When I was a student nurse back in the 1980s at the Royal Adelaide Hospital, one of the Registered Nurses shared a trick with managing nausea. It was pretty simple:

1. Rip open an alcohol swab (“proper” nurses always had some in their pocket, along with scissors, a multi-coloured pen, and about eleventy-seven other things).
2. Advise the patient to hold the alcohol swab close to their face, and breath in the fumes through their nose.
3. Assuming (hoping) that there’s a PRN order for it, scoot off to gather a Metoclopramide* (Maxalon) vial and injecting equipment, but don’t crack the vial.
4. On your return to the bedside, ask whether they are still feeling nauseous and, if so, would they like an IM injection to take the nausea away.

Result = about half the time, maybe a bit more, the nausea had resolved just by sniffing the alcohol swab.

Ye Olde Tradition vs Evidence-Based Practice

I did a quick whip-around a couple of the wards at the hospital where I work today. A couple of nurses had heard of this trick, but most hadn’t. So, is it just nursing folklore/a tradition, or is it evidence-based?

Nurses have noted “that it just works” for a while (Spencer 2004).

A 2002 study found that inhaling alcohol was just as effective as standard treatment in post-op patients (Merritt, Okyere &  Jasinski).

In a study of women undergoing outpatient gynecologic laparoscopic procedures (n = 100), postoperative nausea resolved quicker using 70% inhaled isopropyl alcohol (ie: the content of a typical swab) compared with intravenous ondansetron (Winston, Rinehart, Riley, Vacchiano & Pellegrini, 2003).

Anderson and Gross (2004) conducted a small (n = 33) trial, and found that alcohol, peppermint and saline (as a placebo) were equally efficacious. They speculated that the controlled breathing may be more important than the scent.

A 2018 review of two random controlled trials (n = 226) concluded that inhaling alcohol was effective for mild to moderate nausea in non-pregnant emergency department patients (Lindblad, Ting & Harris).

Finally, a recent randomized, placebo-controlled trial study (n =115) found that inhaling alcohol was significantly more effective than placebo, and those inhaling alcohol were much less likely to require other antiemetic medication (Candemir, Akoglu, Sanri, Onur & Denizbasi, 2021).

*Metoclopramide

The way I remember it, metoclopramide was the only antiemetic medication available back in the 1980s. I’m pretty sure that ondensetron wasn’t invented then (I don’t recall hearing about it), or maybe it just wasn’t  an affordable option at the time.

So What?

I’d imagine that I’ve missed a number of published studies. It’s just my blog dude – not bloody Cochrane Review.

All I wanted to do was see if there had been much research about Ye Olde Antiemetic Sniffing of Alcohol Swabs.

As shown above, there’s been a bit, but certainly nothing like the numbers of patients you’d have if you were trying to get a medication to market. Yet, as none of the studies listed above found unwanted ill-effects, and nearly all of them found that inhaling an alcohol swab was a useful antiemetic, maybe I should do as my senior colleague did back in the 1980s, and spread the word.

Spread The Word

To manage nausea:

1. Rip open an alcohol swab.
2. Advise the patient to hold the alcohol swab close to their face, and breath in the fumes through their nose.
3. Give them a few minutes, then return to see if it’s been effective.
4. If it hasn’t, progress to treatment as usual.
5. Keep score. There’s probably a research paper in this for you/your ward.

End

That’s it for this blog post.

Do you have any other “secret” nursing tips and tricks that should be shared? If so leave a message via the comments section below… maybe you’d like to write a guest post on the blog (it has a couple of thousand visitors most months).

Paul McNamara, 8 February 2021

Short URL: meta4RN.com/swab

References

Anderson, L. & Gross, J. (2004) Aromatherapy with peppermint, isopropyl alcohol, or placebo is equally effective in relieving postoperative nausea. Journal of PeriAnesthesia Nursing, 19(1), pp 29-35. https://www.sciencedirect.com/science/article/pii/S1089947203003071

Candemir, H., Akoglu, H., Sanri, E. Onur, O. & Denizbasi, A. (2021). Isopropyl alcohol nasal inhalation for nausea in the triage of an adult emergency department. The American Journal of Emergency Medicine, 41(1), pp. 9 – 13. https://www.ajemjournal.com/article/S0735-6757(20)31172-4/fulltext

Lindblad, A., Ting, R. & Harris, K. (2018). Inhaled isopropyl alcohol for nausea and vomiting in the emergency department. Canadian family physician Medecin de famille Canadien, 64(8), 580. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189884

Merritt, B., 0 Okyere, C. & Jasinski, D. (2002) Isopropyl Alcohol Inhalation: Alternative Treatment of Postoperative Nausea and Vomiting, Nursing Research, 51(2), pp 125-128. https://journals.lww.com/nursingresearchonline/Abstract/2002/03000/Isopropyl_Alcohol_Inhalation__Alternative.9.aspx

Spencer, K. (2004). Isopropyl Alcohol Inhalation as Treatment for Nausea and Vomiting, Plastic Surgical Nursing: 24(4), pp 149-154. https://journals.lww.com/psnjournalonline/Abstract/2004/10000/Isopropyl_Alcohol_Inhalation_as_Treatment_for.5.aspx

Winston, A., Rinehart, R., Riley, G., Vacchiano, C. & Pellegrini, J.(2003) Comparison of inhaled isopropyl alcohol and intravenous ondansetron for treatment of postoperative nausea. AANA (American Association of Nurse Anesthetists) Journal, 71(2), pp. 127-32. https://pubmed.ncbi.nlm.nih.gov/12776641