POLICY
Mackay Ears makes every effort to provide evidence based, safe and effective ear micro suction services to clients accessing care. Use of the microscope and suction is carried out to remove cerumen and/or foreign by curettage and suction. Mackay Ears requires nurses and clinicians to meet basic requirements and have their ear micro suction technique reviewed by a suitable qualified clinician.
SUPPORTING GUIDELINES
Mackay Ears follows best practice based on following guidelines:
- NHMRC 2010 Australian guidelines for the prevention and control of infection in healthcare.
- RACGP infection prevention a control standard
- Nursing and Midwifery Board Australia – Nursing practice Decision making framework guide
- Manufacturers guidelines in regular checking and maintaining of all equipment
Mackay Ears – Ear Micro suction Competency Assessment
Essential requirements of nurses performing removal of ear wax using Micro Suction technique The clinician has:
- Successfully completed theoretical ear micro suction education.
- Understands the ear micro suction equipment – safety and maintenance requirements.
- Has successfully completed practical aspects of ear micro suction techniques and been assessed as competent by a suitable qualified clinician.
- Has appropriate professional indemnity insurance which includes ear micro suction.
- Has established that ear micro suction is within scope of practice – using Midwifery Board Australia – nursing practice decision making framework guide.
- Has Knowledge confidence and skills to identify and describe both normal and abnormal anatomy and physiology of the ear.
- Understands the indications for ear micro suction, precautions and contraindications Understands the indicators of when to seek additional assessment and how to refer a patient.
- Can explain the procedure, side effects and gain informed consent.
- Can explain and provide written post procedure information care to the client
Mackay Ears - Ear Micro suction Principles
- Procedure can only be performed by suitably qualified clinicians.
- Use of Softening agents recommended 2 days prior to procedure.
- Micro suction is used to facilitate removal of cerumen and foreign bodies.
- Advantages of manual removal of cerumen with micro suction is that it can be quicker and less traumatic and allows clinical user direct visualisation of the procedure with an OScope.
- Micro suction lessens the risk of infection since it does not introduce moisture to the ear canal.
- To determine if micro suction is an appropriate treatment option a detailed medical history and basic examination will be performed prior to procedure.
- Valid consent obtained and documented.
- Infection control guidelines always followed.
Ear Micro suction Precautions and Contraindications
The following precautions will be discussed and reviewed and if any are evident then a referral to GP will be recommended.
- Patients who are unable to sit still or cooperate
- People with dermatological conditions of the external ear
- People who are sensitive to noise and may alarm and intimidate client
- Past radiation therapy as skin in the ear may be fragile
- Care taken for clients that are immunocompromised
- Past or present tympanic membrane perforation
- Moderate to severe pain
- Current or recent infection of the ear (otitis media or otitis externa)
- Current grommet or present within the last 18months
- History of ear surgery e.g., cleft palate or mastoidectomy
- Unilateral hearing
- Recent history of mucus discharge
Protocol for the use of cerumenolytic agents
Mackay Ears protocol for the use of these agents are dependent on the detailed history of the client and after the use of cerumenolytic agents has been trialed for a period of 2 to 7 days.
Indications for ear micro suction after use of cerumenolytic agents:
- Tympanic membrane remains obscured by wax and visulisation is required or clinical purposes and diagnostics
- Conductive hearing loss
- Ear discomfort
- Itching sensation
- Fullness of ear
- Tinnitus (ringing in ears)
- Reflex cough
Potential complications and side effects post ear micro suction
- Failure o cerumen l
- Otitis externa
- Perforation of the
- tympanic membrane
- Damage to the external auditory canal
- Pain
- Temporary vertigo
- Exacerbation of underlying tinnitus if condition is already present.
Ear Micro Suction Procedure
Pre for procedure
Insure scheduled maintenance of safety check of all equipment as per Protocol for use of drops has been followed manufacturers and organizational guidelines.
Detailed patient history, symptoms and ear examination has been performed.
Patient meets criteria for procedure to be performed.
Informed consent has been sort and patients understands procedure.
Describe each step of procedure and nature of noise and importance for patient to remain completely still, explain we can stop at any time.
If at any time patient experiences pain, bleeding, ongoing symptoms despite a clear ear canal or if there is concern – stop immediately and refer to GP
Procedure.Position patient in a comfortable position and ensure patient is at ease.
Chair must be fixed and patient seated at appropriate eye level.
Place Oscope to head and right position and adjust settings as needed.
Wash hands, done gloves, mask as per PPE guidelines.
Place towel or bluey to shoulder of ear being examined to catch wax debri.
Use stool to sit on to maintain correct distance.
Examine the ear pinna, outer ear canal and adjacent ear areas in both ears.
Determine size of spectrum to be used – bigger the better for visualisation.
Gentle pull pinna upwards and outwards in adults, insert speculum and hold it in place.
Rest the small digit in the curve of the Pinna as a trigger for any head movement, this is called anchoring.
Use the light from Oscope to observe direction of the ear canal and the tympanic membrane (there is improved visualisation of the eardrum by using the left hand for the left ear and right hand for right ear.
Direct lighting from Oscope down into ear and examine from half an arm’s length away from patient, in order to focus on ear canal.
Rotate the speculum to move unwanted hairs in the canal (may need to be trimmed if unable to visualise ear canal.
Once ear canal viewed, identify landmarks and note findings of wax and health of ear canal.
Wax comes in many variations and the use of curette, alligator forceps and or micro suction may be required.
Carefully check the cavity and assess suction tip size.
Turn machine on, maintain pressure 50mmhg and 450mmhg by holding finger on suction tube hole.
Insert suction tube into speculum and by using Oscope, direct tip to wax being drawn out.
Once tip is attached to wax maintain suction pressure (you should feel and see wax being drawn into the suction tube).
Avoid touching wall of canal – very sensitive – and may cause patient to move their head.
If wax is not moving you may need to very gently rotate suction tube clockwise to dislodge wax (curette may also assist with removal of wax).
If wax is soft and gluggy and occluded in tubing, clear tubing with warm water or insert metal stylus into suction tube or regularly change suction tube.
At all times assess patient level of comfort and tolerance to procedure.
The patient may need to move their head for a clearer view into cavity/canal to enable.
On occasion not all wax may be removed and may need further wax softening agents to be used.
Discuss cause of wax build up, explain mechanism for cerumen removal.
Discuss findings with patient and assess hearing improvement
Post Procedure
- Provide a handout with post micro suction information to patient.
- Document procedure and outcomes in clinical record.
- Discard disposable suction tip and other waste as per infection control guidelines.
- Grubers speculum/suction connectors cleaned with alcohol wipes and soak for 30 minutes in sonidet and then dry properly (have extra sets on hand).
- After each patient machine cleaned as per manufacturers guidelines with hot soapy water and tubing flushed – single use connectors disposed.
- Clean down all services with clinell wipes.
- Turn suction unit off at wall after each use and never leave dirty tubing or connectors attached.