— Chapter 14 Maternal and Child Nursing ap 14.19: Assisting in Insertion of Intrauterine Contraceptive Device (Copper-T) TION pefINITIC introduction of a specially designed device into the uterine cavity o! lew who desires to pr sagan fora spel period of ime rine cavity ofa fertile woman whi p event conception! pURPOSES pURPOS| 1, Toavoid unwanted pregnancy. 2, To space pregnancies. CONTRAINDICATIONS Absolute 1. Suspected pregnancy. 2, Pelvicinflammatory disease 3. Vaginal bleeding of undiagnosed etiology. 4. Previous ectopic pregnancy. Relative 1. Anemia 2, Menorthagia. 3. History of pelvic inflammatory disease. 4. Distortions of the uterine cavity due to congenital malformations, fibroids. ADVANTAGES OF IUCD 1. Simplicity: No complex procedures are involved in insertion. 2. Hospitalization is not required. F 1UcD staysin place aslongas required (Different rypesof TUCDs have varying durations recommencled forreplaceme depending on the amount of impregnated medication). Inexpensive. Contraceptive effect is reversible by removal of UCD. Free from systemic metabolic side-effects associated with hormonal pills. ‘There is no need for continual motivation. ARTICLES 1. IUCD presterilized insertion package. 2. Sterile tray containing: Vaginal speculum (cuscos)— Disinfectant solution. Kidney tray. a b. Vulsellum—1. c. Uterine sound—1. 4. Sponge holding forceps—2. €. Bow! containing cotton swab. Sterile gloves. & Scissors. h A.GEIL Clinical Nursing Procedures: Ine Are er rere PROCEDURE (INSERTION OF COPPERT) ‘Nursing action 1. Explain the procedure including advanta side-effects of 1UCD. 2. Arrange the equipment near examination table. ages, disadvantages, effect Instruct woman to empty her bladder, 44. Postion woman on her back with knes flexed and urtocks atthe ele oF the table. Provide privacy and drape patient appropriately. 6. Wash hands and don sterile gloves. Load the IUCD (Cu-T) inside the applica threads, the vertical stem and then the horizontal ste vertical stem through the distal end ofthe inserter [Figure 14.191) or in the following manner: The im folded onto the lacing the IUCD in the inserter Figure 14.19(a): Inspect external genitalia, urethra and vagina for signs of infection, lesions or discharge. 9. Cleanse the perineum. Explain to the woman that there will be slight discomfort during speculum 10, Insertion, 11. Insert the speculum gently and observe the cervix for signs of infection and erosion, 12, Clean the external cervical os with an antiseptic soaked swab by using sponge holding forceps. 13, Instruct the patient that there will be disocmfort (pinching pain) when applying the vulsellum, Apply vulsellum at the 12 0' clock position on the cervix, grasp the lip of the cervix. 14, Pass the uterine sound into the cervical canal and insert carefully into the uterine cavity while pulling steadily downward and outward on the vulsellum. (A slight resistance indicates that the top of the uterine sound has reached the fundus), and remove the uterine sound, 15. Measure the length of the device to be inserted into the uterine cavity. The depth of gauge on the inserter- tube is used to mark the de pth of the uterus, Pull the loaded inserter tube gently until the distance between the top ofthe folded”T" and edge of the depth gauge closest to the" T"is equal to the depth of the uterus as measured on uterine sound, ma nationale Helps in obtaining cooperation ofp, reduces anxiety. tien ang Prevents embarassment, Loading in this manner facilitates reas the device as the inserter is withdrawn, Helps in obtaining cooperation. Applies traction to the cervix and straightes the cervical canal. Determines the length of the uterine by noting the level of mucus or blood on" uterine sound.1. 1. 20. 2a. 22 2B. 24, 25. 26. 2. 28, Chapter 14. Maternal and Child Nursing & Nursing action Rationale Carefully pee! the clean plastic cover ofthe package away fom the white packing, Lift the loaded inserter keeping it horizontal so that neither the T" nor the white rod fll ot. Be careful not to push the white rod towards the ™ Grasp the vulsellum and pull firmly downwards : and outwards to align the uterine cavity and cervical canal wth the vagin al canal. Gently introduce the loaded inserter assembly through the cervical canal Keeping the depth gauge into a horizontal postion [Figure 14.19 (b), Figure 14,19(b): Technique of inserting an 1UCD According to the position and direction of the uterine cavity gently and Carefully advance the loaded inserter assembly until the depth gauge comes in contact with the cervix or resistance of the uterine fundus is felt. Hold the vulsellum and the white rod in one hand, Places the loaded applicator in the uterine cavity. Gently and slowly withdraw the inserter keeping the plunger in place, This action frees IUCD into the uterine cavity. Check for the strings protruding from the uterus. Cut the strings shorter so The strings can be seen and felt in the vagina, that they protrude only 3 cm outside the cervix (from the external os), Remove the vulsellum. I there is excessive bleeding from the vulsellum ste, press a sterile cotton ball to the site using forceps until te bleeding stops. Remove speculum and drapes. Instruct patient to stay in bed for sometime. Wash perineum with soap and water and dry it. Remove gloves and discard, Instruct the woman on follow-up measures: a. To confirm presence of IUCD periodically by feeling the presence of threads in vagina, . Instruct patient to vist clinic whenever she exg ‘of problems related to 1UCD such as: P-Delayed period, spotting, bleeding or missing period, ‘A-Abnormal pain or pain during coitus. infection, any vaginal discharge. N-Not feeling wel, fever or pelvic pain. 5 Strings (not feeling the strings in vagina). eriences the warning signsEup Clinical Nursing Procedures: The Amt 0! Us" SIDE-EFFECTS AND COMPLICATIONS 1. Excessive bleeding. 2. Low back pain during menstruation. 3. Pain during menstruation. 4. Pelvic infection. Uterine perforation. . Ectopic pregnancy. . Expulsion of device.