Ears drops instillation

Authors: E.V. Poplavets

Editor: V.V. Rednenko

Equipment for the practical skill:

• simulator (mannequin) with auricles and external auditory canals
• manipulation table
• disinfection table
• medicine for instillation into the ears (in a polyethylene bottle with a 10 ml dropper-dispenser as prescribed by a specialist doctor)
• 3% hydrogen peroxide in a polyethylene bottle with a dropper dispenser (if necessary)
• sterile cotton turunds in individual packaging (if necessary)
• sterile cotton balls individually wrapped
• tweezers in a container with a disinfectant solution
• a container with water for heating a medicine
• thermometer for measuring water temperature
• napkin (towel)
• PPE: medical gown (suit), medical cap, non-sterile gloves
• container "Disinfection of dressing material, PPE"
• container "Packing"
• appointment sheet

Clinical situation:

• You are a physician assistant at a district hospital. Patient V., 46 years old, is hospitalized. Complains of pain in the external auditory canal, hearing loss in the ear (right / left).
• Instill drops into the ear as prescribed by a doctor, if necessary, pre-run the toilet of the external auditory canal.

Possible complications:

injury to the ear canal and painful sensations in the patient during rough manipulation

Preparatory stage:

• do a hygienic hand wash
• check the integrity and expiration date of the balls packaging, turund
• check the integrity, appearance and shelf life of the medicine vial, 3% hydrogen peroxide
• say hello to the patient, introduce yourself
• identify the patient by asking for the last name, first name, patronymic and check with the prescription sheet
• inform the patient about the upcoming injection of the drug into the ears, explaining the purpose and course of the manipulation
• ask if this drug has been instilled into the ears before and if there has been an allergic reaction to it
• obtain oral consent for the medication to be instilled into the ears
• check the name, dose and method of administration of the medicinal product indicated on the vial with the entry in the prescription sheet
• mark the vial with the medicine (say: "I indicate the patient's full name and the date of opening on the vial label")
• warm the medicine (if necessary - and a bottle with 3% hydrogen peroxide) for instillation into the ears:
  • take a thermometer and put it in a container of water to heat the medicine
  • check the temperature of the water (say: "The temperature of the water should be 40-45 ° C") and remove the thermometer from the container with water and put the manipulation on the table
  • place a bottle with a medicine (with 3% hydrogen peroxide) for 1-2 minutes in a container for heating the medicine (say: "The drops are heated to a temperature of 36-37 ° С")
  • put the bottle with the drug (3% hydrogen peroxide) on the manipulation table

The main stage:

• invite the patient to lie on their side so that the affected ear is on top or in a sitting position, tilt the head in the opposite direction from the instillation
• examine the external auditory canal and make sure that there is no discharge in it (say: "If there is a discharge in the ear canal, inform the doctor")
• cover the patient's shoulder with a tissue or towel
• perform hygienic hand antiseptic, wear non-sterile gloves
• if necessary (there is a pathological secretion in the ear) - perform a preliminary toilet of the ear canal:
  • open the package with cotton turunds
  • take the bottle with 3% hydrogen peroxide, remove the cap from the bottle and place it on the manipulation table
  • take the bottle with the first, second and third fingers of your right hand and turn it upside down
  • straighten the ear canal with the first and second fingers of the left hand
    • for an adult patient pull the auricle up and posteriorly

• • • for children under 2 years of age pull the auricle down and back

• • insert the dropper-dispenser with your right hand into the external auditory canal by 3-4 mm
  • press the first and second fingers of the right hand several times on the body of the bottle and drip 6-8 drops of 3% hydrogen peroxide along the outer wall of the ear canal
  • remove the dropper from the ear canal
  • place the medicine bottle on the treatment table
  • wait 1-2 minutes for the secretion to soften
  • with a cotton turunda, remove the pathological secret with rotational movements
• drop the medicine into the ear:
  • open the package with cotton balls
  • take the medicine bottle, with the other hand remove the cap from the bottle and place it on the treatment table
  • Take the medicine bottle with the first, second and third fingers of your right hand and turn it upside down
  • straighten the ear canal with the first and second fingers of the left hand, pulling the auricle up and posteriorly (for children under 2 years of age, pull the auricle down and back)
  • insert the dropper-dispenser with your right hand into the external auditory canal by 3-4 mm
  • press the first and second fingers of the right hand several times on the body of the bottle and drip the required number of drops along the outer wall of the ear canal
  • remove the dropper from the ear canal
  • place the medicine bottle on the treatment table
  • press gently with the second finger of the right hand several times on the ear trag
  • Take the ball from the package with your right hand and insert it into the external auditory canal, placing it superficially behind the ear tragus
  • check the position of the patient after the introduction of the drops (say: “After the introduction of the drops, the patient should lie on the healthy side for 5-10 minutes)
  • remove the ball from the ear with your right hand (say: "The ball is removed from the ear in 5-10 minutes")
• treat the other ear in the same sequence (if necessary)
• ask the patient how they are feeling

The final stage:

• place the ball in the container "Disinfection of dressings, PPE"
• place the balloon packaging in the "Packaging" container
• take off the gloves and place them in the container "Disinfection of dressings, PPE"
• do a hygienic hand wash
• close the vial with 3% hydrogen peroxide and put it in storage
• close the medicine bottle and put it in storage
• place the thermometer in storage
• register the performed manipulation in the medical records

Note:

• these actions are performed with the right hand, left-handed people are performed with the left
• the drug vial should only be used by one person due to the risk of transmission

Grounds: order of the Ministry of Health of the Republic of Belarus on 03/11/2020 No. 287 "On approval of algorithms for performing medical and diagnostic manipulations using simulation equipment"