Fishhooks may become embedded in the subcutaneous layer of skin.
A shallow fishhook is one that goes straight in and has not penetrated to the curve of the hook—the barbed point is directed away from the skin surface. Deep fishhooks have a different removal technique.
- Superficially embedded fishhook in skin
A fishhook in the globe of the eye should be managed by a specialist.
- Chronic granuloma formation
- Cleansing solution, such as povidone-iodine or chlorhexidine
- 21- and 25-gauge needles
- 10-mL syringe
- Local anesthetic, such as 1% lidocaine
- Pliers, 18-gauge needle, or 30 to 40 cm of strong string (eg, suture material) depending on removal method
- Sometimes a #11 scalpel
- Nonsterile gloves
- Rarely, hooks become embedded in or near important structures (eg, nerves, vessels, tendons) that must be taken into consideration during removal.
- Patient comfort with good lighting, excellent exposure of the fishhook, and support of the affected area on a firm surface
Step-by-Step Description of Procedure
Shallow fishhooks are removed by direct traction, for which there are several methods. Some methods use a simple straight pull. Others cover the barb of the hook with a hollow needle or a scalpel blade so it does not snag on tissue and impede removal. For each of the methods
- Clean the site, including protruding hook, with povidone-iodine or chlorhexidine solution.
- Determine the location of the barb of the hook, which is on the inside of the curve of the hook.
- Inject local anesthetic into the area around the hook entrance.
For the simple straight pull (string method)
- Grab the hook near the skin with pliers or pass a looped string, fishing line, or thick suture around the curve of the hook and wrap the end around your dominant hand several times.
- Disengage the barb from the tissue by grasping the hook with the thumb and middle finger of your nondominant hand and pressing the hook a few mm into the skin with your index finger.
- Once the barb is disengaged, sharply pull the hook out with the pliers or string. With the string method (see figure Fish hook removal: String method), protect yourself and bystanders from the hook, which often flies out briskly.
Fish hook removal: String method
1: Pass a looped string, fishing line, or thick suture around the curve of the hook and wrap the end around your dominant hand. 2: Disengage the barb from the tissue by grasping the hook with the thumb and middle finger of your nondominant hand and pressing the hook a few mm into the skin with your index finger. 3: Once the barb is disengaged, sharply pull the hook out with the string. Protect yourself and bystanders from the hook, which often flies out briskly.
For the needle cover method
- Pass a short-bevel 18-gauge needle through the entrance of the hook parallel to the shaft of the hook until the needle bevel covers the cutting edge of the barb. Then withdraw the hook while the barb is covered (see figure Fish hook removal: Needle cover method).
- Alternatively: Insert the point of a #11 scalpel blade to cover the barb and free the subcutaneous tissue that is engaged on the barb.
Fish hook removal: Needle cover method
Provide adequate local anesthesia then pass a short-bevel 18-gauge needle through the entrance of the hook parallel to the shaft of the hook until the needle bevel covers the cutting edge of the barb (left). Then withdraw the hook while the barb is covered (right).
After removing the hook
- Clean the area with soap and water or a mild antibacterial wound cleanser such as chlorhexidine. Bandage the wound.
- Give tetanus toxoid-containing vaccine (eg, Td, Tdap) depending on patient's vaccination history (see table Tetanus Prophylaxis in Routine Wound Management). Incompletely immunized patients should also receive tetanus immune globulin 250 units IM.
- Keep wound clean and dry and remove dressing after 48 hours.
- With foot wounds, elevate extremity and limit ambulation for 1 to 2 days.
- Return for evaluation for increased pain, redness, swelling, or other indications of infection.
- Antibiotics are not used routinely, unless patient is immunocompromised.
No data support the routine use of antibiotics except possibly in immunocompromised patients. If given, use a first-generation cephalosporin or penicillinase-resistant penicillin, or for patients with contraindications to penicillins and cephalosporins, clindamycin, trimethoprim/sulfamethoxazole, or tetracycline.
Warnings and Common Errors
- As with all puncture wounds, there is significant risk of infection.
Tips and Tricks
- When withdrawing a barb, pull slowly and steadily, directly away from the skin without twisting. Curved-tip forceps are best because the outer curve can be laid against the skin while the handle remains far enough from the skin to grasp easily.
- Before removing a fishhook embedded in subungual tissue, use a digital block. Some cases require removing the nail or part of it to expose the hook.
Drugs Mentioned In This Article
|Drug Name||Select Trade|
|immune globulin||Gammagard S/D|
|trimethoprim||No US brand name|