# Fishhook Removal

## Overview

This module describes how to remove fishhooks that are shallow (not embedded beyond the curvature of the hook) or deep (embedded beyond the curvature of the hook).

## Indications

1. Embedded fishhook

## Contraindications

1. None

## Patient information & consent

### How do I explain this procedure?

“This fishhook needs to be removed, but the barb at the tip makes it difficult. Because this fishhook is shallow, I can remove it just by manipulating it. OR: Because this fishhook is deep, I need to push it further until the barb comes out of the skin so I can cut it off and remove the hook.”

### What can my patient expect?

“I will give you an injection for pain, then remove the fishhook.”

### What is my patient’s role?

“Let me know if you have any allergies. Fearing blood or needles is normal, but tell me if you have fainted from it. Tell me if you feel any severe pain. Afterwards, keep the bandage on for two days and keep the wound clean and dry.”

## Preparation

### Documentation

1. Patient notes

### Equipment

1. Alcohol-based hand rub

2. Sharps container
   Sharps container

   If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.

3. Non-sterile gloves

4. Eye protection

5. Skin disinfectant
   Skin disinfectant

   Commonly used preparations include 0.5-2% chlorhexidine in 70% alcohol (Steriprep), or 10% povidone iodine. There is no consensus on the superiority of one agent above another. Caution: chlorhexidine solutions may be associated with burns and skin breakdown in infants < 2 months old.

6. Sterile pack

7. A 5-10 ml syringe

8. Aspiration needle (preferably blunt fill) and small injection needle

9. Lignocaine
   Lignocaine

   It is current best practice to avoid the use of adrenaline in the penis and digits due to concerns of ischaemia; however, this seems to be controversial in the literature.

10. Alcohol swab

11. For the barb covering method: an 18 G needle

12. For the string method: a suture or string

13. For a deep fishhook: a wire cutter

14. Gauze and a transparent film dressing

## Site & Positioning

Position the patient supine or reclining with the fishhook in easy reach.

## Procedure

Follow medical asepsis with non-sterile gloves Due to the nature of embedded fishhooks, sterility may not be possible.

1. Perform hand hygiene and don non-sterile gloves.

2. Draw up lignocaine and anaesthetise the area or perform a digital block.

3. Open the sterile pack to create a sterile field. Open sterile supplies onto the sterile field and pour skin disinfectant into the well.

4. Clean the skin and fishhook with disinfectant-soaked cotton balls and drape the area.

### String method

1. Loop the suture/string around the bend of the hook and hold it tightly in one hand.

2. With the other hand, depress the hook to disengage the barb from the tissues.

3. Pull the hook out sharply with the string.

### Barb covering method

1. Insert a needle along the inner curve of the fishhook until the barb is covered by the bevel of the needle.

2. Withdraw the hook with the barb covered.

### Deep fishhook method

1. Advance the end of the hook until it protrudes from the skin.

2. Use wire cutters to cut the barb off.

3. Withdraw the now barbless hook from the skin.

4. Cover the wound with gauze and a transparent film dressing.

5. Dispose of medical waste safely.

6. Provide the patient with tetanus prophylaxis.

7. Record the completion of the procedure in patient notes.

## Troubleshooting

The hook is deep and under a nail.

You may need to remove part of the nail under a digital block to remove the fishhook.

## Risks

1. Damage to nerves, tendons, or other local structures

2. Bleeding or haematoma formation

3. Wound infection

4. Vasovagal response

5. Sharps injury to healthcare personnel

## References

1. Streitz MJ. How To Remove a Shallow Fishhook. In: MSD Manual. 2020. Available from: https://www.msdmanuals.com/professional/injuries-poisoning/how-to-do-skin,-soft-tissue,-and-minor-surgical-procedures/how-to-remove-a-shallow-fishhook

2. Streitz MJ. How To Remove a Deep Fishhook. In: MSD Manual. 2020. Available from: https://www.msdmanuals.com/professional/injuries-poisoning/how-to-do-skin,-soft-tissue,-and-minor-surgical-procedures/how-to-remove-a-deep-fishhook