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Nasal Medication Administration

3 min read

Nasal Medication Administration

Key Points

  • Nasal medications are administered into nostrils for local and selected systemic effects.
  • Safe administration requires route verification, correct nozzle direction, and contamination prevention.
  • Patient coaching on pre- and post-spray technique improves dose absorption.
  • Intranasal forms include powders, sprays, and washes, and many spray devices require first-use priming.
  • For nasal washes/irrigation, use saline prepared with distilled or sterilized water; avoid tap/well water.
  • Prolonged or inappropriate intranasal use can injure nasal tissue and affect smell, so category-specific duration teaching is important.

Equipment

  • Ordered nasal medication device (powder, spray, or dropper/wash device as prescribed)
  • Tissues and gloves when indicated
  • MAR and order verification access
  • Hand hygiene supplies

Procedure Steps

  1. Verify patient identity, medication, dosage, and nasal route order.
  2. Confirm product is labeled for nasal route only and not intended for eye/oral administration.
  3. Perform hand hygiene and prepare supplies using clean technique with asepsis safeguards.
  4. Instruct patient to blow nose gently before administration.
  5. Prime spray bottle before first use until fine mist appears (if device requires priming).
  6. Position head as directed by product/protocol (commonly seated with head tilted slightly back or supine looking upward for spray/drop instillation; forward over sink for nasal wash).
  7. Insert nozzle into nostril and aim toward the ear/back of head, away from nasal septum.
  8. Administer prescribed dose (for example one spray each nostril when ordered); each spray actuation is typically one metered dose.
  9. Instruct patient to occlude the opposite nostril when using unilateral spray technique and inhale during spray delivery.
  10. Instruct patient to hold breath briefly after spray and then exhale.
  11. Advise patient to avoid blowing nose or tilting head forward for about 5-10 minutes after administration.
  12. For nasal wash workflows, irrigate one nostril while allowing solution to drain from the other side; clean reusable equipment after each use per policy.
  13. Keep spray bottle compressed while removing from nostril after actuation to reduce contamination risk.
  14. Clean outer nozzle/device surface per policy after use and keep nasal devices/wash equipment for single-patient use.
  15. Reassess for unexpected findings (for example epistaxis or increased congestion) and escalate when indicated.
  16. Document medication, dose, route, and patient response.

Patient Teaching Cues

  • Teach decongestant sprays as short-course therapy (commonly no more than about 3 days) to reduce rebound congestion risk.
  • Teach steroid sprays that symptom improvement may take about 1 week and requires consistent daily use.
  • Teach mast-cell inhibitor sprays as preventive agents often started about 1-2 weeks before expected allergy season.
  • For anticholinergic nasal sprays, reinforce that use is generally short-term and monitor for dry mouth, irritation, and epistaxis.
  • For intranasal naloxone rescue products, each device is single-use and should be replaced after administration.

Common Errors

  • Aiming toward septum → increased irritation and reduced delivery quality.
  • Skipping priming on first use → inaccurate dose delivery.
  • Immediate nose blowing after spray → reduced medication absorption.
  • Route/dose mismatch at bedside → preventable medication error.

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