Nasal instillation

Definition

A nasal installation is a medicine solution prepared for administration into the nose. Nasal medicine is given in the form of nose drops or nasal sprays.

Purpose

The purpose of a nasal instillation is to deliver medicine directly into the nose and onto the nasal membranes, where it will be absorbed into the body. The most common nasal medicines are decongestant, antihistamine, and steroid nasal sprays used to relieve nasal congestion secondary to colds or allergies . Some nasal installations are unrelated to the nose, but are given by this method because of the ease of administration and the quick uptake through the nasal membranes.

Precautions

Nasal membranes are sensitive and can be traumatized by overuse of medication and by forceful insertion of a nasal spray or dropper tip.

Description

To instill nose drops, have the client sit in an upright position with the head and nose tilted slightly back. Hold the dropper near the entry to the nostril and instruct the client to inhale as you drop the appropriate dose into the nostril. Keep the client's head back for two to three minutes to allow the drops to roll to the back of the nostril. Repeat in the other nostril. To instill nasal spray, have the client sit erect with the head and nose upright or tilted slightly forward. Remove the cap from the nasal spray, shake the bottle, and gently place the tip of the spray bottle well into the nostril. Instruct the client to exhale, and then inhale vigorously as you squeeze the bottle to deliver the spray. Repeat in the other nostril.

Preparation

The nurse should wash his or her hands before instilling nasal medicine. Each time the medicine is administered, the medication label should be checked to avoid medication errors. It should be confirmed that it is the right medicine, the correct dose (i.e., strength), the proper time, the right patient, and the appropriate method. The expiration date on the label should be checked to ensure that the medication is not outdated. Prior to administration of the medicine, the bottle or canister should be shaken. The patient should blow his or her nose before nasal instillations. It is not unusual for nasal instillations to stimulate a sneeze. Tissues should be kept at hand so that residue can be wiped away and for the client to use to cover the mouth and nose when sneezing.

Aftercare

After rinsing the dropper or nasal spray tip with warm water, the cap should be replaced. Soiled tissues should be placed in a bag that can be sealed and discarded. When the procedure has been completed, the nurse should wash his or her hands.

Complications

Nasal medicines can irritate the lining of the nasal membranes and cause inflammation or nosebleeds when used to excess. Additionally, patients can develop a functional dependence for certain nasal sprays if used to excess.

Results

Most nasal instillations work promptly because of the quick uptake of medicine through the nasal membranes. If signs of nasal irritation occur or if the desired effect is not achieved after several days, the physician should be consulted.

Health care team roles

Administering any medicine is the responsibility of a licensed nurse (i.e., R.N. or L.P.N) in most health care settings. The patient or a patient's family member or friend can be instructed on how to administer nasal medicine in the home setting.

Resources

BOOKS

Smith-Temple, Jean, and Joyce Young Johnson. Nurses' Guide to Clinical Procedures. 3rd ed. Philadelphia: Lippincott, 1998.

OTHER

"Doctor, Should I Take Antihistamines?" American Association of Otolaryngology—Head and Neck Surgery Online. 2000. <http://www.entnet.org/antihistamines.html>.

"How to Use Nose Drops." National Pharmaceutical Association. PharmWeb Online. 2001. <http://www.pharmweb.net/pwmirror/pwz/patient/pharmwebpatinf6.html>.

"Nasal Sprays: How to Use Them Correctly." Information from Your Family Doctor. American Academy of Family Physicians Online. 2000. <http://familydoctor.org/handouts/104.html>.

"Oxymetazoline (Nasal)." Medline. National Library of Medicine Online June 2000. <http://www.nlm.nih.gov/medlineplus/druginfo/oxymetazolinenasal202432.html>.

Mary Elizabeth Martelli, R.N., B.S.