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Wash hands and assemble the necessary equipment (see Box 2). Use disposable single-use items where possible.3


Sit at the


same level as the patient and examine the outer ear and surround- ing scalp. Refer any non-healing skin lesions or skin problems to the doctor. Check the ear using the auriscope, and if irrigation is necessary and the wax is soft enough, proceed with the irrigation. Explain the procedure and ask the patient to indicate if they have


any pain or dizziness. If this occurs the irrigation should be stopped and the patient advised to seek alternative options for clearing the wax. Similarly if the patient suddenly develops a cough during the procedure, this may indicate stimulation of the vagus nerve (the nerve runs along the floor of the ear canal) and the procedure should be stopped as there is a risk of a vasovagal attack. Protect the patient with a waterproof cape. Ensure you are


wearing a headlight and disposable gloves - research has indicated the possible presence of hepatitis B in ear wax.4


Remain


sitting at the same level as the patient. Run the water through the tubing into the receiver (noots tank) to expel any trapped water and to accustom the patient to the noise of the machine. Ask the patient to hold the Noots tank under the ear and with the pressure level set at minimum, run a few drops of water onto the outer ear to check that the temperature is acceptable. Direct the headlight at the ear and insert the jet tip just inside the ear, directing the tip towards the back of the head, at eleven o’clock for the right ear and one o’clock for the left ear.


‘The use of electronic irrigators that have been designed specifically for the purpose has resulted in far fewer problems due to the lower pressures involved’


Using the foot pump, direct a steady stream of water into the


ear until wax comes out. Avoid twisting the jet tip as this will cause trauma to the ear canal. If the wax is slow to move, the pressure can be increased to medium or high as necessary. Check the ear periodically with the auriscope to monitor progress and check for remaining wax. Continue until the ear is clear and the TM visible, or until one tank of water has been used. (Use no more than one tank per ear. If unsuccessful at this stage the patient should be advised to continue with olive oil for a few more days before any further attempts are made to irrigate). When the wax has been removed, dry mop the ear canal under


THE PROCEDURE Confirm the patient’s identity and obtain informed consent prior to starting the procedure. Take a history from the patient. It is useful to ascertain why the


problem has arisen. Explain that wax does have a protective and lubricating function. It is produced at the outer edge of the ear canal in the ceruminous glands, so when wax is seen up against the TM it may be because it has been pushed there by cotton buds or other items. Take the opportunity to advise the patient about avoiding the use of such items in the ear, and to use olive oil drops in the future if recurrent build-up is a problem. Do not perform irrigation if there are any contraindications, and


advise the patient accordingly if there are any special precautions (see Box 1). Remember ear irrigation should be a last resort so counsel the patient carefully and if there is any doubt, seek further advice.


direct light, using cotton wool wrapped securely around the end of a Jobson Horne probe without losing sight of the end of the probe. Remember the ear canal is approximately 24mm long in most people, so take care to hold the probe near the tip and rest the little finger on the cheek. Repeat this at least twice until the cotton wool is dry and no water remains in the ear canal. Stagnation of water and abrasions sustained during the procedure will predis- pose to infection so it is essential that dry mopping is performed properly.5


Examine the ear again using the auriscope and check


that the TM is intact with normal features i.e. pars tensa, pars flaccida, short process and handle of the malleus and light reflex.


FINISHING UP Remove gloves and decontaminate hands. Advise the patient to keep the ear dry for the next 24-48 hours. Document the process


www.nursinginpractice.com Nursing in Practice March/April 2012 75


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