Learn the procedures, steps, risks, and requirements for ear irrigation.
When wax builds in a patient’s ear canal, nurses may need to perform an ear irrigation. If performed incorrectly, ear irrigations can lead to adverse events such as infection and tympanic membrane perforation. Manually removing earwax with instruments like forceps requires adequate visualization, training, experience, and a cooperative patient.
This article will focus on the art of ear irrigations, an essential task for nurses and other medical staff. Mastering these skills may open doors in a nurse’s career and contribute to higher patient satisfaction rates.
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Nurses assist their patients in several ways. Depending on their work environment, they may need to irrigate ears to remove ear wax or remove foreign objects from their patient’s ear canal. Typically, it’s performed on patients who suffer a wax buildup that weakens their hearing.
If you’re studying to become a Registered Nurse (RN), it would be beneficial to learn the proper technique for ear irrigation in a medical environment.
Definition of Ear Irrigation
Ear irrigation is a procedure in which nurses flush their patient’s ear canal with sterile water or saline solution. This is usually done to cleanse the ear canal of any discharge, soften and remove impacted ear wax, or extricate a foreign body from a patient’s ear.
Some common terms associated with ear irrigation:
- Cerumen. Otherwise known as “earwax,” cerumen is a normal substance found in the ear canal.
- Cerumen impaction. An impaction is the result of buildup that prevents assessment of the ear canal or causes other symptoms.
- Cerumen obstruction. This is a buildup of cerumen that totally blocks the ear canal.
How Long Does It Take to Irrigate an Ear?
Irrigation is typically a safe and relatively comfortable method of earwax removal. Most professionals can complete the entire process in about 30 minutes or less.
Who Administers Ear Irrigation?
Various healthcare professionals can perform ear irrigations. In most healthcare settings, nurses will often be required to perform ear irrigations on their patients. It may sound like a simple procedure, but ear irrigations can easily lead to infection or ruptured eardrums if performed incorrectly. Nurses who handle these procedures must take all the necessary precautions. Some RNs may even be tasked with training new employees on how to perform ear irrigations.
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Training Requirements for Ear Irrigation
When manually removing earwax, an RN must be familiar with the anatomy of the ear. They should also be competent in using instruments like an otoscope, headlamp, or binocular microscope. Why? If performed incorrectly, they could pierce the membrane or cause trauma associated with pain, bleeding, and laceration.
To lower the potential for these adverse outcomes, nurses should receive the appropriate education and adequate training required to properly perform an ear irrigation. Some organizations have created educational modules for ear irrigation that nurses and Medical Assistants (MAs) complete in addition to their required training.
After the module has ended, these healthcare professionals practice ear irrigations on a medical mannequin. Then, they demonstrate their competency to a nurse educator, who will assess them using a skills checklist.
Necessary Equipment for Ear Irrigation
To perform ear irrigation, you’ll typically need:
- Irrigating solution warmed to 98.6 F
- Irrigation set (i.e., container and irrigating or bulb syringe)
- Emesis basin, or a shallow basin
- Cotton-tipped applicator
- Cotton balls
- Waterproof pad
Ear Irrigation Procedure
A Detailed Guide to Irrigate a Patient’s Ear
By reviewing the following steps, you can begin to learn more about the process of ear irrigation. Like any other skill, ear irrigation requires both time and practice to master. While in school, try not to feel disheartened if you don’t get it right the first time, and don’t hesitate to ask for your instructor’s help.
Ear Irrigation Steps
The following are some of the general guidelines you should follow when performing a manual ear irrigation:
- Ensure there are no contraindications or situations in which the procedure would be harmful to the patient.
- Explain the procedure to the patient. This will likely help them feel calm and reassured.
- Gather the necessary equipment. Remember to use a moisture-proof bad for the patient as well as their bed.
- Thoroughly wash your hands.
- Instruct the patient to sit up or lie down with their head tilted toward their ear. Ask them to hold an emesis basin under their ear to capture the solution.
- Clean the outer ear as necessary using normal saline or irrigating solution.
- Fill your bulb syringe with solution. Note: If you’re using an irrigating container, don’t forget to let air escape from the tubing.
- Straighten the patient’s ear canal by pulling the pinna, or outer ear, one of two ways: a) down and back for an infant or b) up and back for an adult.
- Inject a slow but steady stream of the solution against the roof of the ear canal. Do NOT block the canal with the irrigating nozzle. You want to make sure the solution flows unimpeded.
- Once you have finished, gently place a cotton ball in the auditory meatus. Ask the patient to lie down on the side of their affected ear; they should use a towel or pad.
- Document everything. This includes the type, temperature, and volume of the solution that you used.
Ear Irrigation Recovery
Because earwax contains protective properties, the ear canal is more vulnerable to infection once it has been removed. Until it produces new wax, instruct your patient to keep their ear dry and not allow any water entry for at least five days.
The patient should consult a doctor immediately if they experience pain, dizziness, reduced hearing, or discharge.
Pro Tips for Mastering the Art of Ear Irrigation
Here are a few tips that may assist you with ear irrigations in the future:
- Always check for any contraindications or situations prior to performing an irrigation. For example, this procedure would be contraindicated if the auditory canal was blocked by vegetables like peas, beans, or corn kernels. These vegetables absorb moisture, which causes them to swell. Other examples of contraindication may include a cold, fever, or ear infection.
- Avoid dropping on the eardrum. Never use more than 500 ml of irrigation solution. If the patient’s membrane is ruptured, check with the doctor before irrigating. Continuously monitor the temperature of the solution carefully.
- If it’s an organizational requirement, acquire a healthcare provider’s order before performing the procedure. Also, be sure to obtain a comprehensive patient health history.
- Consider the frequency of your patient’s ear irrigations. Too many irrigations may increase the buildup of earwax, leading to a cycle of irrigation, more earwax, irrigation, etc.
- Use disposable equipment to prevent contamination. Even after cleaning, particles have been previously found in reusable tips.
- Document the appearance of the tympanic membrane (eardrum) and ear canal after ear irrigation. This will help you identify any potential complications.
- The right temperature and amount of irrigation solution are critical to patient safety.
- The water should be between 98.6 and 104.9 degrees Fahrenheit to lessen dizziness and avoid a caloric response.
- Do not use more than 500 mL of fluid per ear. This decreases the possibility of edema, infection, and perforation.
- Pretreat the patient’s ear with 2-4 drops of warm water. Wait at least 15 minutes for the earwax to soften.
- If the patient says they are experiencing pain, dizziness, tinnitus, or have earwax remains even after 500 mL of fluid has been used, notify their healthcare provider immediately.
Why Should Nurses Learn How to Administer Ear Irrigation?
Supporting the healthcare team by providing ear irrigations may often be part of a nurse’s routine. Performing this task successfully can help facilitate the healing process and contribute to your patient’s overall comfort.
Some organizations feel that every facility should employ nurses or assistants trained in ear irrigation. They state that the gold standard of ear care provision and patient safety would be the widespread availability of microsuction. They also believe that new patients should be asked about their hearing during that first appointment.
In addition, children and people with cognitive impairment or learning disabilities should have their ears examined at every appointment. A doctor or a nurse could perform this exam.
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