‫كليـــة العلـــوم الصحيــة‬

College of Health Sciences

COLLEGE OF HEALTH SCIENCES

Papsmear
Course Title: _____________________________ Course code:_______________________

Student name:______________________ ID number :___________Section: ____Date: ___________

Legend:
0 – NOT OBSERVED Task was not performed
1 – INSUFFICIENT Task was performed incorrectly
2 – ACCEPTABLE Task was performed well enough
3 - COMPETENT Task was performed quickly, systematically, and accurately

STEPS 0 1 2 3 REMARKS
A.Preparation of patient
1. Explain the pap cytology test to the patient. Allow the
patient to ask questions. Consider the protocols to be
followed in specific cases.
2. For patients of child-bearing age, test should be done 10-
20 days after the first day of LMP, and definitely not
when the patient is menstruating or bleeding, unless
bleeding is a continuous condition.
3. Instruct the patient not to douche for 2-3 days before the
test.
4. Instruct the patient not to use vaginal medications or
vaginal contraceptives 48 hours before the examination.
Intercourse should be avoided the night before the
examination.
B.Before procedure
5. Check the physician’s order and progress notes.
6. Identify the patient and check identification against
physician’s order.
7.Bring necessary equipments on bedside table
• A glass slides.
• A sterile Ayre’s spatula
• Cusco’s speculum.
• A pipette.
• Sterile cotton swabs.
• Sterile gloves.
• Ether/95% alcohol solution (1:1).
• Spray fixative. 9. A graphite pencil.
• Light source.
• K-Y jelly.
8. Instruct the patient to empty her bladder and rectum before
examination.
9. Ask the patient to give the following information: a. Age b. Use
of hormone therapy, birth control pills, oral contraceptive devices
c. Past vaginal surgical repair or hysterectomy d. All medications
taken, including prescribed, over-the-counter, and herbal e. Any
 ‫كليـــة العلـــوم الصحيــة‬
College of Health Sciences

radiation therapy f. Any other pertinent clinical history (e.g.

previous abnormal pap smear, signs of inflammation, or
bleeding).
10. Using the graphite pencil, label the ends of the slide with the
patient’s name and the collection site.
11. Ask the patient to undress from waist down.

12. Position the patient in a lithotomy position on an examination

table and drape.
C.During procedure
13. Don sterile gloves, lubricate, and insert a sterile Cusco’s
speculum.
14. For endocervical smear
• Insert a sterile cotton swab into the cervical os and rotate
it by 360°.
• Leave the swab in place for 10-20 seconds.
• Remove the swab and smear onto a glass slide.
• Fix it immediately.
• Note: Fixative must be applied to the slide before drying
of the specimen occurs. b. Ectocervical scraping Insert
Ayre’s spatula into the cervical os, rotate or scrape the
entire surface at the squamocolumnar junction
• Remove the spatula and smear onto a glass slide. Fix it
immediately
Ayre’s spatula in cervical os
• Cervical scraping Insert the pointed edge of a wooden
Ayre’s spatula into the cervical os and rotate the spatula
by 360°.
• Spread the cervical scrapings on a glass slide, fix it with an
ether/95% ethyl alcohol solution, and dry the slide.
• A cervix-brush sampling device may be used, and it is
recommended to be rotated a full 180° to improve the
sampling for abnormal cervical cells.
Vaginal pool:
• Using the blunt side of a wooden Ayre’s spatula, scrape
the vaginal floor behind the cervix.
• Spread the vaginal pool secretions on a glass slide, spray
or soak them in fixative, and dry the slide.
• Vaginal fluid is obtained for suspected endometrial
cancer or for a hormonal evaluation.
Vulvar smear
• Using the blunt side of a wooden Ayre’s spatula, directly
scrape the vulvar lesion.
• Spread the scraping on a glass slide and fix immediately
with spray fixative.
15. Give the patient a perineal pad after the procedure to absorb
any bleeding or drainage.
 ‫كليـــة العلـــوم الصحيــة‬
College of Health Sciences

16. Write the patient’s age, reason for the study, LMP (last
menstrual period), etc., on the requisition form and send the
slides to the cytology laboratory.
Total
Total score: _________ /

___________________________ ____________________________

Name & Signature of the Evaluator Name & Signature of the Student
References: Annamma Jacob, R Rekha, Jadhav Sonali Tarachand, Clinical Nursing Procedures: The Art
of Nursing Practice, Jaypee publications;4th edition:2020