Nasal Irrigation


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Nasal Irrigation

 

Definition

Nasal irrigation is the practice of flushing the nasal cavity with a sterile solution. The solution may contain antibiotics or steroid medications.

Purpose

Nasal irrigation is used to clear infected sinuses or may be performed after surgery to the nose region. It may be performed by adding antibiotics to the solution to treat nasal polyps, nasal septal deviation, allergic nasal inflammation, chronic sinus infection, and swollen mucous membranes. One benefit of nasal irrigation in treating these conditions is that it usually lowers the amount of medication that the patient must take by mouth.
Irrigation is also used to treat long-term users of inhalants, such as illicit drugs (cocaine), or such occupational toxins as paint fumes, sawdust, pesticides, and coal dust.
Nasal irrigation may also be used in occupational medicine to monitor workers for exposure to airborne glass fibers, asbestos, and similar materials.

Precautions

Nasal irrigation should not be performed on people who have frequent nosebleeds; have recently had nasal surgery; or whose gag reflex is impaired, as fluid may enter the windpipe.

Description

Nasal irrigation can be performed by the patient at home or by a medical professional. A forced-flow instrument, such as a syringe, is filled with a warm saline solution. The solution can be commercially prepared (Ayr, NaSal) or can be prepared by the patient, using one half teaspoon salt with each eight ounces of warm water. Occasionally, antibiotics or steroids are added to the solution to kill bacteria and aid healing of irritated membrane. The syringe is then directed into the nostril. The irrigation solution loosens encrusted material in the nasal passage, and drainage takes place through the nose. The patient leans over a catch basin during irrigation, into which the debris flows. Irrigation continues until all debris is cleared from the passage. Nasal irrigation can be performed up to twice daily, unless the irrigation irritates the mucous membrane.

Preparation

Before nasal irrigation, the patient is instructed not to open his or her mouth or swallow during the procedure. Opening the mouth or swallowing may cause infectious material to move from the nasal passage into the sinuses or the ear.

Risks

Complications of nasal irrigation include irritation of the nasal passages due to extreme temperature of the irrigation solution. Rarely, irrigation fluid may enter the windpipe in people with a poor gag reflex.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Hypersensitivity Reactions." Section 12, Chapter 148 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Aukema, A. A., and W. J. Fokkens. "Chronic Rhinosinusitis: Management for Optimal Outcomes."
Because surgery in the nasal area has a high incidence rate for contamination with pathogenic bacteria, nasal irrigation is performed to remove loose tissue and prevent infection. The illustration (right) shows a cannula in place while the sinus passages are being flushed.
Because surgery in the nasal area has a high incidence rate for contamination with pathogenic bacteria, nasal irrigation is performed to remove loose tissue and prevent infection. The illustration (right) shows a cannula in place while the sinus passages are being flushed.
(illustration by Electronic Illustrators Group.)
Treatments in Respiratory Medicine 3 (February 2004): 97-105.
Brown, C. L., and S. M. Graham. "Nasal Irrigations: Good or Bad?" Current Opinion in Otolaryngology and Head and Neck Surgery 12 (February 2004): 9-13.
Lavigne, F., M. K. Tulic, J. Gagnon, and Q. Hamid. "Selective Irrigation of the Sinuses in the Management of Chronic Rhinosinusitis Refractory to Medical Therapy: A Promising Start." Journal of Otolaryngology 33 (February 2004): 10-16.
Paananen, H., M. Holopainen, P. Kalliokoski, et al. "Evaluation of Exposure to Man-Made Vitreous Fibers by Nasal Lavage." Journal of Occupational and Environmental Hygiene 1 (February 2004): 82-87.

Organizations

American Academy of Family Physicians (AAFP). 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. http://www.aafp.org.
American Academy of Otolaryngology, Head and Neck Surgery, Inc. One Prince St., Alexandria, VA 22314-3357. (703) 836-44 44. http://www.entnet.org.

Key terms

Irrigation — In medicine, the practice of washing out or flushing a wound or body opening with a stream of water or another liquid.
Saline — A solution made from salt and water.

irrigation

(ir?i-ga'shon) [L. irrigatio, watering]
The cleansing of a canal or cavity by flushing with water or other fluids; the washing of a wound. The solutions used for cleansing should be sterile and, for comfort, have an approximate temperature slightly warmer than body temperature (100° to 115°F [37.8° to 46.1°C]). When irrigation is performed for bleeding, cold or iced irrigant may be used. Synonym: lavage See: gastric lavage

bladder irrigation

Washing out the bladder to treat inflammation or infection or to keep a urinary catheter flowing. The irrigation may be intermittent or continuous. Normal saline is commonly used.

