2015 Peer Assessment PAP Smear

Peer Assessment Tool
Cervical (Pap) smear

Before procedure
Gather equipment as per included list
Communicate with patient and obtain appropriate consent for procedure
Identify patient
This is an aseptic procedure, use aseptic technique throughout procedure
Steps
1. Label glass slides with the patient’s information

2. Confirm that the patient has emptied her bladder
3. Wash your hands OR make use of alcohol spray
4. Prepare instruments for gynaelogical examination
5. Position her in the supine position, knees bend and pull up her legs, put her heels together
and then move her knees widely apart
6. Switched light source on and position the light source
7. Puts non sterile gloves
8. Choose appropriate speculum size and check that it can open and close properly
9. Lubricate the speculum 1-2 cm from tip, taking care not to contaminate the tip with
lubricant
10. Use the non-dominant hand and either separate the labia minora with two fingers or gently
press downwards on the perineum at the vaginal opening
11. Advance the speculum with the blades closed, pointing it downwards and backwards and
rotate the speculum blade so that the handle are positioned upwards or downwards
12. Once you pass the vaginal opening open the speculum slightly to visualize the cervix,
13. Once the cervix are visualised, lock the speculum screw
14. Examine cervix and vaginal fornices for any abnormalities
15. Obtain sample by inserting the longer tip of the Ayres’spatula into the endocervical canal
and rotate through 360⁰ x 1
16. Immediately smear sample onto labelled glass slide with a few light sweeping motions in
order to get a one-cell thickness
17. Spray with fixative spray holding the spray container approximately 30cm from the slide to
prevent decaying of the cells
18. Release (unscrew) and gently remove speculum with blades slightly open
19. Inspect the anterior and posterior vaginal walls
20. whilst removing speculum, blades should be closed
21. Perform a bimanual examination
Revised April 2015 by Dr. Heyns van der Merwe

Procedure available on Sunlearn
Reference
Dehn, R.W., Asprey, D.P., 2013. Essential Clinical Procedures. Third Edition. Philadelphia: Elsevier Saunders
Kruger, T.F., Botha, M.H. 2011. Clinical Gynaecology. Fourth Edition. Juta and Company Ltd.
Equipment needed for procedure
Cervical smear
Alcohol spray and/or hand wash facility
Non-sterile gloves
Lubricant (KY Jelly)
Pap smear glass slides
Cusco speculum, different size speculums available (small, medium, large)
Ayres spatula or Aylesbury spatula
Fixative spray
Linen saver
Good light source
Cotton swabs

Reference
PURPOSE:
The purpose of this procedure is the description of the steps for obtaining a cervical (Pap) smear
LEARNING ASSUMED TO BE IN PLACE:
 Anatomy and physiology of the female external and internal genitals.

 Infection prevention and control principals.
 Communication skills.
SPECIFIC OUTCOMES
Students declared competent in performing this procedure will have achieved the following specific
outcomes:
 Assessment of the patient, environmental and culture issues prior to the procedure.
 Planning to perform the procedure.
 Implementation of the applicable actions.
 Evaluation of the outcomes of the actions.
 Record keeping.
QUALITY/ RISK CONTROLS:
Actions Rationale
Wash your hands OR make use of alcohol spray Standard procedure to reduce the risk of
transmission of microbes/pathogens
Puts non sterile gloves on Appropriate use of PPE
Gloves should be worn when potential exposure
to body fluids
 Gathering of information
Actions Rationale
History–taking: History taking is the first step of patient
Obtaining a complete general/ family and assessment
gynaecological history Development interpersonal communication skills
Holistically approach this will promote patient-physician interaction,
trust and will help with the patient assessment
and treatment
Women should have a gynaecological assessment Sexually active women should undergo a
according to the requirements of the Department gynaecological assessment once a year
of Health until she has had three smears at yearly intervals
Family history of cervical cancer – inform patient which were normal
to do PAP Smear more regularly Any women who is older than 30 years and has
never had a smear and every ten years thereafter
HIV patient should have a smear taken every

