Definition
Instilling ear drops is a common yet delicate nursing procedure used to treat infections, soften wax, relieve pain, or deliver local medications.
Purposes of Instilling ear drops
- To soften ear wax for removing it.
- To reduce localized inflammation and destroy infective organisms in the external ear canal.
- To relieve pain.
- To facilitate removal of foreign body
Contraindication Instilling ear drops
- Rupture of tympanic membrane.
Articles Instilling ear drops
- Clean gloves (optional)
- Cotton-tipped applicators Medication bottle with dropper
- Medication bottle with dropper
- Cotton balls
- Kidney basin
- Bowl with normal saline (optional).
Procedure Instilling ear drops
| Nursing Action | Rationale | |
| 1. | Before procedure Assess for: Allergy to medication. Redness/abrasion in the pinna/meatus. Type and amount of discharge. Complaints of discomfort. Ability to cooperate during procedure. Specific drug action and side effects. Patient’s knowledge about medication to be administered. | Identifies contraindication for ear instillation. |
| 2. | Check medication order for name, dose, time, amount and ear to be treated. | Reduces risk of medication errors. |
| 3. | Identify patient and explain procedure, the purpose of medication and position to assume during and after instillation. | Reduces anxiety and promotes cooperation of patient. |
| 4. | Obtain assistance in case of children or infants, to immobilize them. | Prevents accidental injury due to sudden movement during the procedure. |
| 5. | Assist patient to a side – lying position with ear being treated uppermost. | |
| 6. | During procedure Wash hands. | Prevents cross contamination. |
| 7. | Clean the external ear canal, using cotton-tipped applicators. Use normal saline, if necessary. | Removes any discharge before instillation. |
| 8. | Warm container in hand or by placing it for a short time in warm water. | Promotes patient comfort and prevents vertigo and nausea. |
| 9. | Fill ear dropper partially with medication. | |
| 10. | Straighten auditory canal. For an infant or child less than 3 years, pull pinna down and back. For an adult or child older than 3 years, pull pinna upward and backward. | Straightening the canal can ensure solution to flow the entire length of the canal. |
| 11. | Instill correct number of drops alongside of ear canal by holding the dropper one centimeter (½ inch) above ear canal. | Reduces trauma to tympanic membrane. |
| 12. | Press gently and firmly a few times on the tragus of the ear. | Pressing on the tragus assists flow of medication into ear canal. |
| 13. | Instruct the patient to remain in side-lying position for about 5 minutes. | Prevents drops from escaping and enables medication to reach all sides of canal. |
| 14. | Insert a small piece of cotton fluff loosely at the canal for 15-20 minutes. | The cotton helps to retain medication when patient is upright. If pressed too tightly, the cotton will interfere with the action of drug and movement of secretion. |
| 15. | After procedure Assess for patient’s comfort, response and check for discharge/drainage from the ear. | |
| 16. | Replace medication and other articles. | |
| 17. | Wash hand. | Reduces spread of microorganisms. |
| 18. | Document medication administration, name of medication, number of drops administered, and patient’s responses. |
Special Considerations
- Use sterile technique in administration of medication in case of perforation of the tympanic membrane.
- Hydrocortisone ear drops are contraindicated in patients with fungal/viral infection in the ear.
Paediatric Variation
- Position: Prone or supine with head turned to the opposite side.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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