Atlas of Primary Care Procedures, 1st Edition

General Procedures

7

Fishhook Removal

Persons with penetrating fishhook injuries commonly present to the office or emergency department. Most of these injuries occur to the hand, face, head, or upper extremity. The pull of the fishing line tends to create a tangential entry and superficial penetration. Although ocular involvement should prompt immediate referral to an ophthalmologist, most removal techniques can be performed without skin incisions.

Three of the most commonly employed techniques are demonstrated in this chapter. The retrograde technique is the simplest of the removal techniques, but it frequently is unsuccessful. The retrograde technique works well for barbless hooks or those in very superficial locations. This technique does not require any additional tools.

The string yank technique is a modification of the retrograde technique. This technique is relatively atraumatic and works well with small to medium-sized hooks or those that are deeply embedded. The string yank technique is rapid and can be performed without the need for local anesthesia. The technique cannot be performed on hooks embedded in mobile body parts such as earlobes.

The advance and cut technique is almost universally successful, even when removing large, multibarbed hooks. The technique is best performed with two tools: needle-nosed pliers for advancing the hook and fine-point wire cutters to cut through the needle. These instruments are relatively inexpensive and can be purchased at most hardware stores. Local anesthesia should be administered for this technique. One major disadvantage of the advance and cut technique is the creation of additional trauma and a second wound site on the skin.

After removal of the hook, the wound should be explored for possible foreign bodies. Topical antibiotics should then be applied to the site. Most well-conducted, controlled studies do not demonstrate benefit from systemic antibiotic use.

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INDICATIONS

• Fishhooks that are embedded in the skin and superficial tissues

CONTRAINDICATIONS

• Ocular embedded fishhooks
• Obvious penetration through other deep, vital structures such as hand extensor tendons
• Fishhooks in mobile structures such as earlobes (i.e., for string yank technique)

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PROCEDURE

Apply downward pressure to the shaft of the hook in an attempt to disengage the barb. Back out the hook through the path of entry.

Fishing line or a string is tied to the midpoint of the bend in the hook (Figure 2A). Grasp this string tightly only 3 to 4 inches from the hook, and then use the nondominant hand to stabilize the tissues around the embedded hook. Apply downward pressure to the shaft of the hook while firmly and rapidly pulling on the string to withdraw the hook (Figure 2B).

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After administration of local anesthesia, grasp the upper shaft of the hook using a stabilizing instrument such as a needle driver or needle-nose pliers (Figure 3A). Advance the hook through the skin, following the curvature of the hook (Figure 3B). Using fine-tipped wire cutters, cut the upper shaft just below the eye of the hook (Figure 3C). Grasp the hook near the tip, and pull it free from the skin (Figure 3D).

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CODING INFORMATION

INSTRUMENT AND MATERIALS ORDERING

Needle-nose pliers and fine-tipped wire cutters can be purchased at any hardware store. These instruments can be inexpensive but valuable additions to the primary care office for unusual emergencies. A suggested anesthesia tray that can be used for this procedure is listed inAppendix G.

BIBLIOGRAPHY

Brown JSB. Minor surgery: a text and atlas, 3rd ed. London: Chapman & Hall, 1997:335.

Cannava PE. Fishhook removals. Arch Ophthalmol 1999;117:1668–1669.

Doser C, Cooper WL, Ediger WM, et al. Fishhook injuries: a prospective evaluation. Am J Emerg Med 1991;9:413–415.

Eldad S. Embedded fishhook removal [Letter]. Am J Emerg Med 2000;18:736–737.

Gammons M, Jackson E. Fishhook removal. Am Fam Physician 2001;63:2231–2236.

Lantsberg L, Blintsovsky E, Hoda J. How to extract an indwelling fishhook. Am Fam Physician 1992;45:2589–2590.

Rudnitsky GS, Barnet RC. Soft tissue foreign body removal. In: Roberts JR, Hedges JR, eds. Clinical procedures in emergency medicine, 3rd ed. Philadelphia: WB Saunders, 1998:623–624.

Suresh SD. Fish-hook removal. Lancet 1991;338:1463–1464.

Weber LE. Removing fishhooks. In: Driscoll CE, Rakel RE, eds. Patient care procedures for your practice. Los Angeles: Practice Management Information Corporation, 1991:331–335.