Objective: To cleanse the canal of discharge, to soften and remove impacted cerumen, or to dislodge a foreign object.
Indication: Cerumen impaction or a foreign body in the ear.
Contraindication: This procedure is contraindicated when the auditory canal is obstructed by a vegetable foreign body such as pea, bean, or corn kernel. These vegetable absorb moisture, causing them to swell. The procedure is also contraindicated if the patient has a cold, fever, ear infection or unknown injury or rupture of the tympanic membrane.
Nursing alert: Avoid dropping or squiring on the ear drum. Never use more than 500 ml of solution. If the tympanic membrane is ruptured, check with the doctor before irrigating. Monitor temperature of solution carefully. Forceful instillation of the solution can rupture the tympanic membrane. If pain or dizziness occurs, stop the procedure.
Charting: Document the date and type of irrigation and which ear was irrigated. Also note volume and type of solution and the appearance of the return flow
a.Discard equipment in appropriate area.
bWash your hands.
Equipment: Prescribed irrigating solution warmed to 37 C (98.6 F), irrigation set (container and irrigating or bulb syringe), emesis basin, cotton-tipped applicator, cotton balls, waterproof pad.
1.Explain the procedure to the client.
Rationale: Explanation facilitates cooperation and provides reassurance for the patient.
2.Assemble the equipment. Protect the client and bed linens with a moisture proof pad.
Rationale: This provides for an organized approach to the task.
3.Wash your hands.
Rationale:Handwashing deters the spread of microorganisms.
4.Have the client sit up or lie with the head tilted toward the side of the affected ear. Have the client support a basin under the ear to receive the irrigating solution.
Rationale: Gravity causes the irrigating solution to flow from the ear to the basin.
5.Clean the pinna and the meatus at the auditory canal as necessary with the normal saline or the irrigating solution.
Rationale: Materials lodged on the pinna and the meatus may be wahed into the ear.
6.Fill the bulb syringe with solution. If an irrigating container is used, allow air to escape from the tubing.
Rationale: Air forced into the ear canal is noisy and therefore unpleasant for the client.
7.Straightening the auditory canal by pulling the pinna down and back for an infant and up and back for an adult.
Rationale: Straightening the ear canal aids in allowing solution to reach all areas of the ears easily.
8.Direct a steady, slow stream of solution against the roof of the auditory canal, using only sufficient force to remove secretions. Do not occlude the auditory canal with the irrigating nozzle. Allow solution to flow out unimpeded.
Rationale: Solution directed at the roof of the canal aids in preventing injury to the tympanic membrane. Continuous in-and-out flow of the irrigating solution helps prevent pressure in the canal.
9.When the irrigation is completed, place a cotton ball loosely in the auditory meatus and have the client lie on the side of the affected ear on a towel or an absorbent pad.
Rationale: The cotton ball absorbs excess fluid. Gravity allows the remaining solution in the canal to escape from the ear.
10.Wash your hands.
Rationale: Handwashing deters the spread of microorganisms.
11.Chart the irrigation, the appearance of the drainage, and the client’s response.
Rationale: This provide accurate documentation.