The patient has been snagged with a fishhook and arrives
with it embedded in his skin.
What to do:
Cleanse the hook and puncture wound with povidone-iodine or another antibiotic solution. Provide tetanus prophylaxis as needed. Most patients will benefit from local infiltration of 1% buffered lidocaine using a 27 gauge needle inserted through the hole created by the fishhook.
For hooks lodged superficially, first try the simple "retrograde" technique. Push the hook back along the entrance pathway while applying gentle downward pressure on the shank (like the downward pressure in the "string" technique below). If the hook does not come out, an 18 gauge needle may be inserted into the puncture hole and used as a miniature scalpel blade. Manipulate the hook into a position so you can cut the bands of connective tissue caught over the barb and release it.
For more deeply imbedded hooks, a more complex technique of "needling" the hook
requires somewhat greater skill but also allows you to work on
an unstable skin surface such as a finger or ear. Slide a
large gauge (#20 or #18) hypodermic needle through the puncture
wound alongside the hook. Now blindly slide the needle
opening over the barb of the hook and, holding the hook
firmly, lock the two together. Now with the barb covered,
remove the hook and needle as one unit.
When a single hook is superficially embedded in a stable skin surface
such as the back, scalp or arm, a simple way to remove it is
by using the "string" technique. Align the shaft of the
hook so that it is parallel to skin surface. Press down on
the hook with your index finger to disengage the barb. Place
a loop of string (fishing line or 1-0 silk) over your wrist
and around the hook, and with a quick jerk opposite from the
direction the shaft of the hook is running, pop the hook
out. When done properly, this procedure is painless and does
not require anesthesia. The hook may shoot out in the direction that the string is being pulled, so be careful that no one is standing in the path of the fishhook.
When the hook is deeply embedded, the barbed end of the hook is protruding through the skin, or you are unable to
utilize the previous techniques, proceed with the tried
and true "push through" maneuver. Locally infiltrate the
area with l% buffered lidocaine and then push the point of the hook
along with its barb up through the skin. Now with a pin
cutter or metal snip, cut off the tip of the hook and
remove the shaft or cut off the shaft of the hook and pull
the tip through.
If a multifaceted (treble) hook is embedded, cover the free hooks with corks or use a pin cutter or metal snips to remove the free hooks and protect
the patient as well as yourself from additional harm. When
significant manipulation is anticipated, infiltrate first
with 1% buffered lidocaine.
What not to do:
Do not try to remove a multiple hook or a fishing lure
with more than one hook without first removing the free
hooks or embedding them in a protective material.
Do not attempt to use the "string" technique if the hook
is near the patient's eye.
Do not routinely prescribe prophylactic antibiotics. Even hooks that have been contaminated by fish rarely cause secondary infection.
Discussion:
With the string, retrograde and needling techniques, there is no lengthening of the
puncture track or creation of an additional puncture wound. The quickest and easiest method for removing a fishhook is
the string technique. It is a technique you can use
in the field because no special equipment or anesthesia is
required, but it is not recommended when the hook is
positioned on a skin surface that is likely to move when the
string is pulled. This movement will cause the vector of
force to change and therefore the barb may not release.