Reference
three years
 Prepare the patient, environment and equipment

 Perform the procedure as follow
Identification of patients. Ensure the correct patient is prepared for

procedure.
Prepare the patient and explain the procedure. To obtain consent and relief patient anxiety
Ensure privacy. Patient’s basic right.
Prevents emotional trauma.
Offer a bedpan/toilet Ensures comfort and reduce interruption
during procedure.
Abdominal / Bi-manual palpation of the
abdomen increase discomfort if bladder is full
Prepare instruments for gynaelogical examination A Cusco vaginal speculum is a gynaecological
instrument which is used to view a woman’s
cervix properly.
Position her in the supine position, knees bend and The examiner has easy access, inspect of the
pull up her legs, put her heels together and then external genitalia and performing the
move her knees widely apart procedure
Switched light source on and position the light source Good light is essential for inspection of the
external and internal genitalia
Puts non sterile gloves on Gloves should be worn when potential
exposure to body fluids
Choose appropriate speculum size for patient Small, medium and large speculum is
determined by the women body size,
pregnancies and also the structure of the
women vagina.
Preheat speculum under warm water if needed To ensure patient comfort
Check that the speculum can open and close properly To prevent emotional discomfort for the
before use patient
Examiner ensure safe working instrument.
Lubricate the speculum 1-2 cm from tip of the To prevent contamination of the cervical
speculum surface which may hinder the cytological
evaluation when taking a smear
Use the non-dominant hand and either separate the To reduce discomfort to the external genitalia
labia minora with two fingers or gently press Open passage to insert speculum through the
downwards on the perineum at the vaginal opening introitus
Advance the speculum with the blades closed, Blades closed to reduce discomfort
pointing it downwards and backwards and rotate the According to which is an appropriate for the
speculum blade so that the handle are positioned patient
upwards or downwards

Reference
Once the cervix are visualised, lock the speculum To keep the vaginal passage open
screw
Open the speculum to visualize the cervix and lateral Local infections
vaginal fornices Vaginal discharge
Loss of rugae and atrophy of the epithelium
Ulcerations, polyps, tumours
Obtain sample by inserting the longer tip of the Ayres 360⁰ smear to detection of cervical cancer
’spatula into the endocervical canal and rotate
through 360⁰ x 1
Immediately smear sample onto labelled glass slide Will provide good sufficient information
with a few light sweeping motions in order to get a about the patient condition of cervix
one-cell thickness
Spray with fixative spray holding the spray container To prevent damage of the cellular material
approximately 30cm from the slide to prevent
decaying of the cells
Release (unscrew) and gently remove speculum with To reduce discomfort
blades slightly open
Inspect the anterior and posterior vaginal walls Infection and vaginal discharge
Loss of rugae and atrophy of the epithelium
Ulcerations, polyps, tumours
Ask patient to bear down while the speculum is pulled To detect uterovaginale prolapse with cysto-
out slowly with blades closed and rectocele
Perform a bimanual examination See peer assessment tool

Reference

2015 Peer Assessment PAP Smear

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Peer Assessment Tool

Cervical (Pap) smear

This is an aseptic procedure, use aseptic technique throughout procedure

1. Label glass slides with the patient’s information

Revised April 2015 by Dr. Heyns van der Merwe

Alcohol spray and/or hand wash facility

Lubricant (KY Jelly)

Pap smear glass slides

Cusco speculum, different size speculums available (small, medium, large)

Ayres spatula or Aylesbury spatula

Good light source

Revised April 2015 by Dr. Heyns van der Merwe

LEARNING ASSUMED TO BE IN PLACE:

 Anatomy and physiology of the female external and internal genitals.

QUALITY/ RISK CONTROLS:

Revised April 2015 by Dr. Heyns van der Merwe

 Prepare the patient, environment and equipment

Identification of patients. Ensure the correct patient is prepared for

Revised April 2015 by Dr. Heyns van der Merwe

Revised April 2015 by Dr. Heyns van der Merwe

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