Fish Hook Removal: Foreign Body Assessment

00:01 Hi, my name is Glenna Lashley and I am a family Nurse practitioner.

00:05 Here at Lecturio, we realize that many students don't always get a chance to see or talk through invasive skills during their clinical rotations.

00:14 We are passionate about giving you this opportunity.

00:18 Unless you work in urgent care or the emergency room care setting, you are less likely to see a hook injury in your practice.

00:25 However, depending on the extent of the injury, it is within your scope of practice to attempt to remove.

00:32 I'm going to talk you through how to know when it is reasonable to attempt to remove it, and when you should refer the patient to emergency care services.

00:41 When assessing the situation, you need to think about the hook or the foreign body, which I'm going to call it from this point forward, foreign body. First, let's consider the foreign body.

00:53 What is the depth of penetration? Is it superficial or deep? Is there presence of multiple entry points and exit points? Does it have single or multiple barbs? What is the hook size and the gauge? What is the hook made of? Is it metal, plastic or something else? And are there any contamination levels? You need to think about this, particularly when you're removing and is there a potential need for antibiotic therapy? Now let's think about the patient.

01:26 Does your patient have any comorbidities related to potential antibiotic choices and the adherence to post-wound care instructions? Has your patient had their tetanus vaccination or is it up to date? The ability to cooperate with the removal? So on a child this might be more difficult, which might require a higher level of service. Need for systemic anti-anxiety or pain therapy.

01:54 Routinely, that won't take place, but if it did, you might have to think about a higher level of care as well.

02:00 And localized numbing agent.

02:03 With all of that information in mind, let's take a brief look at the particulars of the skin and muscle anatomy and physiology.

02:11 If there's a possibility the foreign body has penetrated beyond the surface layers, removal could cause more damage and a referral is necessary.