Fishhook Removal

Aka: Fishhook Removal, Fishing Hook Foreign Body, Fishing Hook Removal, String-Yank Fish Hook Removal, Retrograde Fish Hook Removal, Needle Cover Fish Hook Removal, Advance and Cut Fish Hook Removal

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II. Preparation

  1. Detach any connected fishing line
  2. Tape or cut uninvolved hooks
  3. Clean fishhook insertion site prior to removal
    1. Topical Povidone-Iodine (Betadine) or
    2. Hexachlorophene (Hibiclens)
  4. Administer Local Anesthesia
  5. Surgeon to wear Eye Protection
  6. Perform proper wound care after hook removal (washing wound, irrigation)
  7. Update Tetanus Vaccination

III. First-line Technique: Retrograde Technique

  1. Indications
    1. Barbless fishhook
    2. Superficially embedded fishhook
  2. Images
    1. Retrograde Technique
      1. FishHookRetro.jpg
  3. Technique
    1. See preparation above
    2. Apply downward pressure to fishhook shank
      1. Rotates hook deeper
      2. Disengages barb if present
    3. Back fishhook out of skin
  4. Precautions
    1. Stop procedure if resistance or catching occurs

IV. First-Line Technique: String-Yank (Stream Technique)

  1. Indications (do not use on earlobe)
    1. Small and medium sized fish hooks
    2. Deeply embedded fish hooks
    3. Ideal for low resource areas (e.g. wilderness travel) where Anesthesia and clean conditions are lacking
  2. Contraindications
    1. Multiple embedded barbs
    2. Uncooperative patient (consider anxiolysis, e.g. oral Lorazepam or intranasal Midazolam)
    3. Tissue is free floating (e.g. earlobe)
  3. Technique
    1. See preparation above
    2. Tie fishing line, Suture or umbilical tape onto hook
      1. Tie at midpoint of bend in hook
    3. Hold string tightly or attach to Tongue depressor
    4. Stabilize involved skin against flat surface
    5. Stabilize the hook between the index finger (on the hook's curve) and the thumb (supporting the hook's eye)
      1. Depress hook's curve with the index finger (as in Retrograde Method) to disengage the barb
    6. Clear path of fishhook of people
    7. Give string a firm, quick jerk
  4. Resources
    1. String Yank Technique (Image)
      1. FishHookYank.jpg
    2. String Yank Technique (YouTube Video)
      1. https://www.youtube.com/watch?v=ZRgH1oLMNnI

V. Second-Line Technique: Needle Cover Technique

  1. Indications
    1. Large hooks with single barbs
    2. Barb superficially embedded
  2. Images
    1. Needle Cover Technique
      1. FishHookNeedle.jpg
  3. Technique
    1. See Preparation above
    2. Advance 18 gauge needle along entrance of fishhook
      1. Insert parallel to shank
      2. Bevel pointing toward inside curve of hook
      3. Longer edge of needle matches end of hook angle
    3. Disengage barb by advancing fishhook
    4. Pull and twist hook so hook point enters needle lumen
    5. Back the needle and hook together out of the wound

VI. Third-Line Technique: Advance and Cut Technique

  1. Indications
    1. Large fishhook
    2. Fishhook near skin surface
  2. Advantages
    1. Highly successful technique
  3. Disadvantages
    1. Increased Trauma to surrounding tissue
  4. Images
    1. Advance and Cut Technique
      1. FishHookAdvance.jpg
  5. Technique
    1. See Preparation above
    2. Advance hook/barb through skin (use needle driver)
    3. Single Barb
      1. Cut barb off and back hook through skin
    4. Multiple Barbs
      1. Cut off eye of hook and pull hook through skin

VII. Management: Post-operative wound care

  1. Explore wound for additional foreign bodies
  2. Do not Suture wound
  3. Apply Antibiotic ointment and bandage
  4. Tetanus Prophylaxis

VIII. Management: Prophylactic Antibiotics

  1. General
    1. Antibiotic prophylaxis is not typically indicated in healthy, uncomplicated wounds
  2. Indications
    1. Immunocompromised
    2. Diabetes Mellitus
    3. Peripheral Vascular Disease
    4. Deep wound involving Muscle, tendon or ligament
  3. Typical prophylactic Antibiotic selection
    1. Start with coverage of typical skin flora (Staphylococcus aureus, Streptococcus Pyogenes)
    2. Cephalexin or Cefadroxil
    3. Dicloxacillin
  4. Contaminated wounds (stagnant water, sea water, rivers, lakes, ponds)
    1. Possible exposure to many atypical organisms: Aeromonas, Vibrio vulnificus, Ersipelothrix, Mycobacterium marinum
    2. Broad prophylaxis is NOT recommended (beyond typical described as above)
      1. Instead perform close interval follow-up
      2. Start with typical narrow coverage as above
    3. Significant active Wound Infections after contaminated water exposure are empirically covered broadly
      1. First Generation Cephalosporin AND
      2. Fluoroquinolone AND
      3. Doxycycline (if sea water for Vibrio species) AND
      4. Metronidazole (if contaminated with sewage)
  5. References
    1. Brothner in Stack and Wolfson (2024) Fish Hook Removal techniques, UpToDate, accessed 10/27/2024
    2. Sinkoff (2024) Freshwater Fishhook Injuries and Antibiotic Prescribing Patterns, Henry Ford Scholarly Commons
      1. https://scholarlycommons.henryford.com/cgi/viewcontent.cgi?article=1013&context=hfjhrs2024
    3. Doser (1991) Am J Emerg Med 9(5):413-5 +PMID: 1863292 [PubMed]

IX. References

  1. Haynes in Pfenninger (1994) Procedures, Mosby, p.128-32
  2. Warrington (2024) Crit Dec Emerg Me 38(10): 20-1
  3. Cook (1981) Emerg Med 223 [PubMed]
  4. Gammons (2001) Am Fam Physician 63(11):2231-6 [PubMed]
  5. Lantsberg (1992) Am Fam Physician 45(6):2589-90 [PubMed]

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