GOVERNMENT COLLEGE OF NURSING

PROCEDURE
ON
COPPER-T INSERTION

SUBMITTED TO SUBMITTED BY
MRS.SUMI MATHEW GEETA DHAKA
HOD OBG MSc NSG (PREV.)
GCON, JODHPUR GCON, JODHPUR
 COPPER-T INSERTION
DEFINITION
Cu-T is an intrauterine contraception device which is inserted into the uterine cavity.
TYPES OF CU-T
a) Copper-T 380A : It carries 380 mm2 surface area of copper wire on stem (176 mg) and copper
sleeves on horizontal stem (66.5 mg). Replaced/removed after 10 years.
b) Copper-T 200B medicated : It carries 215 mm2 surface area of fine copper wounded around
verticals stem. Stem is made up of a polyethylene frame. Two threads are tried at the end of
vertical stem. Barium sulphate is also incorporated in the device. It contains 124 mg of copper and
the rate of copper loss is 50 mg/day. Removed/replaced after 4 years.
c) Copper-T 200: It carries 210 sq.mm surface area of copper and 120 mg. copper and is
replaced/removed after 3 years.
PURPOSES OF CU-T INSERTION
 For birth spacing.
 For emergency contraception.
TIMINGS OF CU-T INSERTION
 6 weeks following normal childbirth or abortion and 3 months after caesarean. It is preferable to
insert 2-3 days after completion of menses. It can be inserted at any time during cycle even during
menstruation with advantage of having open cervical os, distended uterine cavity and less cramp.
 At the end of M.T.P i.e after D and E.
 In postpartum period before discharge but rate of expulsion is high.
 In post placental delivery: insertion is immediately following delivery of placenta, in less
motivated mother but expulsion rate is very high.
ARTICLES
A sterile tray containing
 Alice forceps/tenaculum
 Sims speculum
 Uterine sound
 Sponge holder
 Perineal guard/sheet
 A pair of scissors
 A Cu-T
 A pair of sterile gloves
 A bowl containing sterile swabs to add 1:60 dettol
OTHER ARTICLES
 Screen
 Draping sheet
 Hand washing articles
 Mackintosh
STEPS OF CU-T INSERTION
Preliminary steps
 Prior to insertion, the provider needs to obtained a medical history and discuss contraceptive
choices.
 General and pelvic examination to exclude any contraindication of insertion and shape, position
and size of the uterus.
 Explain the complications and show device and obtained consent as per the policy of the hospital.
 Insertion is done under aseptic technique in OPD.
 Ask patient to empty the bladder.
 Placement of the device (Cu-T) inside the inserter.
 The device is taken out from the sealed packet. The thread, the vertical stem and the horizontal
stems are introduced through the distal end of the inserter. The horizontal tips are inserted not
more than 6 mm (¼ inch). The blue collar guard is kept 7 cm distance from top on transverse
plane.
Final steps
 Place patient in lithotomy position.
 Give sterile personal care with sponge holder.
 Hold anterior lip of the cervix about 2 cm from the OS with the help of Alice or tenaculum.
 Posterior vaginal speculum is introduced and the vagina and the cervix are cleansed by antiseptic.
 Pass uterine sound through cervical canal to note the position of the uterus and the length of the
uterine cavity.
 The inserter with the device placed inside is then introduced through cervical canal right up to the
fundus after positioning it by the guard. The Alice is handed over to assistant and the inserter with
right hand withdrawn keeping the plunger in position and pushing the Cu-T out. The plunger is
removal first to avoid pulling on the tail of the IUD, followed by the removal of the inserter. The
strings of thread cut 2.5-3 cm from the external OS.
 Women rest for 15-20 minutes and thereafter leave.
AFTER CARE
 Put all instruments in 1% bleach 30 minutes and then for sterilization.
ADVICES
 Explain the possible symptoms of pain and vaginal bleeding to the patient.
 To feel the thread periodically especially after each menstrual cycle by the finger.
 To come for follow up within 3 -6 weeks after insertion and the annually.
 Report immediately in case of any complication/ problems like abdominal pain. Chills, fever,
heavy vagina, bleeding /discharge and pain during intercourse.
 To take prophylactic antibiotics in time if prescribed.
 Cu-T should be removed when planning for next pregnancy.
 It is best to wait for three months before attempting next pregnancy and meantime use some other
contraceptive measure.
 Pelvic inflamed disease more in nullipara.
 Spontaneous expulsion (expulsion rate to 5 per cent).
COMPLICATIONS
 Cramps give antispasmodic drugs.
 Partial or complete perforation due to faulty technique of insertion.
 Abnormal menstrual bleeding. Iron supplement is advised.
 Pelvic inflammatory disease more in nullipara.
 Spontaneous expulsion (expulsion rate to 5 per cent).
CONTRAINDICATIONS
 Irregular or heavy bleeding
 Molar pregnancy in past
  PID (pelvic inflammatory disease)
 Bicornuate or septate uterus
 Ectopic pregnancy in past
 Dysmenorrhoea
 Heart disease
 Stenosis of cervical canal
REMOVABLE OF CU-T
 Expiration of the device.
 Patient desire to become pregnant.
 Persistence of excessive or regular uterine bleeding.
 Flaring up of salpingitis or pelvic pain.
 Perforation of the uterus.
 Downward displacement of the device.
 Pregnancy occurring with device in.
 Missing thread.
STEPS OF REMOVAL OF CU-T
 Removal may occur at anytime in the menstrual cycle but it may be earliest during menses or mid-
cycle.
 To remove an IUD, the provider should apply steady gentle traction in the string. If gentle traction
is not effective, the provider can straighten the anterior retroversion with Alice and then pull on the
string.
 Ensure that Cu-T which is removed is checked and shown to the patient.