From wood shards lurking on gym bleachers to sharp remnants from broken objects or sneaky thorns hiding in the bushes, splinters are an inevitable part of childhood adventures. School nurses are well-acquainted with splinter crises - when those microscopic menaces cause big student reactions. In this blog post, we'll explore practical and effective interventions for managing splinters, enabling you to provide acute care and compassionate reassurance to students needing splinter support. 

What exactly are we dealing with?

A splinter is simply a foreign object that has become embedded under the skin. While wood is a common culprit, splinters can also be made of glass, metal, or plastic. The size and depth of a splinter are critical factors in determining the appropriate course of action for intervention or treatment. A superficial splinter may often be easily removed with basic first aid techniques, while deeper or larger splinters may necessitate more comprehensive medical intervention. Most tiny slivers in the top layer of skin don't cause much pain, while deeper objects or those in the foot can be quite painful. Students might complain about a "feeling" or " something in there," another telltale sign that a splinter may be deeply embedded. 

How (and when) should splinters be removed?

Splinters that are very small, near the skin's surface, and not painful do not necessarily need to be removed and will come out on their own with normal skin shedding. However, splinters that are deep, cause pain, or are easily accessible should be removed to provide relief and prevent infection. Basic splinter care at school may simply involve assessment, cleaning of the area, covering the splinter with a bandage, and giving reassurance to the student and instructions to the parents/guardians for splinter removal at home. However, when done per school policies and within the scope of practice for school nurses, appropriate splinter removal techniques may include the following interventions, provided by the American Academy of Pediatrics:

• Always wash the area around the splinter with rubbing alcohol or soap and warm water, but don't soak the area if the splinter is wood, as this can cause it to swell and make removal harder.
• A magnifying glass can help to visualize the splinter better. Determining its size, location, and the angle at which it enters the skin allows for easier removal.
• If part of the splinter is sticking out of the skin, use sterilized tweezers to gently pull it out at the same angle it entered. Shop tweezers here.
• If the splinter is embedded under the skin, use a sterilized needle or similar tool to gently pierce the skin at one end of the splinter to expose it, then use the tweezers to pull it out.
• After removal, rewash the area with soap and water and apply an antibiotic ointment (if OTC medication policies allow), followed by an adhesive bandage.

Certain splinters, such as cactus spines and fiberglass particles, can be challenging to remove due to their fragile nature; they often break when pressure is applied with tweezers. To extract these delicate materials effectively, the AAP suggests using a piece of sticky tape—such as packaging or duct tape. Gently press the tape against the affected area and then peel it away; this method can help lift out small spines or spicules without causing further fragmentation. 

When should I send for further evaluation or intervention?

While many splinters can be safely managed in the school nursing setting, certain characteristics warrant a referral to the primary care provider. School nurses should carefully assess splinters presenting with the following clinical indicators:

• The splinter is too deep or cannot be removed after several attempts.
• It is difficult to reach underneath a fingernail or toenail.
• There are signs of infection, like increased warmth, swelling, redness, drainage, or pain.
• The embedded object is barbed or from materials that may pose additional health risks (rusty metal, potentially contaminated sources).

Remember, it's okay to err on the side of caution. If you are uncomfortable removing a splinter or think it might require too much "digging, " clean the area, cover it, and inform the parents. Splinters may be small, but they can loom large in a student's world. School nurses can stop those tiny troubles from becoming big dramas with the right tools and techniques - and a little TLC.