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        Ingrown Toenail Removal
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          Contents

          Ingrown Toenail Removal

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            Article summary

            Toenails can grow into the surrounding skin, creating pain. Removing part of the toenail can eliminate the discomfort. Medicine is sometimes used to prevent that portion from growing back.

            In advance (Huddle)

            • MA to confirm supplies needed with provider.

            Glove size:

            		                           

            Scalpel type

            #10

            #11

            #15

            Lidocaine

            		2% WITHOUT epi

            Other requests:



            It is important to use lidocaine WITHOUT epinephrine.  Epinephrine could potentially constrict the blood vessels and endanger the toe.
            Providers: 2% lidocaine is used to minimize the volume of medicine.  Using too much volume in a digital block could create a compartment-syndrome effect, resulting in neurovascular compromise.

            PPE

            • Sterile gloves
            • Gown
            • Eye protection
            • Surgical mask

            Setup (MA)

            • Complete demographics portion of consent form.
            • Verify if allergy to iodine or Betadine.
            • Ensure all supplies are available and in procedure room.

            For sterile field

            • Toenail Procedure Pack
              • Straight Kelly forceps
              • Straight mosquito forceps
              • Iris scissors
              • Nail splitter
              • Nail elevator
              • Fenestrated drape
              • Gauze 4x4s (sterile)

            Prepped on non-sterile counter

            • Consent form (demographics completed)
            • PPE (see above)
            • Chux (procedure underpad)
            • Alcohol wipes
            • Betadine swabs
              • Substitute Chloraprep swabs if allergic to iodine or Betadine.
            • Rubber band (for tourniquet)
            • Syringe, 5 mL
            • Needle, 18 g x 1” (for drawing medicine)
            • Needle, 27 g x 1” (for administering)
            • Lidocaine 2% WITHOUT epi
            • Dressing supplies
              • Bacitracin
              • Tube gauze for dressing
              • Tube gauze applicator (cage)
              • Bandage scissors

            Procedure (Provider)

            Before

            • Have patient sign consent form.
            • Using sterile technique, place appropriate items on sterile field.
            • Confirm allergies.
            • Perform time out immediately before procedure.

            After

            • Remove all sharps from work stand and place in sharps container. 
              • Do not delegate this task.

            Dressing (MA or Provider)

            • Dress toe using tube gauze.
            • Give patient after-care instructions.
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