Nursing Procedure Checklist

Administering an Eye Irrigation

Instruction: Check under Correctly Done if identified skill is correctly performed; Incorrectly Done if
skill is not performed correctly; and Not Done if the student failed to perform the skill.
Correctly Incorrectly Not Done
Procedure Done Done
1. Gather equipment. Check the original physician’s order for
the irrigation according to agency policy. Clarify any
inconsistencies. Check the patient’s chart for allergies.
2. Identify the patient. Usually, the patient should be identified
using two methods. Compare information with the MAR or
CMAR.
a. Check the name and identification number on the patient’s
identification band.
b. Ask the patient to state his or her name.
c. If the patient cannot identify him or herself, verify the
patient’s identification with a staff member who knows the
patient for the second source.
3. Explain procedure to patient.
4. Assemble equipment at patient’s bedside.
5. Perform hand hygiene.
6. Have patient sit or lie with head tilted toward side of affected
eye. Protect patient and bed with a waterproof pad.
7. Put on disposable gloves. Clean lids and lashes with
washcloth moistened with normal saline or the solution ordered
for the irrigation. Wipe from inner canthus to outer canthus. Use
a different corner of washcloth with each wipe.
8. Place curved basin at cheek on side of affected eye to receive
irrigating solution. If patient is able, ask him or her to support
the basin.
9. Expose lower conjunctival sac and hold upper lid open with
your nondominant hand.
10. Fill the irrigation syringe with the prescribed fluid. Hold
irrigation syringe about 2.5 cm (1”) from eye. Direct flow of
solution from inner to outer canthus along conjunctival sac.
11. Irrigate until the solution is clear or all the solution has been
used. Use only enough force to remove secretions gently from
the conjunctiva. Avoid touching any part of the eye with the
irrigating tip.
12. Pause irrigation and have patient close eye periodically
during procedure.
13. Dry periorbital area after irrigation with gauze sponge. Offer
towel to patient if face and neck are wet.
14. Remove gloves and perform hand hygiene.
15. Assist the patient to a comfortable position.
16. Evaluate patient’s response to medication within appropriate
time frame.

Comments:
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Score : ________________________________________

Evaluated by: ________________________________ Date of Evaluation: ________________

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