Effective Date: August 31, To provide guidelines for the proper administration of ear irrigation
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1 SUBJECT: EAR IRRIGATION 1. PURPOSE: COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION - Treatments POLICY NUMBER: 406 Effective Date: August 31, 2006 To provide guidelines for the proper administration of ear irrigation 2. POLICY: 1. Ear irrigation may only be administered on the current order of a licensed physician or other licensed clinician who is legally authorized to write orders. 2. Ear irrigation may be administered by the Registered Nurse. The RN is expected to be familiar with: The Individual s diagnosis and nursing implications associated with the diagnosis, purpose of ear irrigation and its therapeutic effects, and possible untoward effects The nursing considerations for ear irrigation Method of application Individual teaching Adverse side effects Contraindications for ear irrigation 3. The RN is responsible for insuring the ear irrigation is administered safely and that the Individual, through education and therapeutic counseling is assisted to understand and participate in this form of treatment intervention. 4. The Individual is to be assessed on a continual, ongoing basis to provide the physician with data that assist in establishing the diagnosis, supports the need for ear irrigation, and identifies if a therapeutic effect is being achieved ad maintained. 3. DEFINITION: Ear Irrigation- irrigation of the external ear canal delivered through a stream of solution for removal of a foreign body, cerumen, or preventing local inflammation of the canal. -1-
2 4. COMPETENCY/TRAINING: 1. Nursing practice requires that Nursing Services staff continue to update their knowledge base concerning medications and treatments and for developing and maintaining skills that enables this staff person to administer all types of medications/treatments correctly. 2. All level of care nursing staff personnel are required to attend the Principles of Medication Administration at the time of hire and the Medication Re-certification class annually. 5. SAFETY PRECAUTIONS: 1. Inspect external ear with the otoscope to assess the condition of the canal before irrigating. DO NOT irrigate if Individual has a perforated eardrum. 2. DO NOT irrigate the ear if a foreign body such as a bean or piece of corn is present (will absorb water & make removal difficult). 3. Irrigation should be done with liquid warmed to body temperature to avoid vertigo (dizziness) or nausea in Individuals. 4. The greatest danger during administration of ear irrigation is rupture of the tympanic membrane. Fluids must not be instilled under pressure or with the ear canal occluded by the irrigation device. 5. Nursing personnel, having direct contact or the potential for contact with exposure to blood, body fluids, or other potentially infectious material of Individuals or staff, are expected to practice STANDARD PRECAUTIONS according to guidelines established by the CSH Infection Control Program. 6. ASSESSMENT: 1. Review the physician s order for the specified solution, purpose of treatment and amount of irrigation. 2. Assess Individuals level of cooperation and understanding of procedure in order to perform the procedure safely ad to provide health education. 3. Assess the external auditory canal for signs of redness, swelling, abrasions, edema, discharge, occlusion, foreign body, or tumors. 4. review medical record for history of ruptured tympanic membrane or visualize Individual s tympanic membrane using the otoscope. 5. Observe the tympanic membrane for ay abnormalities (a dull, bluish or pearly gray, translucent appearance should be present). 6. Ask the Individual if he/she is experiencing discomfort. Note Individual s ability to hear. 7. Review Individual s knowledge of purpose for irrigation and of normal care of the ears. 7. PLAN: 1. Allay the Individual s fear and anxiety -2-
3 2. Prevent further damage and infection to the ear 3. Provide Individual teaching on proper care of ears 4. Offer a thorough explanation of what will occur during the procedure 5. Obtain the Individual s cooperation in remaining still during the examination and procedure. 6. Skin overlying the meatus and canal becomes clear, without redness, swelling, tenderness or discharge. Canal is clear of cerumen and foreign material. 7. Warn Individual that the irrigation may cause sensation of dizziness, ear fullness, and warmth. 8. EQUIPMENT: 1. Obtain prescribed irrigating solution 2. Curved basin, towels, & cotton balls 3. Otoscope 4. Disposable Gloves 5. Water pic is used in the clinic for ear irrigation on the lowest pressure setting 6. Syringe-type: 4oz. stainless steel 9. IMPLEMENTATION AND INTERVENTIONS: NURSING ACTION KEY POINTS A. Wash hands before and after A. Reduces transfer of procedure, arrange supplies and apply microorganisms, helps the nurse to gloves perform procedure smoothly. B. Assist Individual to a sitting or lying B. Position minimizes leakage of fluids position with head turned toward around neck and facial area. Solution affected ear. Place towel under will flow from ear canal to basin Individual s head and shoulder and have the Individual hold basin under affected ear C. Gently clean auricle and outer ear C. Prevents infected material from canal with moistened cotton applicator. reentering ear canal. Do not force drainage or cerumen into the ear canal. D. Examine ear(s) prior to procedure D. Findings provide baseline to monitor effects of medication or solution E. Place a rounded speculum on the end of the otoscope. Use a speculum that will comfortably fit into the external auditory canal. Check to see that the light is working. E. The larger speculum provides better visualization F. Gently pull the pinna Upward and F. Pulling the ear and inserting the -3-
4 Backward. Insert the speculum just inside the external opening. To visualize the entire canal, tilt the otoscope and change body position G. Fill irrigating syringe with solution (approximately 50ml.) H. Slowly instill irrigating solution by holding the tip of the syringe 1cm above the opening to the ear canal. The fluid should be directed toward the superior aspect of the ear canal. Allow the fluid to drain out during instillation. Continue until canal is cleansed or solution is used I. Do not occlude the canal with the tip of the syringe. J. Irrigate until return fluid is clear or as ordered. Examine contents of basin and clean K. Dry outer ear canal with cotton ball. Leave cotton loosely in pace for 5-10 mins. L. Remove towel and leave Individual comfortable M. Emphasizes the importance of keeping foreign/sharp objects out of ears N. Clean all reusable equipment with soap and water, detergent, or bleach solution. Return equipment and discard disposable gloves/supplies visible soiled in the biohazards waste container. speculum along normal curves of the canal will minimize discomfort and the chance of trauma. DO NOT continue procedure if visualization of tympanic membrane is reddened, perforated, or foreign object is visualized. Contact the physician for further evaluation. G. Enough fluid is needed to provide a steady irrigating stream. H. Slow instillation prevents buildup of pressure in the ear canal and ensures contact of the solution with all canal surfaces. Discontinue treatment if Individual complain of severe pain, nausea, dizziness, or faintness. I. Build up of fluid in canal under forced pressure could cause rupture of the tympanic membrane K. Maintains comfort. Absorbs excess moisture in ear canal N. Reduces transmission of infection. 10. EVALUATION: Documentation in IDN should include: 1. After administration of ear irrigation, the Individual should be observed for desired results, expected side effects, and untoward reactions. 2. Observe, report to physician, and record in the ID Notes any adverse reactions and, or unexpected outcomes. -4-
5 3. Re-inspect condition of meatus and canal to determine if solution relieves symptoms and removes foreign materials 4. All treatments given must be charted on the Treatment record within one hour of administration 5. Document all Individual teaching in the IDN of the procedure, amount of solutions instilled, time of administration and ear receiving the irrigation. -5-
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