Ear irrigation policy

[meledrn]

Wanting to know what some of your hospitals policies are on irrigating ears. I feel like the hospital I work at we irrigate way too many ears, and I have seen a lot of TM ruptures from doing so. We have one size ear tip for all patients and don't inform parents that TM rupture is a risk involved with the procedure. I read in an ENT article that ear irrigation should involve informed consent and that if OM is suspected irrigation should be avoided. Any thoughts?

[PeakRN]

If we are looking for a source of a fever, especially in pre/non-verbal children, then you have to visualize the TM.

We irrigate ears pretty frequently, rarely do we have any injury to the TM or ear canal thought this can be a risk. Some tips I would recommend in to place colace in the ear for about 20-30 minutes before irrigation to help soften the wax. You should only be using a 60 mL syringe or something like a elephant ear irrigation system, smaller syringes allow for more pressure which can injure the ear. You should only be using tips designed for irrigation or a short piece of tubing with a luer lock (I cut approximately one cm from the end of a IV extension set leaving only the soft tip), the use of angiocaths also produces high pressures that are more likely to injure the TM.