Chloraprep used for facial surgery

[coleeliza]

I am a newer (2.5 years) nurse currently working in the operating room for the past year and a half. I have been circulating in ENT for awhile and like to think I had a pretty good idea of ENT standards of perioperative practice. However, today we did an excision of a lipoma that was located at the patient's left face (next to the ear). I asked my surgeon what kind of prep he wanted me to use, and he responded "I don't care." I looked at my case cart and saw that SPD had sent up Chloraprep. I asked him if Chloraprep was ok and he said "sure." I began to prep the cheek after sectioning off the eye with a 1000 drape in order to prevent the eye from coming in contact with the prep (knowing chloraprep was contraindicated in eyes) and began to prep down to the edge of the lipoma. Once I reached this point, I remembered that I probably shouldn't prep the ear either. So I ran and got sterile cotton balls to stick in the ear in order to prevent the prep from reaching the inner ear. I prepped the outer ear due to the fact that it was so close to the incision site... and then asked my surgeon to wait 3 minutes before draping in order to allow the prep to dry. The cotton balls were removed, the patient was draped and the surgery was peformed. The surgery went fine and we took the patient back to PACU. After the patient woke up (about a half hour after the surgery), she stated she couldn't hear out of her left ear and asked if that was normal. I am now also wondering the same. I thought I did everything to prevent the instillation of the skin preparation into the ear. Everything I am reading states that Chloraprep should not reach the middle ear due to the fact that it can cause ototoxicity, however a perforated tympanic membrane must exist in order for this to occur. Now I just think I'm an idiot and should have chosen Betadine in the first place, or asked for more help in the event of a careless surgeon. Anyone have any insight into this situatioN?

[Rose_Queen, BSN, MSN, RN]

We use Chloraprep frequently in head, neck, and face surgery. Cotton ball in the ear and an appropriately size Chloraprep- our policy states only 10.5mL can be used for preps above the neck.

[Silverdragon102, BSN]

Moved to the OR forum

[coleeliza]

Thank you for your input! I am now wondering if it is against best practice for an OR RN to call a patient at home in order to check up on them? I just want to make sure she can hear out of that ear now! The nurse in ambulatory said that the patient was not complaining of any difficulty hearing prior to being discharged to home. But I feel so anxious about it that I almost just need to know for my own peace of mind.

[Rose_Queen, BSN, MSN, RN]

It would not be wise to call the patient to check on them- your professional relationship with the patient has ended and it would be crossing professional boundaries.

[coleeliza]

Thank you.

[birdie22]

Definitely dont call them at home. If the nurse said the patient was fine before d/c, Id take her word and try and accept that. That being said, we usually use betadine solution for ENT cases just to be on the safe side where I work

[offlabel]

Thank you for your input! I am now wondering if it is against best practice for an OR RN to call a patient at home in order to check up on them? I just want to make sure she can hear out of that ear now! The nurse in ambulatory said that the patient was not complaining of any difficulty hearing prior to being discharged to home. But I feel so anxious about it that I almost just need to know for my own peace of mind.

You probably just shoved some ear wax down the canal with the cotton ball. A groggy patient might not know the difference. You'd need to pour that prep directly into the ear to have a problem like you're thinking. Forget about it.