Assisting in

Papanicolaou
Smear
(Pap Smear)

NCM 109 L
Papanicolaou smear
(Pap smear, cervical smear)
• is a safe, noninvasive cytological examination for early
detection of cervical cancer.

• Pap smear is performed by a practitioner and takes

approximately about 5 to 10 minutes.

• The American Cancer Society recommends a Pap smear at least once

every three years for women ages 21 to 29 who are not in a high-risk
category and who have had negative results and who have had
negative results from three previous Pap tests. While a Pap test and
an HPV test is recommended every five years for women ages 30 to
65 years old.
Indications of Pap Smear
• Identify the presence of sexually transmitted disease such as
human papillomavirus (HPV), herpes, chlamydia,
cytomegalovirus, Actinomyces spp., Trichomonas vaginalis, and
Candida spp.
• Detect primary and metastatic neoplasms
• Evaluate abnormal cervical changes (cervical dysplasia)
• Detect condyloma, vaginal adenosis, and endometriosis
• Assess hormonal function
• Evaluate the patient’s response to chemotherapy and radiation
therapy
Pap Smear Procedure
The step-by-step procedure is as follows:

1. The patient is positioned.

The client is assisted in a supine, dorsal
lithotomy position with feet in stirrups.
2. A speculum is inserted.
The practitioner puts on gloves and
inserts an unlubricated plastic or metal
speculum into the vagina and is opened
gently to spread apart the vagina to
access the cervix. The speculum may be
moistened with saline solution or warm
water to make insertion easier.
Pap Smear Procedure
3. Cervical and vaginal specimens'
collection.
After positioning the speculum, specimen
from the vagina and cervix are taken. A
cytobrush is inserted inside the cervix and
rolls it firmly into the endocervical canal. The
brush is then rotated one turn and removed.
A plastic or wooden spatula is utilized to
scrape the outer opening of the cervix and
vaginal wall.
Pap Smear Procedure
4. Collection technique (Using the conventional
collection).
The specimen from the brush and spatula is wiped
on the slide and fixed immediately by immersing
the slide in equal parts of 95% ethanol or by using a
spray fixative.

5. Collection technique (Using the Thin Prep

collection).
The brush and spatula are immediately immersed in
a ThinPrep solution with a swirling motion to
release the material. The brush and spatula are then
removed from the solution and the bottle lid is
replaced and secured.
Pap Smear Procedure
6. Label the specimen
The slides are properly labeled with the patient’s name, age, initials of
the health care provider collecting the specimen, date, and time of
collection.
7. Specimens are sent to the laboratory
The specimens are transported to the laboratory for cytologic analysis.
8. Bimanual examination may follow.
After the removal of the speculum, a bimanual examination may be
performed wherein the health care provider will insert two fingers of
one hand inside the vaginal canal to feel the uterus and ovaries with
the other hand on top of the abdomen.
• Normal findings in a Pap smear will indicate a negative
result which means that no abnormal, malignant cells or
atypical cells are found. While a positive result signifies that
there are abnormal or unusual cells discovered, it is not
synonymous to having cervical cancer.
Factors or Conditions that may alter the
outcome
• Delay in fixing a specimen, allows the cells to dry therefore
destroying the effectiveness of the stain and makes cytologic
interpretation difficult
• Improper collection site may cause rejection of the specimen.
Samples for hormonal evaluation are taken from the vagina while
samples for cancer screening are obtained from the vaginal fornix
• Use of lubricating jelly on the speculum that may affect the viability
of some organisms
• Specimen collection during normal menstruation since blood can
contaminate the sample
• Douching, using tampons, or having sexual intercourse within 24
hours before the exam can wash away cellular deposits
• Existing vaginal infections that may interfere with hormonal cytology
Nursing Responsibility for
Pap Smear

• Nurses play an important role in promoting

public health awareness to inform,
encourage and motivate the public in
considering health screening such as pap
smear.
 Before the procedure
• Secure patient’s consent. The test must be adequately explained and understood
by the patient before a written, and informed consent is obtained.
• Obtain the patient’s health history. These include parity, date of last menstrual
period, surgical status, contraceptive use, history of vaginal bleeding, history of
previous Pap smears, and history of radiation or chemotherapy.
• Ask lists of the patient’s current medications. If a patient is taking a vaginal
antibiotic, the pap smear is delayed for one month after the treatment has been
completed.
• Explain that Pap smear is painless. The test requires that the cervix may be scraped
and may experience minimal discomfort but no pain from the insertion of the
speculum.
• Avoid interfering factors. Having sexual intercourse within 24 hours, douching
within 48 hours, using a tampon, or applying vaginal creams or lotions is avoided
before the test since it can wash away cellular deposits and change the ph of the
vagina.
• Empty the bladder. Pap smear involves the insertion of the speculum into the
vagina and could press down the lower abdomen.
After the procedure
• Cleanse the perineal area. Secretions or excess lubricant from the
vagina are removed and cleansed.
• Provide a sanitary pad. Slight spotting may occur after the pap
smear.
• Provide information about the recommended frequency of
screening. The American Cancer Society recommends screening
every three years for women aged 21 to 29 years old and co-testing
for HPV and cytological screening every five years for women aged
30 to 65 years old.
• Answer any questions or fears by the patient or family. Anxiety
related with the pending test results may occur. Discussion of the
implications of abnormal test results on the patient’s lifestyle may be
provided to the patient.