Fish Hook Removal: Supplies and Procedure

00:01 Once you have decided to attempt a removal, there are a sequence of steps you need to follow. Let's begin by walking you through the steps verbally, and then I'll show you how to perform the procedure.

00:13 First, patient consent.

00:15 Before the procedure, you want to explain the goal to the patient, which is to remove the foreign body with as little discomfort as possible.

00:23 Make sure you are following and using your facility policies for consent forms.

00:29 You do this before giving the patient anything orally or for anxiety or pain.

00:35 Some policies may even require before and after photography.

00:42 Because splashing or jerking is possible, wearing goggles or face mask is recommended.

00:47 And of course you'll be wearing gloves.

00:50 I always recommend you gather more equipment than you need, because there's nothing worse than getting inside someone's body and needing another tool. Regular gloves are needed.

01:02 A sterile field setup.

01:04 Local anesthetic 1% lidocaine with epinephrine.

01:09 Chloraseptic or iodine prep.

01:12 Wire cutters and needle driver.

01:14 Forceps. Normal saline for irrigation.

01:18 Antibiotic ointment and check for sulfa allergies.

01:22 Goggles on the face are also needed.

01:26 Step two. We're going to prepare for the procedure.

01:29 You want to make sure that you have saline for irrigation of the wound.

01:33 You also want to make sure that you have iodine or chlorhexidine to clear the area before you do a field block.

01:41 You also want to make sure that the patient is fully anesthetized.

01:45 So you're going to make sure to try a pricking test before going forward.

01:50 They should feel the pressure but not the pain.

01:53 Then you're going to select the removal technique based on the hook location.

01:58 You're going to consider advanced technique.

02:01 Pushing the hook through to cut the barb.

02:04 And then using the backout technique which is going to be reversed direction of the entry.

02:10 You're going to control the hook shaft with a needle driver.

02:13 So this is going to be very similar to putting in a suture.

02:17 You're going to cut the barb at the end depending on how the hook has to be removed.

02:22 And you're going to remove using the chosen technique with smooth deliberate motion.

02:29 You're going to irrigate the wound thoroughly after the removal, as well as assess for any retained fragments and assess for pain and bleeding.

02:39 Then we want to talk about post care instructions.

02:42 You're going to apply antibiotic cream.

02:45 You're going to put a dry gauze with some non-adherent dressing over it.

02:50 You're going to provide aftercare instructions, of course, to your patient, including signs and symptoms of infection.

02:57 In some cases, you may need to prescribe antibiotics if they're indicated.

03:02 So you want to make sure what your patient's allergic to.

03:05 Use over-the-counter pain medications when appropriate according to your patient's history, and you're going to follow up with your primary care provider within one week to make sure the wound is healing appropriately.