The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [316]
7 If there is any discharge proceed as for eye swabbing (see Procedure guideline 9.2). To remove any infected material. E
8 Ask the patient to hold the receiver against the cheek below the eye being irrigated. To collect irrigation fluid as it runs away from the eye. E
9 Position the towel and plastic cape. To protect the patient’s clothing. E
10 Hold the patient’s eyelids apart, using your first and second fingers, against the orbital ridge. The patient will be unable to hold the eye open once irrigation commences. E
11 Do not press on the eyeball. To avoid causing the patient discomfort or pain (Alexander et al. 2007, C).
12 Warn the patient that the flow of solution is going to start and pour a little onto the cheek first. To allow time to adjust to the feeling of water flow. E
13 Direct the flow of the fluid from the nasal corner outwards (see Action Figure 13). To wash away from the lacrimal punctum and prevent contaminating other eye. E
14 Ask the patient to look up, down and to either side while irrigating. To ensure that the whole area, including fornices, is irrigated (Stollery et al. 2005, E).
15 Evert upper and lower lids whilst irrigating. To ensure complete removal of any foreign body. E
16 Keep the flow of irrigation fluid constant. To ensure swift removal of any foreign body (Marsden 2006, R5).
17 When the eye has been thoroughly irrigated, ask the patient to close the eyes and use a new swab to dry the lids. For patient comfort. E
18 Take the receiver from the patient and dry the cheek. To prevent spillage of receiver contents and promote patient comfort. E
19 Make the patient comfortable.
Postprocedure
20 Remove and dispose of equipment. To keep area clean and reduce risk of cross-infection (Fraise and Bradley 2009, E).
21 Wash hands with bactericidal soap and water. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
22 Complete the patient’s recording chart and other hospital and/or legally required documents. To maintain accurate records. To provide a point of reference in the event of any queries. To prevent any duplication of treatment (NMC 2009, C).
23 Discuss with the patient any changes post procedure; report any adverse effects to the patient’s doctor. To monitor effectiveness of procedure, trends and fluctuations (NMC 2009, C).
Action Figure 13 Irrigation of the eye from inner to outer canthus.
Procedure guideline 9.4 Contact lens removal: hard lenses
Essential equipment
Sterile dressing pack
Contact lens solution
Low-linting or lint-free swabs
Optional equipment
Sterile/non-sterile powder-free gloves
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their consent (NMC 2008a, C).
2 Wash hands thoroughly using bactericidal soap or alcohol handrub. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
Procedure
3 Using thumb and forefinger, separate the eyelids. Keeping the eyelid stationary, place the index finger on the lens. Gently move the lens to one side of the cornea and pull away (see Action Figure 3). To minimize corneal trauma (Stollery et al. 2005, R5).
4 Store lenses in the appropriate solution as recommended by the manufacturer and ensure lenses are placed in the correct left and right storage pots. To prevent deterioration and contamination (Stollery et al. 2005, R5).
5 Refer to manufacturer’s instructions for further storage information, particularly if patient will not be using the lenses for a lengthy period of time. To prevent deterioration of lens and growth of organisms. E
Postprocedure
6 Remove and dispose of equipment. To keep area clean and reduce risk of cross-infection (Fraise and Bradley 2009, E).
7 Wash hands with bactericidal soap and water. To reduce the risk of cross-infection (Fraise and Bradley 2009, E).
8 Complete the patient’s recording chart and other hospital and/or legally required documents. To maintain accurate records. To provide a point of reference