working in urgent care

[Wrangler156]

I recently started working at urgent care PRN, they clean out ears there of course. A lot more people than you would think come in "clogged up ears". My concern is this... the nurses RNs and LPNs get an order to flush out the ear with hydrogen peroxide/warm water mixture. So they stick the thing in there and just go to flushing and tell me "see the patient jump a little? that means your in the right place".... I do not agree with this AT ALL. I also am worried about flushing an ear without being able to see the eardrum to know if the eardrum is potentially perforated or not. Then they go to scraping the ear wax out and one of the nurses said again to me as she did this "see him cringe a little? that means your on the eardrum so you are getting all the wax" ummmm I'd rather not be poking the ear drum! What are my options here? Am I being to cautious to not want to blindly squirt something or scrape in someones ear? I am worried to death of squirting ear wax through a perforated ear drum and causing more damage. Maybe I am being to cautious, but I must say this doesn't sound right to me. I usually try to pass tasks like this off to a RN that works there full time, and I handle triaging the patient, simply because it seems like a lawsuit waiting to happen.

[AliNajaCat]

You're supposed to aim the flush so it hits the wall of the ear canal and then runs from there. And gently. It's supposed to take a little time.

If you don't have a written protocol on how this is supposed to be done (including learning about inspecting the area with an otoscope yourself before you do anything), why not find some online, write it up, and get it passed a policy? That will help everybody.

[Everline]

Before I became a nurse I went to the doctor for a regular physical exam. He said I had too much wax in my ear and that I needed it removed. He sent in his MA to do it. She took what looked like a type of squirt bottle and powerfully blasted water into my ear several times. I did not feel well and did not like the feeling at all. For several days after, my ear was messed up. It hurt and was extremely sensitive to sound (I would cringe when someone talked to me). I am a musician and it hurt to play my instrument. I was concerned that permanent damage had been done. Eventually, things got back to normal but I will never allow myself to be subjected to that again. If I need my ear cleaned, I'll go to someone who knows what they are doing. As a nurse, I would never do this to a patient without knowing what I was doing. I would not be comfortable with that. As the previous poster suggested, find out how to properly do this and try to get a written policy that guides the nurses to do it correctly.

[SaltySarcasticSally, LPN, RN]

I used to work for an ENT, no way I'd go to an urgent care for wax removal. We flush with water as nurses but only after the ENT has taken a quick peek. Also, flushing should be a slow process otherwise what happened to poster above is likely. There is only a certain amount of flush we would use as well, if there was no water left but pt still had wax, we sent them home with ear drops that softened the wax. You don't want to yank wax off an ear drum if it is not budging easily.