Ear Irrigation
Anatomy
• Outer Ear
• Pinna or Auricle
• External Auditory Canal
• Tympanic Membrane
• Middle Ear
• Ossicles
• Malleus
• Incus
• Stapes
• Eustachian Tube
• Inner Ear
• Cochlea
• Vestibule
• Semicircular canals
Philosebaceous Glands
• Ceruminous Glands
• Hair Follicles
• Sebaceous Glands
Cerumen Impaction
• Feeling of fullness in the ear
• Otalgia
• Itchy ear
• Imbalance
• Cough
• Decreased in hearing
• EAR IRRIGATION
The most common ear, nose, and throat procedure carried out in primary care
Purposes:
• Remove excess wax/ cerumen
• Remove debris occluding the ear canal
• Remove foreign bodies that are not hydroscopic
Common Cause:
• Use of hearing aids
• Persistent use of ear plugs
• Cleaning the ears with cotton swabs
Contraindications
• Patient’s inability to sit upright
• Patent tympanostomy tube
• Unable to sit still
• Perforated tympanic membrane
• Opening into the mastoid
• Severe swimmer’s ear or ear infection
• Immunocompromised
• Cleft palate
EQUIPMENT
• Face Shield
• Otoscope
• Cerumenolytic of choice
• Warm water or saline
• 30 or 60ml syringe
• G16 or 18 IV catheter
• Kidney Basin
• Underpad
• Clean gloves
• Apron or gown
• Alligator forcep
STEP BY STEP PROCEDURE
1. Introduce yourself, verify the patient’s identity
2. verify doctor’s order and obtain the patient’s consent by explaining the procedure, risks, and
possible complications
3. Prepare the equipment
4. Perform Hand hygiene and Don PPE (Personal Protective Equipment)
5. Assess the external ear through inspection and palpation, then the ear canal up to the tympanic
membrane using the otoscope
6. Ask the patient to sit upright and apply cerumenolytic of choice in the External ear canal leaving
it for 15-30mins
7. Draw warm water into the syringe and attach IV catheter to the end of the syringe
8. Position the IV catheter into the External ear canal and ask the patient to hold the kidney basin
tightly below the ear
9. Direct the IV catheter superiorly and posteriorly in the ear canal
10. Following irrigation, remove any lose piece of wax with a cerumen scoop or alligator forceps
11. Dry the ears and offer towel if needed
12. Re-assess the ears once again for the need to repeat the procedure or for possible
complications.
13. Assist the patient to a comfortable position
14. Doff PPE
15. Document the procedure and evaluate the patient’s response
STOP WHEN THERE IS…
• Sudden pain
• Ringing in the ears
• Loss of the ability to hear
• Nausea
• Dizziness
SIDE EFFECTS
• Temporary dizziness
• Ear canal discomfort or pain
• Tinnitus
COMPLICATIONS
• Otitis externa
• Vertigo
• Perforation of the tympanic membrane
Eye Irrigation
Anatomy
EYE IRRIGATION
Is a procedure involving washing of the conjunctival sac by a stream of liquid
PURPOSES
• Treat inflammatory process of the conjunctiva
• Application of medication
• Prepare for eye surgery
CHEMICAL EYE BURNS
• Most common eye injury
• Extent of the ocular surface damage is influenced by the type, temperature, volume, and pH of
the corrosive substance and duration of exposure
INSTILLING MEDICATION
• Intraocular ophthalmic irrigation
a sterile cleansing solution.
used to maintain the natural condition of the eye during a surgical procedure such as cataract
surgery
CONTRAINDICATIONS
• Protruding foreign body
• Penetrating eye injury
• Suspected or actual rupture of the globe
• Instilling irrigation with medications on patients with known allergy
EQUIPMENT
• Faceshield
• Apron or gown
• Clean Gloves
• Kidney Basin
• Underpad
• Syringe 20 or 30cc
• Irrigating solution
• 4x4 gauze
• Towel
STEP BY STEP PROCEDURE
1. Introduce yourself and verify the patient’s identity.
2. verify doctor’s order and obtain the patient’s consent by explaining the procedure, risks, and
possible complications
3. Prepare the equipment
4. Perform hand hygiene and Don PPE (Personal Protective Equipment)
5. Have the patient lie with the head tilted on the affected eye, put on underpad under the
patient’s head
6. Clean lids and lashes with gauze moistened with water or normal saline. Wipe from inner to
outer cantus and use different corner of gauze with each wipe
7. Place kidney basin at cheek on the side of the affected eye, if the patient is able, ask him to hold
the basin
8. Place thumb near margin of lower eyelid and two fingers above eye. Apply pressure downward
to expose the lower conjunctival sac as the lower lid is pulled down. Hold upper lid open with
your fingers.
9. Fill the irrigation syringe with the prescribed fluid. Hold irrigation syringe about 2.5 cm (1 in)
from eye. Direct flow of solution from inner to outer canthus along the conjunctival sac.
10. . Irrigate until the solution is clear or all the solution has been used.
11. Pause the irrigation and have the patient close the eye periodically during the procedure.
12. Dry the periorbital area after irrigation with gauze sponge. Offer a towel to the patient if face
and neck are wet.
13. Assist the patient to a comfortable position.
14. Doff PPE
15. Document the procedure and evaluate patient’s response.
SIDE EFFECTS
• Vision problems
• eye pain or redness
• increased sensitivity to light
• headache; or
• mild eye discomfort.
COMPLICATIONS
• Corneal abrasion
