NARAYANA NURSING INSTITUTION

CHINTHAREDDY PALEM
NELLORE

2nd International conference on

“ExcEllEncE in OncOlOgy nursing”
2019
PAP SMEAR PROCEDURE
 INTRODUCTION
• PAP TESTS (OR Pap smears) look for cancers
and precancers in the cervix. Precancers are cell
changes that can be caused by the human
papillomavirus (HPV). If not treated, these
abnormal cells could lead to cervical cancer.
• An HPV test looks for HPV in cervical cells. Most
women 21 to 65 years old need to get Pap tests or
a Pap test and HPV test together. Not all women
need to be tested every year.
• The Pap technique was developed by and named
after George Papanicolaou (1883-1962), a Greek-
born physician and scientist who moved to the
U.S. In 1923, while looking at vaginal smears
from women with cervical cancer, Papanicolaou
saw cancer cells.
• After two decades of research on this subject, he
reported in 1943 that both cervical and uterine
cancer could be detected in their early stages with
this test that has, since its inception, saved
innumerable lives.
 Worldwide, approximately 500,000 new cases of cervical cancer
and 274,000 deaths are attributable to cervical cancer yearly,
making cervical cancer the second most common cause of death
from cancer in women.
 Fortunately, the incidence of cervical cancer has decreased by more
than 50% in the past 30+ years, largely due to the increasing use of
cervical cancer screening with cervical cytology.
 The American Cancer Society estimates about 13,240 new cases of
invasive cervical cancer will be diagnosed and about 4170 women
will die from cervical cancer in 2018.
 Although worldwide cervical cancer rates have decreased
dramatically with the increase in screening efforts, incidence and
prevalence in developing countries remains high due to lack of
screening programs, with approximately 80% of all cervical cancer
deaths occurring in the developing world
 PAP SMEAR
• Pap Smear: A screening test for cervical
cancer based on the examination of cells under
the microscope.
• The cells are collected from the cervix,
smeared on a slide and specially stained to
reveal premalignant (before cancer) and
malignant (cancer) changes as well as changes
due to noncancerous conditions such as
inflammation from infections. Also called
a Pap smear.
 PURPOSE
• To detect early cancer of the cervix
• To determine estrogen activity related to
menopause or endocrine abnormalities.
INDICATIONS OF PAP SMEAR
• Pap smear is usually not necessary for females
younger than 21. After 21, the screening schedule
is as follows:
• ages 21–29: screening every 3 years
• ages 30–65: screening every 3 years, an HPV test
every 5 years, or an HPV test and Pap smear
every 5 years
• Anyone with HPV who has recently had an
abnormal Pap smear or who has other risks
factors for cervical cancer may need additional
tests or more frequent screenings.
 INDICATIONS OF PAP SMEAR

• Those over 65 with a history of previous

screenings: no tests
• Those who have had a hysterectomy: no
tests
 Screening Methods for Average-Risk
Asymptomatic Women
• Age 21 to 29: Every 3 years with cytology
(Pap testing), regardless of age of onset of
sexual activity or other risk factors.
• Age 30 to 65: Every 5 years with HPV co-test
(Pap + HPV test) OR every 3 years with
cytology.
 INDICATIONS OF PAP SMEAR

 Having a family history of cervical cancer

 A diagnosis of cervical cancer or a Pap smear that
showed precancerous cells
 Detect primary and metastatic neoplasms
 Evaluate abnormal cervical changes (cervical
dysplasia)
 Detect condyloma, vaginal adenosis,
&endometriosis
 Assess hormonal function
 Multiple sexual partners
 INDICATIONS OF PAP SMEAR
 A sexually transmitted infection, such as genital herpes or
chlamydia ,cytomegalovirus, Actinomyces spp.,
Trichomonas vaginalis, and Candida spp.
 Previous cancer of the genital tract
 Smoking
• Evaluate the patient’s response to chemotherapy and
radiation therapy
INDICATIONS OF PAP SMEAR
• Posttreatment follow-up for cervical
dysplasia, malignancy
• Any visible or palpable lesion of the cervix
(also need colposcopy)
• Any abnormal vaginal bleeding or discharge
• After supracervical (subtotal) hysterectomy
• As part of the initial workup for victims of
rape, incest, abuse
 WHEN NOT TO SCREEN

• Older Than Age 65: No screening past age 65

if adequate prior screening can be assessed
accurately (three consecutive negative
cytology results or two consecutive negative
HPV results within 10 years before screening
cessation, with the most recent test occurring
within 5 years) and not otherwise at high risk
for cervical cancer.
 Cont…
• screening recommendations do not apply to
women—
• With a prior diagnosis of a high-grade
precancerous cervical lesion or cervical cancer,
• With in utero exposure to diethylstilbestrol, or
• Who are immunocompromised (such as those
who are HIV positive, organ transplant
recipients, or on chronic corticosteroids).
 CONTRAINDICATIONS

