Womens Health Workshop-The Basics Presented by: Laurel Hallock - - PowerPoint PPT Presentation

Women’s Health Workshop-The Basics

Presented by: Laurel Hallock Koppelman, DNP, FNP-C, APRN Assistant Professor, OHSU School of Medicine

Disclosures

• I have nothing to

disclose.

Shout out!!!

Aimee Holland, DNP, WHNP-BC, FNP-C, FAANP | Associate Professor DNP Program Director UAB School of Nursing | The University of Alabama at Birmingham

• You will find the videos on the University of Alabama at Birmingham School of

Nursing website: http://www.uab.edu/nursing/home/technology-innovation/faculty- clinician-resources/gyn-np-procedures

• The simulation publications are in Nursing for Women's Health: A Journal for

NPs: https://npwomenshealthcare.com/archives/

What we are planning on doing today and

• bjectives
• Endometrial Biopsy
• Endometrial Polypectomy
• Vulvar Biopsy

Reasons for Endometrial Biopsy

• AUB

– Amenorrhea for a year – Post menopausal bleeding

• Cancer screening*

(hereditary colorectal)

• Endometrial dating
• Infertility evaluation.
• Done with colposcopy

When not to do an endometrial biopsy

• Pregnancy
• Acute PID
• Acute cervical or

vaginal infections.

• Clotting disorders
• Anatomy

– Severe stenosis of cervical os

Equipment Needed

• Sterile

– Sterile gloves – Speculum – Uterine sound – povidone-iodine – Endometrial suction catheter – Tenaculum – Ring forceps – Sterile 4 × 4 gauze – Sterile scissors

• Non-Sterile

– gloves – Lubricating jelly – Chux pad – Sampling container – 20 percent benzocaine (Hurricaine) spray with the extended application nozzle* – Cotton swabs

How to perform endometrial biopsy

• https://cdnapisec.kalura.com/index.php/extwidget/

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How to perform endometrial biopsy

• Negative HCG and consent signed.
• Perform bimanual exam.
• Insert speculum.
• Cleanse the cervix with betadine using ring forceps
• Place tenaculum on anterior edge
• Sound uterine depth
• Insert endometrial biopsy catheter up to the fundus

How to perform endometrial biopsy

• Draw back internal tube on the catheter
• Move catheter in and out and twist 360 degrees as

you do this w/o tip leaving endometrial cavity.

• Place sample in formalin jar
• Remove tenaculum, apply pressure if bleeding and

remove speculum

Endometrial biopsy PEARLS

• Can’t get through:

– Change attachment of tenaculem

• Anterior vs Posterior

– Use dilator – Use OS finder – Still no luck:

• Get an ultrasound

– What is blocking that OS

• Always use a leg

– Support don’t strike

• Ibuprofen
• Syncope:

– It happens

Cervical Polyp Removal-Indications

• AUB/concern for malignancy
• Noted on exam

– With or without symptoms

• May cause irregular menstrual bleeding
• Bleeding after or during sex
• Photo from https://planbwellness.com/what-are-cervical-polyps/

Cervical Polyp Removal: Contraindications

• Bleeding disorders
• Pregnancy
• Multiple polyps (too much bleeding)
• Endometrial polyps or thick stalk (too much

bleeding)

Cervical Polyp Removal: Supplies

• Non sterile gloves
• Speculum
• Betadine
• Ring forceps
• Formalin jars
• Silver nitrate sticks

Cervical Polyp Removal

• https://cdnapisec.kaltura.com/index.php/extwid

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How to perform cervical polyp removal

• Verify neg HCG and consent.
• Speculum to cervix and visualize polyp.
• Cleanse with antiseptic
• Grasp the polyp with the ring forceps and twist

the forceps around the stalk until it breaks off

• Put tissue in formalin jar
• Control bleeding with silver nitrate stick if needed

Vulvar biopsy indications

• Vulvar itching
• Skin discoloration or texture changes
• Vulvar bleeding
• Vulvar lesion that does not heal

Vulvar biopsy Equipment

• 2 or 3mm skin punch
• Lidocaine in a 3cc syringe with 27g needle
• Sterile scissors
• Skin forceps
• Betadine
• Antibiotic ointment

Vulvar Biopsy Procedure

• https://cdnapisec.kaltura.com/index.php/extwidget

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Vulvar biopsy procedure

• Consent
• Cleanse area with betadine
• Inject 1-2 cc of lidocaine in a wheal at site of

concern

• Push 2mm or 3mm punch (no bigger or you will

need suture) into center and collect specimen

• Send to pathology in jar of formalin
• Apply abx ointment
• Cover with dressing as needed

References

• THOMAS J. ZUBER, M.D., Saginaw

Cooperative Hospital, Saginaw, Michigan. Endometrial biopsy. Am Fam

• Physician. 2001 Mar 15;63(6):1131-1135.
• https://ir.uiowa.edu/cgi/viewcontent.cgi?articl

e=1036&context=fmrc