Finger nails are used for scratching, in defense, and, more obviously, to pick up small objects.
However, the nail also protects the fingertip, contributes to tactile sensation, and plays an
important role in the regulation of peripheral circulation. An abnormal nail is both a cosmetic and
functional problem in that it catches on objects, particularly cloth, and causes finger pain and
damage to the object.

Indications
Nail deformities that require nail removal can occur secondary to anything that causes injury or
deformation of the nail bed. This may include infection,[1] self-mutilation, tumor, or trauma.[2]

Onychocryptosis (ingrown nail)[3]

Onychogryposis (deformed, curved nail)

Onychomycosis

(fungal

infection

of

the

nail)[4]

(see

the

image

below)

Candidal onychomycosis in a patient with chronic

mucocutaneous candidiasis. Total onychomycosis and paronychia. Image courtesy of Dr
Antonella Tosti.

Chronic recurrent paronychia (inflammation of the nailfold)[5] (see the image below)

Typical appearance of paronychia.

Contraindications

Allergy to local anesthetics (relative contraindication)

Bleeding diathesis

Anesthesia
Although many procedures like nail removal can be carried out safely under local ring block,
some patients may opt for general anesthesia. The following anesthetic procedures are commonly
used:

Local ring block (For more information, see Local Anesthetic Agents, Infiltrative
Administration.)

Procedural sedation (This may be considered but generally should not be required.)

Equipment

Surgical preparatory supplies

Syringe, 5 mL

Needle, 27 gauge (ga)

Local anesthetic without epinephrine

Finger tourniquet (eg, rubber band, small Penrose drain, or the finger part of a glove)

Iris scissors or small Kutz periosteal elevator (nail elevator)

Straight hemostats (2)

Nonadherent gauze and tubular gauze dressing

Positioning

Position the patient supine.

Abduct the arm.

Place the hand on an arm extension with the palm facing down.

Technique

Scrub and drape the finger in a sterile fashion.

Administer local anesthetic to ring-block the finger.

Confirm that anesthesia is achieved (wait 5-10 min).

Use a straight hemostat to firmly secure a finger tourniquet around the base of the finger.

Insert the blades of curved Iris scissors or a small periosteal elevator beneath the free
edge of the nail (hyponychium).
o Gently open and close the Iris scissors blades or gently press the nail bed with the
small periosteal elevator.
o Advance proximally in between the nail plate and the nail bed until the instrument
reaches the nail fold.

Take appropriate care to avoid any further damage to the nail bed or overlying nail fold
during this process.

Once the nail is sufficiently separated from the nail bed, it is gently removed by applying
firm and steady distal traction using a hemostat.

Pearls

Apply a tourniquet at the base of the finger to minimize bleeding.

Take appropriate care to avoid any further damage to the nail bed or overlying nail fold
during nail removal.

Complications

Bleeding

Infection

Nail bed injury

Nail matrix injury

Paronychial injury

Kebijakan
Tujuan
Referensi
Ruang Lingkup
Penanggungjawab
Masa berlaku
Definisi

Pelaksanaan Pelayanan BP Umum harus mengikuti langkah-langkah

kerja pada Protap Terapi
Pemeriksaan Pernafasan
Pendidikan Keterampilan Keperawatan, Program Studi Ilmu
Keperawatan Fakultas Kedokteran UGM 2003
Dilakukan di BP Umum
Koordinator BP Umum
Ditinjau ulang setahun sekali
Melakukan tindakan menarik dan mengangkat kuku, dilanjutkan dengan
reseksi ringan jaringan granulasi disekitarnya
Indikasi :
unguis inkarnatus : bagian kuku masuk kedalam kulit pinggir kuku
paronikia : infeksi di sekeliling kuku
abses sub ungula
korpus alienum di bawah kulit
trauma pada kuku
radang / infeksi lain di dorsal dan proksimal kuku

Alat dan Bahan

Minor set
Kassa steril
Sarung tangan
Larutan disinfektan
Spuit 3 cc
Lidokain / chlor etyl

Langkah-langkah

Cara Kerja :
1.
2.
3.
4.
5.

Cuci tangan
Beritahu pasien tindakan yang akan dilakukan
Siapkan alat, lakukan anestesi block pada basis dari haluks
Pakai sarung tangan
Pegang haluks dengan tangan kiri , tangan kanan memegang klem
lengkung
6.
Masukkan klem dipinggir kuku yang sehat, cekam pinggir kuku
dengan klem, kunci klem
7.
Putar/gulung klem dengan cepat dan pasti kearah ujung kuku yang
lain
8.
Potong dan buang jaringan granulasi yang ada sampai bersih
9.
Perdarahan yang biasanya difus tidak perlu dijahit
10.
Kompres luka dengan rivanol dan betadine lalu dibungkus
11. Cuci tangan