Gunshot wounds and shrapnel injuries are all too common during war, but even within the borders of the United State the rate of gun violence is alarmingly high.  It is a widely accepted practice to remove embedded fragments that are easily accessible, but to leave those that are hard to reach.  However, the debate over whether to aggressively remove embedded shrapnel is reemerging as a result of continued research into the health effects of embedded heavy metal fragments such as depleted uranium and tungsten alloy and concerns over carcinogenicity of some heavy metals.  Careful evaluation of the literature and emerging research highlights the need to review the practice of leaving shrapnel embedded and identifies a gap in nursing research.