Fish hook removal – how do you do it?
August 26, 2012
The image here is my all time favourite fish hook injury. I called the Surgeon to ask him to review this one and he was somewhat dismissive. After a more prolonged explanation he begrudgingly agreed to look at it. Several hours of operation later we had the hook out and a lot of structures explored!
Now, there are few issues that divide my colleagues more than fish hook removal techniques.
Some like to push, some pull, some use a complex string tension technique. Then there is the large piece of metal that you yank…. Out it pops.
So I want to know – what is your preferred technique for pulling out barbed hooks?
Let me know on the comments, or link to a video / diagram
Do you have a trick to share? Casey
thats not a fish hok – it’s a freaking anchor.
Lots of fish hooks up here in Darwin.
For all of techniques – infiltrate with LOTS of local anaesthetic first.
The “string-yank” technique works on smaller hooks, however there’s a trick to it. You have to push the non-hook end (the loop where where the fishing line ties on) vertically downwards, all the way so you’re indenting the skin, (this dis-engages the barb) before looping your silk suture material around the hook-end and giving a fast, solid, horizontal yank. Again – make sure you & the medical students/RMO’s, wear goggles, as the hook really can go flying out.
For larger hooks you can do a cut down along the inner radius of the hook til you get to the barb, then just cover the barb with your forceps as you extract it & it’ll slide right out (ensuring you don’t cut through any vital structures along the way).
For superficial small hooks you can do the “push through” method – cut off the loop where the line ties on with pliers and just push the hook end out through the skin. Can be harder than it sounds – sometimes you’ll need to make a small incision as it comes through to get the barb out.
If you think it’s hooked into deeper structures like muscle/tendon/bone & you have a friendly surgeon around – send them to theatre – these need careful dissection out with a bloodless field.
As a pharmacist, my management would be “send to ED” (with a written referral if that’s what it took to get the patient to go – something I’ve had to resort to in the past).
More importantly, what would be the post-op antibiotic course? Around here it would probably be ciprofloxacin (inland; fresh water pathogens)…