Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed. Ask the patient to explain how their eyes feel, if they are able to do so.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [162], C). To have a baseline understanding of current problems or changes the patient is experiencing (Marsden [120], E).
2. 2.Show
   Wash hands and put on personal protective equipment.
   To reduce the risk of cross‐infection (NHS England and NHSI [148], C).
3. 3.Show
   If possible, remove any contact lenses (see Procedure guideline 9.11: Contact lens removal: hard lenses and Procedure guideline 9.12: Contact lens removal: soft lenses)
   To ensure no reservoir of chemicals remains in the eye (Marsden [120], E).
4. 4.Show
   Instil anaesthetic drops if required.
   To relieve pain and aid irrigation (Marsden [119], E).
5. 5.Show
   The patient should sit upright with their head supported and tilted to the affected side.
   To avoid the solution running either over the nose into the other eye or down the side of the cheek (Marsden [120], E).
6. 6.Show
   Drape the patient's shoulders with a towel or, if available, a waterproof cape. Ask the patient to hold the receiver (kidney dish or plastic receptacle) against the cheek below the eye being irrigated.
   To protect the patient from getting wet and to collect irrigation fluid as it runs away from the eye (Marsden [120], E).
7. 7.Show
   Prepare the irrigation fluid to the appropriate temperature by placing it in a bowl of water until warmed. Hang the irrigation fluid on the drip stand, connect the fluid to the intravenous fluid‐giving set and prime the line. Pour the solution across the inner aspect of your wrist to test the temperature.
   Tepid fluid will be more comfortable for the patient (Stevens [220], E).

   To ensure that the irrigation fluid is ready for the procedure (Marsden [120], E).

Procedure

1. 8.Show
   If there is any discharge from the eye, proceed as for eye swabbing (see Procedure guideline 9.7: Eye swabbing).
   To remove any infected material. E
2. 9.Show
   Hold the patient's eyelids apart, using your first and second fingers, against the orbital ridge. Do not press on the eyeball.
   The patient will be unable to hold the eye open once irrigation commences (Marsden [120], E).

   To avoid causing the patient discomfort or pain (Stevens [220], E).
3. 10.Show
   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 flowing (Marsden [120], E).
4. 11.Show
   Direct the flow of the fluid from the nasal corner outwards (Action figure 9.9). Keep the fluid flow constant by adjusting the giving set roller clamp.
   To wash away from the lacrimal punctum and prevent contaminating the other eye. E

   To ensure a constant flow (Stevens [220], E).
5. 12.Show
   Ask the patient to look up, down and to either side while irrigating.
   To ensure that the whole area, including the fornices, is irrigated (Stevens [220], E).
6. 13.Show
   Evert the upper and lower lids while irrigating.
   To ensure complete removal of any foreign body (Stevens [220], E).
7. 14.Show
   When the eye has been thoroughly irrigated, ask the patient to close their eyes and use a new swab to dry the lids.
   For patient comfort (Marsden [120], E).
8. 15.Show
   Take the receiver from the patient and dry the cheek.
   To prevent spillage of receiver contents and promote patient comfort (Marsden [120], E).
9. 16.Show
   Make the patient comfortable.
   To promote comfort and dignity (NMC [162], C).

Post‐procedure

1. 17.Show
   Remove and dispose of equipment as per local policy, and decontaminate hands.
   To keep the environment clean and reduce the risk of cross‐infection (NHS England and NHSI [148], C).
2. 18.Show
   Document the intervention in the patient's notes.
   To maintain accurate records. To provide a point of reference in the event of any queries. To prevent any duplication of treatment (NMC [162], C).
3. 19.Show
   Discuss with the patient any changes post‐procedure; report any adverse effects to the patient's doctor.
   To monitor the effectiveness of procedure as well as any trends and fluctuations (NMC [162], C; RCN [193], C).