• No absolute contraindications to obtaining a

Pap smear are known.
• Relative contraindications include clinical
circumstances in which sample collection is
difficult to obtain or difficult to interpret.
 ARTICLES REQUIREMENT
Screen : for privacy
A CLEAN TRAY CONTAINING THE FOLLOWING
ARTICLES
 Perineal drape
 Sponge holding
 Bowl with sterile cotton swabs
 Bi-valve speculum (various sizes)
 Water-soluble lubricant.
 Sterile examination gloves.
 Spot Light
 Savlon Solution
 Large swabs for gentle blotting of excess
discharge.
 Wooden spatulas or plastic spatulas for
ectocervical sample.
 Cytobrush Plus for endocervical sample.
 As an alternative to taking two samples, a
"broom" device can be used for ectodermal and
endocervical samples
 Microscope slides, fixative or media for liquid-based
testing.
 Appropriate patient identification and history forms.
 Cervical tenaculum or cervical hook (rarely needed).
 Ring forceps.
 Materials and solutions for liquid-based Pap smears
(e.g., ThinPrep)
 Container for transporting slide to the lab
 Specimen Form
 Lead pencil for labeling slide
CUS CUS VAGINAL SPECULUM
 PRELIMINARY ASSESMENT
• Nurse should advise patient to make an
appointment other than during menstruation
• Before appoiment :
• 1.Avoid intercourse for 2 days
• 2.Refrain from douching for 1 day
• 3.Cease the use of vaginal medication for at
least 48 hours.
 PREPROCEDURE
• Inform and explain the procedure to patient
• Confirm the patient’s details (e.g. name and
date of birth)
• Advice patient to void.
• Provide privacy.
• Assistant position Lithotomy to her on
examining table
• Drape patient permit minimal exposure.
 DURING PROCEDURE
• Explain the procedure as needed
• Encourage the patient to take deep breaths
helps the pelvic muscles relax
• Give support to the patient
• Assist the doctor/nurse in doing the papsmear.
• Help to open the gel.
• Help to focus the torch light to perineal area of
patient.
 STEPS:
WASH HANDS /USE HAND RUB
WEAR THE GLOVES
INSPECT THE VULVA
 GENTLY INSERT THE SPECULUM
SIDEWAYS WITH THE BLADES CLOSED
ONCE INSERTED ROTATE THE
SPECULUM BACK 90 DEGREES
OPEN THE SPECULUM BLADES GENTLY TO
OBTAIN OPTIMAL VIEW OF THE CERVIX
 FIX THE POSITION OF THE
SPECULUM USING THE LOCKING
NUT
INSPECT THE CERVIX
GENTLY INSERT THE ENDOCERVICAL
BRUSH INTO THE EXTERNAL OS
ROTATE THE BRUSH 360 DEGREES, 5
TIMES, IN A CLOCKWISE DIRECTION
 REMOVE THE ENDOCERVICAL BRUSH,
AVOIDING TOUCHING THE SPECULUM AS
YOU DO SO
 DEPOSIT THE ENDOCERVICAL
BRUSH TIP INTO THE SAMPLE POT
LOOSEN THE LOCKING NUT
GENTLY REMOVE THE SPECULUM, WITH THE
BLADES PARTLY CLOSED, INSPECTING THE
VAGINAL WALLS AS YOU DO SO
Wash hands
TO COMPLETE THE PROCEDURE…
• Thank the patient
• Allow the patient time to get re-dressed
• Label the sample
• Document the procedure in the medical
notes including the details of the chaperone
 POST-PROCEDURE CARE
• Observed any discharge from the vagina.
• Perineal care as needed.
• Assist the patient from dorsal recumbent position /lithotomy
position to supine position.
• Documentation.
• Send the smear to laboratory with form.
• Inform the patient to expect minor spotting or cramping.
• Make sure that you have accurate follow-up contact
information and patient preferences for contact methods.
• When results are available, take time to explain your
recommendations for follow-up.
• All Pap smears reported as abnormal require some form of
intervention.
 COMPLICATIONS
• The Pap smear is only a screening test. False-
negative rates are high.
• Minor spotting and occasional uterine cramps
commonly follow Pap smear sampling.
RESULTS INTERPRETATOIN
 HEALTH EDUCATION

Tell patient to inform any excessive bleeding

after procedure(a little bid bleeding is normal).

Instruct the patient to follow up the procedure

atleast annually or biannually.(Depend on
results)
 NARAYANA COLLEGE OF NURSING
II ND INTERNATIONAL CONFERENCE ON EXCELLENCE IN ONCOLOGY
NURSING 2019 –PAPSMEAR PROCEDURE