POTD Trauma Tuesdays: Fish Hook Removal

FISH HOOK REMOVAL

Introduction
▪ Most fishhooks consist of an eyelet at one end, a straight shank, and a curved portion that ends in a barbed point on the inner curve that points away from the hook’s tip. By design, it is constructed to prevent the hook from dislodging once it engages tissue
▪ Fish hooks are most often caught on hands and feet
▪ ED physicians may remove superficially embedded hooks but those embedded in vital structures (eyes, testicles, carotid artery, etc) should be referred to the appropriate surgical specialist covering that organ

How do I prepare to remove it?
▪ Stabilize the hook with a hemostat and remove any attachments, such as lures, fishing lines, sinkers, etc.
▪ Cleanse with betadine
▪ Use local anesthesia
▪ Children may need procedural sedation
▪ Pain control
▪ Tetanus prophylaxis

What methods are used for removal?
▪ Back out technique
⁃ If the hook is barbless, this is the easiest method.
⁃ As the name implies, back the hook out with a hemostat.

▪ Push through technique
⁃ Use when the tip of the hook is near the skin surface.
⁃ Push the hook through until you break the skin, and then use a wire cutter to cut the tip off.
⁃ Then back out the remainder of the hook.

▪ String technique
⁃ Hook’s belly should be directly in front of you with the shank pointing in the opposite direction
⁃ Loop a piece of string or large silk suture (3-0) around the belly of the hook and then wrap the ends around your index finger
⁃ Push down on the shank and eye of the hook with your other hand to disengage the barb from the surrounding tissue
⁃ Pull string slowly until it is taut in the plane of the hook’s long axis
⁃ Keeping it taut, jerk it quickly and firmly in the same direction

▪ Cut it out technique
⁃ When all else fails, cut with a scalpel along the hook, and then blunt dissect down with a hemostat.

Should I give antibiotics?
▪ No trials have investigated antibiotic therapy for fish hook injuries
▪ Most superficial fish hook wounds heal well without sequelae
▪ Consider antibiotics if the fish hook is deeply embedded in an infection-prone area such as a fingertip or ear
▪ Most infections are caused by skin flora
▪ If hook is contaminated (touched sea water, fish, bait, etc), consider abx treatment
⁃ Cephalexin 500mg PO q6 or cefazolin 1g IV q8 or Clinda 300mg PO q6 or 600mg IV q8
⁃ Seawater? ADD Doxycycline 100mg q12
⁃ See recent guidelines for other specific situations