NASAL INSTILLATION

INTRODUCTION- Nasal instillations are used to treat allergies, sinus infections, and nasal congestion.
The nose is normally not a sterile cavity, but because of its connection with the sinuses, medical asepsis
should be observed carefully when using nasal instillation.

DEFINITION-A nasal installation is a procedure in which medicine solution is administration into the nose
in the form of nose drops or nasal sprays.

Nasal instillation is the process by which a liquid is introduced into the nasal cavity drop by drop.

PURPOSE-

 To shrink swollen mucus membrane of nasal cavity (astringent effect)

 To loosen secretion and facilitate drainage.
 To treat infections of the nasal cavity or sinuses.
 To give local anesthesia.

GENERAL INSTRUCTION-

 Caution the client to avoid the use of nasal decongestants for a prolonged period as it can lead
to a rebound effect in which the nasal congestion worsens.
 Medicines are instilled only on written order from doctor.
 Avoid oil based solutions as nasal drop since it interferes with the normal ciliary action and
cause aspiration pneumonia.
 The anterior nares should be clean and free from any discharge before instillation.
 Medical asepsis should be followed carefully throughout the procedure

CONTRAINDICATION:
 Hypertensive patient, increased intra cranial pressure
 Patient having overactive thyroid gland
 Heart disease, nose bleed
 Diabetic patient

ARTICLES REQUIRED:

ARTICLES RATIONALE
Medication with a clean dropper For instillation of drops
A medication card To ensure accurate nasal instillation
A handkerchief/facial tissue/small towel. To wipe the nose
Pillow For proper positioning
Kidney tray To discard wet waste
Paper bag To discard dry waste
Gloves To prevent cross infection
 PRELIMINARY ASSESMENT
 Review physician’s order and determine which sinus is affected by referring to medical
record.
 Assess patient’s history of hypertension, heart diseases, diabetes mellitus and
hyperthyroidism.
 Determine whether patient has any known allergies to nasal instillation.

PROCEDURE
S. No Steps
1. Check the physician’s order for medication, name
of the drug, concentration, number of drops and
the time of administration.
2. Explain the procedure to the client including to
breathe through mouth until he/ she is made to
sit up at the end of the procedure.
3. Arrange articles at bed side.
Rationale
To ensure safe and correct administration of
medication.
It helps reduce the patient’s anxiety.
It reduces chances of aspirating nasal drops
into trachea and lungs.
Ensures smooth orderly procedure.

4. Wash hands and wear gloves. It reduce transmission of micro-organism

5. Instruct the client to blow the nose gently unless To clear the nasal passage of mucous and
contra-indicated (e.g. Risk of increased intra- secretions that can block even distribution of
cranial pressure or nose bleeds.) medication.
6. a) Assist the client to a supine position. Position access to nasal passages.
b) Position head properly.
i. For access to posterior pharynx Position allows medication to drain into
tilt patient’s head backward. affected sinus.
ii. For access to ethmoid or
sphenoid sinuses, tilt head back
over edge of bed or place small
pillow under patient’s shoulder
and tilt head back.
iii. For access to frontal and
maxillary sinus, tilt head back
over ridge of bed or pillow with
head turned toward side to be
treated.
7. Support patient’s head with non dominant hand. Prevents straining of neck muscles.
Instruct patient to breathe through mouth. Mouth breathing reduces the chance of
aspirating nasal drop.
8. hHold the dropper 1 cm above nares and instill the It avoids contamination of the dropper .it also
oprescribed number of drops towards the midline facilitate distribution of medication over the
lof the ethmoid bone nasal mucosa.
9. Instruct the client to remain in a supine position It promotes the maximum amounts of
for 5 minutes. Give him a handkerchief/facial medication to be absorbed.
tissue/hand towel to blot running nose, but
caution him not to blow the nose for several
minutes.
 10. Assist the client to a comfortable position after It helps restore comfort.
the drug has been absorbed.

AFTER CARE:

 Dispose of the soiled supplies in a proper container.

 Remove gloves and wash hands.
 Observe patient for onset of side effects 15-30 minutes after administration.
 Ask if patient is able to breathe through nose after decongestant administration.

RECORDING AND REPORTING:

 Record the procedure date, time and medicine’s name.

 Report the physician for any side effects.
 REFERENCE

 Annamma Jacob (2011), Clinical Nursing Procedures: The Art Of Nursing Practice, Second
Edition, Jaypee Brothers Medical Publishers Ltd, Page No. 301-303.
 Pamela Evens Smith (2005), Taylor’s Clinical Nursing Skill, Fifth Edition, Lippincott Williams And
Wilkins Publication, Page No. 177-179.
 Sandhya Ghai, National Institute of Nursing Education (NINE) Clinical Nursing Procedures, First
Edition, CBS Publishers, Chandigarh, Page No. 177-178.
 Barbara Kozier, (2006), Fundamentals Of Nursing, Seventh Edition, Dorling Kindersley (India)Pvt.
Ltd, Page No. 804-805.