Cervical smear

Introduction

• Wash hands; Introduce self; ask Patient’s name and what they like to be called; Explain examination, why it’s necessary, and obtain consent 
• Get a chaperone
• Explain smear programme
• Explain procedure
  • Be impersonal, e.g. ‘It will involve placing a small plastic tube inside the vagina to look at the cervix.’
  • ‘It shouldn’t be painful, but if at any point you are uncomfortable or want to stop, just say so. One of the nurses will also be present to ensure you are comfortable and act as a chaperone.’ 
  • Patient should be lying flat in lithotomy position but remain covered initially: ‘You will need to undress from the waist down, put your heels together and bring them as close to your bottom as possible, then flop your knees down outwards.’
• Before starting, ask about: last menstrual period, intra-menstrual bleeding, discharge, contraception, last smear
• Ask if the patient needs the toilet before the procedure
• Position the patient so you are on their right side if possible

NB: keep talking to and reassuring the patient, using their name throughout.

Gather equipment

Equipment list

• Gloves and apron
• Speculum
• Cervical smear brush
• Cervical smear sample bottle
• Wash tray and place equipment inside in partially open packets

 

NB: ensure you also have suitable lighting and a source of warm tap water

Performing the smear

Preparation

• Put on gloves and apron
• Inspect the vulva for any obvious abnormalities 
• If required, use warm water to lubricate the speculum (lubrication jelly is generally avoided because it can alter the results)

Speculum insertion

• Warn the patient prior to insertion
• Part labia and insert the speculum with the screw sideways
• Rotate speculum as you advance it so that the screw is facing upwards. Open speculum and tighten screw when resistance is met.
• Hold it in place with your left hand so it doesn’t slide out
• Direct light to visualise cervix – look for discharge, erosions, ulcerations, growths, cervicitis, blood, polyps, ectropion

Sampling

• Use your right hand to open the sample bottle and place it in your left hand (which is also holding the speculum)
• Take the smear using your right hand. Place the centre piece of the brush in the endocervical canal and gently rotate the brush 3-5 times (360˚) clockwise in the endocervix and then remove.
• Depending on type of brush, either snap off the head into the sample bottle or twirl the brush in the liquid inside the sample bottle 10 times
• Replace the lid and return sample bottle to tray
• Close speculum blades (but not fully to avoid pinching vaginal wall)
• Remove speculum while rotating it back sideways

To complete 

• Thank patient, give them a tissue and restore clothing
• Fill in the sample bottle and request form details
  • Name, DOB, hospital/clinic number, address, GP name and address
  • Date of test, last smear and last menstrual period
  • Reason for smear (e.g. routine recall, first smear, previous abnormal test etc.)
  • Sampling device
  • Condition (pregnant, postnatal, any intra-uterine devices, taking hormones)
  • Appearance of cervix
  • Clinical details
• Document in patient’s notes
• Advise patient results will take approximately 2 weeks and will be sent by letter

Test your knowledge on cervical smear screening and results

Who gets invited for cervical smear screening?

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What is the frequency of screening?

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What is screened for?

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What are the types of Cervical Intraepithelial Neoplasia (CIN)?

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Try out some gynaecological procedure OSCE stations

1. Pelvic examination
2. Gynaecological swabs
3. Find more stations here