PROCEDURE FOR EYE IRRIGATION FOR ADULTS AND CHILDREN

Transcription

1 PROCEDURE FOR EYE IRRIGATION FOR ADULTS AND CHILDREN First Issued April 2007 Issue Version Two Purpose of Issue/Description of Change To promote safe and effective eye care in PCT Walk In Centre s Planned Review Date 2012 Named Responsible Officer:- Approved by Date Walk In Centre Nurse Manager Nursing Policy Group June 2009 Policy File:- Nursing Policy File N o 17 Impact Assessment Screening Complete Date: May 09 Full Impact Assessment Required Y/N UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE PCT WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 This procedure should only be undertaken by Wirral PCT employed registered nurses trained in the procedure working in Minor Injuries Units or Walk-in-Centres. Note: This procedure should NOT be used for eyes contaminated with C/S gas ( 2-Chlorobenzalmalononitrile ) Equipment Required Waterproof cape Towel Irrigation solution Sodium chloride 0.9% Receiver Administration set (if required) Anaesthetic drops Gauze swabs Vinyl Gloves Apron Sterile dressing pack ph check strips (specific eye testing strips) Nursing records Relevant Patient Group Direction Procedure Verbally check the identity of the patient by asking for the patients full name and date of birth Explain the procedure, including risks and benefits Establish patient has no known allergies Remove contact lenses immediately if present Check ph ( a measure of the hydrogen ion concentration) of the eye prior to treatment using specific eye testing strips for chemical injury ph testing should not delay commencement of irrigation When patient gives history of exposure to agents containing alkali or acid immediate irrigation should precede full examination Instil anaesthetic drop (if required) as per Patient Group Direction To ensure positive identification of the patient So the patient understands the procedure and to gain patient s informed consent and co-operation To reduce risk of allergic reaction To facilitate irrigation and prevent corneal damage To determine if an acidic or alkaline corrosive substance is present To reduce damage to anterior segment ;the amount of damage is related to the duration of the exposure To reduce discomfort and aid assessment 2/4

3 Procedure Prepare the saline, check that it is at room temperature To reduce discomfort Assist the patient into an appropriate position: Head comfortably supported with chin almost horizontal Head inclined to the side of the eye to be treated To reduce discomfort Decontaminate hands and prepare equipment Put on single use disposable apron Remove any discharge from the eye by cleansing To reduce the risk of transient micro-organisms on the healthcare workers hands To protect uniform and prevent contamination To prevent discharge from running across cheek Ask the patient to hold the receiver against the cheek, below the eye being treated To collect fluid running from the eye Apply towel and cape If a Child: Two nurses required One nurse to hold child, with parental /carer consent and one nurse to hold the child s eyelids apart using the first and second finger held against the orbital ridge. One nurse to administer wash out. To protect the patient s clothing Patient will be unable to hold the eyelids themselves once irrigation commences Do not press on the eyeball Inform the patient that irrigation is about to start and pour a little of the fluid onto the cheek Direct the flow of irrigation fluid from the nasal corner Ask the patient to look up, down and to either side whilst irrigating Evert the eyelids when irrigating and ensure there is a constant flow of irrigation fluid To avoid causing unnecessary discomfort To prepare the patient and to make them aware of the sensation and temperature of the irrigation fluid To wash away any secretions To ensure the whole eye is irrigated To ensure complete removal of any foreign body 3/4

4 Procedure Check ph ( a measure of the hydrogen ion concentration) of the eye prior to irrigation and after 20 minutes of irrigation using specific eye testing strips for chemical injury, Irrigation should be continued until the conjunctival sac ph is normal ( ). Retest after 20 minutes and use further irrigation if necessary identify chemical and discuss with Toxbase a national poisons data base Patients with: corneal damage patients whose symptoms do not resolve rapidly and patients who have been exposed to strong acids or alkalis Should be referred for urgent ophthalmologic assessment [same day] Ask the patient to close the eye and dry lid with a gauze swab Remove receiver and dry patient s cheek Examine eye for corneal damage by installation of Fluorescein as per Patient Group Direction Remove trolley and dispose of waste as per Disposal of Clinical Waste policy On completion of procedure remove and dispose of any personal protective equipment Decontaminate hands Document all actions and observations (including consent and patient perceptions) in nursing records A ph above 8.0 or below 7.5 may indicate that an acidic or corrosive substance is still present in the eye To assess level of chemical risk hosts the Toxbase web site To ensure emergency opthalmic assessment of severe eye injury To promote patient s comfort To promote patient s comfort To detect corneal damage To prevent environmental contamination To comply with waste management policy To reduce the risk of transient micro-organisms on the healthcare workers hands Ensure compliance with PCT Health Records Policy 4/4

5 REFERENCES AND BIBLIOGRAPHY Dougherty, L. and Lister, S.E. (2004) The Royal Marsden Manual of Clinical Nursing Procedures Sixth Edition. Blackwell Publishing, Oxford. St. Paul s Primary Care Eye Centre Guidelines for eye irrigation Royal Liverpool University Hospital NPIS (2007) Chemicals splashed or sprayed into the eyes. TOXBASE. National Poisons Information Service. [Accessed: 12/03/2009]. Clinical Knowledge Summaries- Corneal Superficial injury Management [Accessed 12/03/2009] 5/4