Eardrops may be instilled to treat infection and inflammation, soften cerumen for later removal, produce local anesthesia, or facilitate removal of an insect trapped in the ear by immobilizing and smothering it.
Instillation of eardrops is usually contraindicated if the patient has a perforated eardrum, but it may be permitted with certain medications and adherence to sterile technique. Other conditions may also prohibit instillation of certain medications into the ear. For instance, instillation of drops containing hydrocortisone is contraindicated if the patient has herpes, another viral infection, or a fungal infection.
Equipment
Prescribed eardrops • patient's medication record and chart • light source • facial tissue or cotton-tipped applicator • optional: cotton ball, bowl of warm water.
Preparation of equipment
Verify the order on the patient's medication record by checking it against the physician's order.
To avoid adverse effects (such as vertigo, nausea, and pain) resulting from instillation of eardrops that are too cold, warm the medication to body temperature in the bowl of warm water or carry it in your pocket for 30 minutes before administration. If necessary, test the temperature of the medication by placing a drop on your wrist. (If the medication is too hot, it may burn the patient's eardrum.) Before using a glass dropper, make sure it isn't chipped to avoid injuring the ear canal.
Implementation
Wash your hands.
Confirm the patient's identity by asking his name and checking the name, room number, and bed number on his wristband.
If your facility utilizes a bar code scanning system, be sure to scan your ID badge, the patient's ID bracelet, and the medication's bar code.
Provide privacy if possible. Explain the procedure to the patient.
Have the patient lie on the side opposite the affected ear.
Straighten the patient's ear canal. For an adult, pull the auricle of the ear up and back. (See Positioning the patient for eardrop instillation.)
PEDIATRIC ALERT For an infant or a child under age 3, gently pull the auricle down and back because the ear canal is straighter at this age.
Using a light source, examine the ear canal for drainage. If you find any, clean the canal with a tissue or cotton-tipped applicator because drainage can reduce the medication's effectiveness.
Compare the label on the eardrops with the order on the patient's medication record. Check the label again while drawing the medication into the dropper. Check the label for the final time before returning the eardrops to the shelf or drawer.
To avoid damaging the ear canal with the dropper, gently support the hand holding the dropper against the patient's head. Straighten the patient's ear canal once again, and instill the ordered number of drops. To avoid patient discomfort, aim the dropper so that the drops fall against the sides of the ear canal, not on the eardrum. Hold the ear canal in position until you see the medication disappear down the canal. Then release the ear.
Instruct the patient to remain on his side for 5 to 10 minutes to let the medication run down into the ear canal.
If ordered, tuck the cotton ball loosely into the opening of the ear canal to prevent the medication from leaking out. Be careful not to insert it too deeply into the canalbecause this would prevent drainage of secretions and increase pressure on the eardrum.
Clean and dry the outer ear.
If ordered, repeat the procedure in the other ear after 5 to 10 minutes.
Assist the patient into a comfortable position.
Wash your hands.
Special considerations
Remember that some conditions make the normally tender ear canal even more sensitive, so be especially gentle when performing this procedure. Wash your hands before and after caring for the patient's ear and between caring for each ear.
To prevent injury to the eardrum, never insert a cotton-tipped applicator into the ear canal past the point where you can see the tip. After applying eardrops to soften the cerumen, irrigate the ear as ordered to facilitate its removal.
If the patient has vertigo, keep the side rails of his bed up and help him during the procedure as needed. Also, move slowly and unhurriedly to avoid exacerbating his vertigo.
Teach the patient to instill the eardrops correctly so that he can continue treatment at home, if necessary. Review the procedure and let the patient try it himself while you observe.
If both an ointment and drop have been ordered, the drops should be administered first.
Documentation
Record the medication used, the ear treated, and the date, time, and number of eardrops instilled. Also document any signs or symptoms that the patient experienced during the procedure, such as drainage, redness, vertigo, nausea, and pain.