Patient care

The necessary sterile equipment and the prescribed irrigant are assembled. The patient is covered with draping to preserve privacy and maintain antisepsis, and provided with information about how the procedure is done and what sensations will be experienced. A triple-lumen indwelling catheter is inserted into the urinary bladder via the urethra; placement is confirmed by the flow of urine, and the anchoring balloon inflated via its lumen. The prescribed volume of irrigant is instilled via the irrigation lumen; the catheter is clamped to allow the solution to remain in the bladder for the prescribed period of time; then the catheter is unclamped to allow the irrigant to flow out of the bladder via the drainage lumen by gravity into a collecting basin or closed drainage system. The irrigation is repeated the prescribed number of times. The character of the irrigation solution returned and the presence of any mucus, blood, or other material visible in the drainage is noted. The catheter is removed as per practitioner order. The time of the procedure, the type and volume of irrigant instilled, the type and volume of return, and the patient's response to the procedure are documented. If intermittent or continuous bladder irrigation is required, the catheter remains in place. Two large bags of irrigating fluid on a Y tubing are hung for continuous irrigation, with flow-rate controlled to maintain clear drainage. Urine output is determined by subtracting the amount of irrigant instilled from the total drainage obtained.

CAUTION!

Patients who receive high volumes of dilute fluids may absorb these irrigants and develop fluid overload or hyponatremia. To ensure patient safety, careful measurement of inputs and outputs and regular assessments of electrolytes, BUN, Cr, and oxygenation should be performed.

colonic irrigation

Flushing of the colon with water; an enema.
Synonym: colonic lavage

continuous bladder irrigation

Abbreviation: CBI
A constant flow of normal saline (or other bladder irrigant) through a three-way urinary catheter to keep the catheter patent. It is typically used postoperatively following a transurethral resection of the prostate gland.

Patient care

During CBI the volume of fluid infused and the volume returned is monitored and recorded.

high-pressure irrigation

Irrigation of a wound with sterile fluid at a pressure of 7.0 pounds per sq. inch.

joint irrigation

The flushing of a joint space with fluids to remove particles such as crystals or fragments of bone or cartilage. It may be used as a treatment for osteoarthritic joint pain.

low-pressure irrigation

Irrigation of a wound with sterile fluid at a pressure of 0.5 pounds per sq. inch.

nasal irrigation

Nasal lavage.

oral irrigation

Flushing of the mouth, teeth, and gums with fluids. This is done to remove plaque and to treat or prevent periodontal disease.

whole bowel irrigation

The administration of large volumes of a nonabsorbable fluid to remove potentially hazardous contents from the gastrointestinal tract. It is used to prepare some patients for bowel surgery and to decontaminate the gut after overdose.
References in periodicals archive ?
In this study of participants who continued their usual treatments for sinusitis, addition of nasal irrigation with the commercial solution gave statistically significant relief of symptoms compared with a control group who did not use sinus irrigation.
The study results suggest that daily hypertonic nasal irrigation may be a useful therapy for reducing the high morbidity and often refractory symptoms associated with sinusitis, Dr.
The American Academy of Family Physicians says: "Contraindications for saline nasal irrigation include incompletely healed facial trauma, because of the potential to leak saline into unwanted tissue planes or spaces; and neurologic or musculoskeletal problems, such as significant intention tremor, that increase the risk of aspiration.
Medicated nasal irrigation can also be used both pre- and postoperatively to contain and control infection and inflammation.
Nasal irrigation with the Hydro-Pulse Nasal/Sinus Irrigation System is a drug-free, medically-proven method that actually helps the body use its own defenses to remove bacteria and other irritations before they cause sinus symptoms.
NeilMed is the world's category leader for saline nasal irrigation products, according to A.
The left serous otitis media eventually disappeared after the patient was treated with endoscopic removal of the crusting, nasal irrigation, and antibiotics.
Leading ear, nose and throat specialists are recognizing the value in nasal irrigation with a saline solution as a safe and natural alternative to antibiotics," says Marc Elton, Director of Scientific and Legal Affairs at B.
Nasal irrigation with saline, including hypertonic saline, has long been recommended for the treatment of sinonasal disease, and it has been shown to have a positive effect on the physiology of the nasal mucosa.
Frequent saline nasal irrigation has been used to clear the nasal and sinus cavity.
Daily nasal irrigation with Hydro Pulse(R) is the natural way to clear nasal passages of infectious toxins, the common cold, and allergens.