EAR IRRIGATIONS TO REMOVE IMPACTED CERUMEN - STANDARDIZED NURSING PROCEDURES

Effective Date: 
Wed, 09/01/2010
Reviewed: 
Sat, 08/27/2011
Revised: 
Sun, 08/28/2011

Impacted cerumen is a common complaint. This procedure allows an RN to assess the amount of cerumen in the ear canal and to initiate the process of clearing the ear canal when the RN or clinician assesses excess cerumen.
Procedure
 The patient may be pre-treated with a solution to soften cerumen prior to the procedure:
 Research indicates that many common agents for cerumen softening instilled 15 to 30 minutes prior to the procedure helped to improved clearance. The RN may instill 3 to 5 drops of Debrox, or Docusate, or plain water into the affected ear and then request that the patient wait 15 to 30 minutes before flushing.
 Using room temperature water and the ear lavage equipment, gently flush the ear canal, allowing the water to collect in the basin held below the ear. Repeat until cleared.
 If the patient complains of dizziness, nausea, or pain, stop the treatment and refer to the clinician for evaluation.
Experience, Training and/or Education
Current CA RN license
Completion of UCSC orientation specific to this procedure
Evaluation of Competency
Initial Competence
 Observes experienced person doing the procedure at least twice.
 Demonstrates successful use of this procedure under direct supervision at least twice.
 Submits a minimum of 2 additional chart notes demonstrating correct use of the procedure to the Clinic Director for review.
On-going Competence

Chart reviews of this procedure occur as part of the on-going Quality Assurance program of the UCSC Student Health Center.
Scope of Supervision
No direct supervision required.
Criteria for Provider Consultation & Referral
 Patients who report pain, dizziness, nausea with the procedure should be referred for clinician evaluation.
 If repeated flushings fail to clear cerumen, the patient should be referred for clinician consultation.
Documentation
Documentation according to the standards delineated in the UCSC Student Health Center Policy on Documentation of Care.