Pre‐procedure

ActionRationale

1. 1.Show
   Discuss benefits and limitations of screening and significance of smear results. Explain the purpose of the procedure and explain what will occur at each step.
   To ensure that the patient/client understands that the procedure involves removing underwear and that the speculum will be inserted into her vagina, and consents to the procedure (NHSCSP [105], C; RCN [133], C). Allows the woman time to ask any questions. E
2. 2.Show
   Document the woman's clinical and screening history, specifically:

   • date of last menstruation
   • any abnormal bleeding
   • any unusual vaginal discharge
   • contraception
   • date of last cervical smear
   • any abnormal smear results
   • any treatment to the cervix.
   To ensure relevant history is recorded (NHSCSP [105], C).
3. 3.Show
   Place all the equipment required for the procedure on the trolley.
   To facilitate the efficient taking of the smear. E
4. 4.Show
   Close room door or curtains and ask the patient/client to remove her underwear.
   To provide privacy and comfort for the patient/client. E

Procedure

1. 5.Show
   Turn the light source on and position at end of examination table.
   To provide illumination of the cervix and increase the accuracy of the smear taking (NHSCSP [102], C; NHSCSP [105], C; RCN [129], C).
2. 6.Show
   Assist the patient/client into a supine position on the couch, with knees drawn up and legs parted. Keep her as covered as possible.
   To facilitate easy access of the vaginal speculum and the taking of the cervical smear (NHSCSP [102], C; NHSCSP [105], C; WHO [170], C).
3. 7.Show
   Wash hands with antibacterial detergent and running hand‐hot water. Ensure hands are dried with disposable paper hand towels.
   To reduce the risk of contamination and cross‐infection (Fraise and Bradley [50], E; RCN [132], C).
4. 8.Show
   Apply gloves and apron.
   To reduce the risk of contamination and cross‐infection (Fraise and Bradley [50], E; RCN [132], C).
5. 9.Show
   Select the appropriate size speculum, from very small, small, medium, large including a long‐bladed narrow speculum if the vagina is long or the cervix is lying posterior. If a reusable sterilized speculum is used it can be warmed or cooled using clean tap water.
   To promote patient comfort and reduce anxiety (NHSCSP [105], C). If removed from a sterilizer, speculum may need to be cooled down, if cold then warmed up to reduce patient discomfort. It must be explained to the patient that the speculum has been sterilized but the water will not contaminate it. E
6. 10.Show
   Apply lubricant to the speculum. Part the labia and, holding the speculum blades together sideways, slip the speculum into the vagina.
   To insert the speculum and reduce patient discomfort (Fraise and Bradley [50], E; WHO [170], C; RCN [129], C).
7. 11.Show
   When the speculum is halfway into the vagina, turn it so that the handle is facing down.
   To promote patient comfort and reduce contamination of the cervix with lubricants (NHSCSP [105], C).
8. 12.Show
   Gently open the blades of the speculum and look for the cervix. It may be necessary to move the speculum up or down until the entire cervix is visible.
   To reduce patient discomfort and visualize the cervix (WHO [170], C).
9. 13.Show
   Using the cervix brush, insert the central bristles into the endocervical canal so that the shorter, outer bristles fully contact the ectocervix.
   To ensure accuracy of site sampled (NHSCSP [102], C; NHSCSP [105], C; Singh et al. [150], R5).
10. 14.Show
    Using pencil pressure, rotate the brush in a clockwise direction five times and then remove the brush. Note: the plastic fronds of the brush are bevelled for rotation in a clockwise direction only.
    To ensure good contact with the ectocervix and gather a high cellular yield (NHSCSP [102], C; NHSCSP [105], C).

    Firm pressure is required to ensure the cells cling to the brush (NHSCSP [102], C; NHSCSP [105], C).

Either:

Using Thinprep, using a swirling motion, rinse the brush into the fixative vial; then push the brush into the base of the vial at least 10 times, forcing the bristles apart.
To ensure a usable amount of cellular material is collected (NHSCSP [102], C; NHSCSP [105], C).
Inspect the brush for any residual material and remove any remaining material by passing the brush over the edge of the fixative vial.
To ensure the cellular material reaches the preservative solution (NHSCSP [102], C; NHSCSP [105], C).
Ensure that the material reaches the liquid. Then tighten the cap so that the material passes the torque line on the vial and give the vial a shake.
To ensure that the cells do not cling to the device (NHSCSP [102], C; NHSCSP [105], C).
Or:
 
Using SurePath, remove head of the brush from the stem and place into the vial of fixative. Then screw lid on tightly and shake the vial. Note: it is essential that the sample is placed into the vial immediately in order to achieve fixation.
To ensure accurate preservation of cervical material (NHSCSP [102], C; NHSCSP [105], C).
1. 15.Show
   Gently pull the speculum out until the blades are clear of the cervix, then close blades and remove speculum, placing in clinical waste bin if disposable or into CSS container if reusable.
   To prevent pinching cervix or vaginal walls and ensure safe disposal of contaminated equipment (NHSCSP [105], C; WHO [170], C).
2. 16.Show
   Cover the patient/client and offer tissue paper to wipe away any excess vaginal discharge.
   To ensure dignity and privacy while promoting hygiene and comfort. E

Post‐procedure

1. 17.Show
   Remove gloves and dispose of waste in clinical waste receiver.
   Safe disposal of clinical waste (DH [35], C).
2. 18.Show
   Assist the patient/client off the examination table and allow her to dress.
   To ensure safety and promote dignity and privacy. E
3. 19.Show
   Using a black ballpoint pen, label the vial with patient/client name, clinic number and date of birth.
   To ensure patient details are documented correctly. E
4. 20.Show
   Place the vial into plastic specimen bag with the correctly labelled specimen form and send to laboratory.
   To ensure safe handling and transportation of a biohazard (HSE [68], C; DH [35], C; WHO [171], C).
5. 21.Show
   Document the procedure in the patient's records.
   To ensure timely and accurate record keeping (NMC [114], C).