Eye drop instillation

Authors: Rednenko V.V., Rednenko L.I.

Editor: Rednenko V.V.

Equipment for the practical skill:

• patient or simulator for eye drop instillation sitting on a chair or lying on a bed
• manipulation table (bedside table)
• sterile solution of ophthalmic medication
• small gauze squares or cotton balls
• sterile normal saline solution or antiseptic water solution (0.02% furacilin solution)
• tray
• container
• thermometer
• PPE: medical gown, hat, mask, non-sterile gloves
• MAR
• waste containers (tray)

Clinical situation:

• You are a nurse at a hospital. Install eye drops to patient as physician’s directives

Order of the skill performance:

Preparatory stage:

• Check the equipment at the workplace, complete the workplace if necessary
• Put on your protective equipment
  • Perform hygienic handrub
  • Put on your gloves
• Identify the patient
  • Say hello to the patient, introduce yourself;
  • Specify the last name, first name and patronymic of the patient, check the prescription sheet
• Get informed consent
  • Inform the patient about the upcoming manipulation,
  • Obtain verbal consent to conduct it
• Check physician's directives.

Maine stage:

• Help the patient to get into the required position:
  • Tilt the patient's head back slightly if he is sitting
  • Place the head over a pillow if he is lying down.
• Cleanse the eyelids and lashes (if necessary, in the presence of purulent discharge)
  • prepare an antiseptic to clean the eyelids and eyelashes
    • take a bottle with 0.02% furacilin solution
    • take a container and fill it with warm water
    • measure the temperature of the water in the container with a thermometer (say: Water temperature is 40 (40-45) ° C)
    • place the bottle with 0.02% furacilin solution for 1-2 minutes in a heating container (say: "Furacilin is heated to a temperature of 36-37 ° C")
    • place the bottle with 0.02% furacilin solution on the manipulative table
  • perform hygienic hand antisepsis, put on non-sterile gloves
  • open the  the bottle with 0.02% furacillin solution and pour 1-2 ml of this solution into the tray
  • open the pack of cotton balls, take one and moisten it with 0.02% furacilin solution
  • ask the patient to close the eye and wipe the eye with only one stroke from the outer to inner canthus of the eye with the moistened  ball

• Wipe this eye with a movement from the outer corner of the eye to the inner, taking a clean, dry cotton ball.
• repeat the manipulation with the other eye in the same sequence, taking a clean cotton ball
  • take a cotton balls or gauze pledgets
  • moisten them with normal saline
  • use each cotton ball or pledget for only one stroke, moving from the outer to inner canthus of the eye.

• Instill the drops
  • Fill eye dropper with medication but prevent from flowing back into the bulb end.
  • Using forefinger, pull lower lid down gently.
  • Instruct patient to look upward.
  • Hold the dropper close to the eye but avoid touching the eyelids.

• • Allow the prescribed number of drops to fall in the lower conjunctival sac but do not allow to fall onto the cornea.
  • Release the lower lid after the drops are instilled.
  • Press the inner corner of the eye with a sterile ball for 1-2 minutes so that the drug does not slide down the lacrimal canal into the nose
  • Instruct the patient to close their eyes and make circular rotational movements of the eyeballs
  • Wipe off excess solution with gauze or cotton balls
• Repeat the procedure with the other eye in the same order
• Ask the patient how he is feeling

Final stage:

• place the ball in the "Dressing disinfection, PPE" container
• place the package from the balls in the container "Packaging"
• remove gloves and place in container "Dressing disinfection, PPE"
• perform hygienic hand washing
• close the bottle with furacilin and put it in a storage place
• close the vial with the drug and put it in the storage place
• put the thermometer in storage
• register the performed manipulation in the medical records