pressure directly to the stud on the anterior surface to guide the backing out of the posterior earlobe while spreading the posterior skin with the other hand Consider inserting forceps or hemostats into the posterior opening to grasp the earring backing The elasticity of tissue in the earlobe frequently allows for the backing to be removed from the pre-existing skin opening However, if an incision is required, use a no 11 scalpel blade to make a small incision over the palpable object to reveal the imbedded jewelry Once the necessary portions of the jewelry are visible, remove as instructed above Simple suture closure may be necessary Following the procedure, provide instructions for keeping the area clean with warm compresses if necessary Topical antibacterial ointment or systemic antibiotics should be prescribed if clinically indicated REMOVAL OF FISH HOOKS Indications Presence of a barbed fish hook through the epidermis Fish hooks embedded in or around the eye should be removed with the direct involvement of ophthalmology to prevent or avoid further injury to the globe Complications Infection Direct damage to tissue Equipment Antiseptic solution 5-mL syringe, 27- or 30-gauge needle Lidocaine 1% Needle holders Procedure Barb cut ( Fig 130.42A ) Explain the procedure as appropriate to the child and the parent or guardian Position and restrain the child to provide easy access to the fish hook Cleanse the area with antiseptic solution Achieve local anesthesia by injecting 1% lidocaine into the surrounding skin or, when appropriate, perform a digital block Wearing gloves, grasp the fish hook with needle holders Apply advancing pressure along the curve of the fish hook (proximal to distal) to force the barb end of the hook out through the skin ( Fig 130.42A , part 1) After the barb has been advanced through the skin, clip the barb with a wire cutter ( Fig 130.42A , part 2) The remainder of the hook can then be withdrawn along its original path of entry ( Fig 130.42A , part 3) String removal ( Fig 130.42B ) When the fish hook lies too deep to force through a second wound, an alternate method can be used Explain the procedure and restrain the child as necessary Cleanse the area with antiseptic solution Achieve local anesthesia by injecting 1% lidocaine needle into the surrounding skin Loop a piece of string around the hook (part 1) With the nondominant hand, depress the shaft of the hook against the skin (part 2) Grasp the end of the string with the dominant hand and pull sharply (part 3) This action should disengage the barb, and the hook can be removed through the entry wound Following removal, cleanse the area and apply a dressing Give active or passive tetanus immunization as indicated Consider antibiotic prophylaxis in immune-compromised patients