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a5.2.2

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    WOMEN AND NEWBORN HEALTH SERVICE King Edward Memorial Hospital  DPMS Ref: 7498  All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 1 of 4 CLINICAL GUIDELINES S ECTION  A   :  OBSTETRICS AND G YNAECOLOGY 5 VAGINAL PROCEDURES 5.2  SPECIMEN COLLECTION   Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs Date Revised: August 2012 Section A Review Date: August 2015 Clinical Guidelines  Authorised by: OGCCU King Edward Memorial Hospital Review Team: OGCCU Perth Western Australia 5.2.2 LOW VAGINAL, HIGH VAGINAL, ENDOCERVICAL AND RECTAL SWABS KEY WORDS Low vaginal, high vaginal, rectal, speculum, swab, smear, transtube, pathology, chaperone IM The correct collection of vaginal and rectal specimens. EQUIPMENT   Sterile swab   Transtube swab (with transport medium)   Glass slide in a slide carrier   Blood agar plate (for after hours specimens only)   Bi-Valve speculum if required   Unsterile examination gloves   Patient identification labels   Adjustable light source   Biohazard labelled bag PROCEDURE ADDITIONAL INFORMATION 1 Consent Obtain verbal consent before the procedure is commenced. Offer a chaperone to all women. It is recommended for practitioners conducting vaginal examinations or procedures to have another practitioner in attendance. See clinical guideline B 1.6.4 Performing a Vaginal Examination The additional chaperone / practitioner   provides security for both the examiner and the woman   may give assistance if required.  7  If the offer of a chaperone is declined document in the woman’s medical records.    Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs Date Revised: August 2012 Section A Review Date: August 2015 Clinical Guidelines Written by:/Authorised by: OGCCU King Edward Memorial Hospital Review Team: OGCCU Perth Western Australia DPMS Ref: 7498 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 2 of 4 PROCEDURE ADDITIONAL INFORMATION 2 Explanation of the procedure Explain the procedure to the woman, and offer her the option of self-collection of swabs if appropriate. 1, 2   Assess if the woman has had previous pelvic examinations and her knowledge of the procedure. Explanation of the procedure and a chance for her to ask questions eases anxiety. 3   3 Preparation 3.1 Ensure the bladder is empty. An empty bladder increases the woman’s comfort and allows a more accurate assessment of the pelvic organs. 3  3.2 Ensure the woman is adequately covered and comfortable. 3.3 Position the woman for speculum examination with her head on one pillow, lying in a dorsal position with the knees flexed and hips abducted. 3.5 Position the light. 3.6 Hand hygiene should be performed before and after patient contact. See Infection Control Policy, 2.4 Hand Hygiene. 4 Inspection Part the lips of the labia minora with the non-dominant hand and inspect the external meatus, and vulva. Enables detection of:   abnormal skin conditions   lesions   vaginal discharge or bleeding   scar tissue   skin piercing   evidence of female genital mutilation. 4   5 Insertion of the speculum See Clinical Guidelines, Section A, 5.2.1 Speculum Examination.     Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs Date Revised: August 2012 Section A Review Date: August 2015 Clinical Guidelines Written by:/Authorised by: OGCCU King Edward Memorial Hospital Review Team: OGCCU Perth Western Australia DPMS Ref: 7498 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 3 of 4 PROCEDURE ADDITIONAL INFORMATION 6 Collection of the swabs 6.1 Low / High Vaginal and Endocervical swabs  A smear and a swab must be collected when performing a LVS/HVS or ECS Smear Swab the area using the sterile swab. Gently roll the swab 2-3 timed in non overlapping passes on to the middle of the glass slide. Discard this swab. Write the patient’s name on the ground glass end of the slide with a pencil or use a patient ID sticker around the slide carrier. Allow the smear to dry in air before closing the slide carrier. Swab for Culture Use the transtube swab. Insert the sterile swab 1-2cm into the lower entrance of the vagina, and swab the sides of the vagina. The woman may prefer to collect her own (Low vaginal swab only), with instructions from the medical / midwifery / nursing staff. Women in studies have shown that they prefer non invasive techniques rather than a pelvic examination 1, 2   Insert the swab into the transport medium and label with the woman’s identification sticker and indicate the site of collection.   Place the slide and the transtube in a specimen bag with the request form in a separate pocket and send to the Specimen Centre KEMH 6.4 Rectal Swab Pre moisten the swab with the transport medium.  Allows easier insertion of the swab. See Clinical Guidelines, Section B, 1.4.1 Group B Streptococcal Disease The woman may prefer to collect her own swab, with instructions from the medical / midwifery / nursing staff. The swab is inserted into the rectum past external anal sphincter and the specimen is collected. The swab is then inserted into the Transport medium and labelled with the woman’s identification sticker and indicate the site of collection.    Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs Date Revised: August 2012 Section A Review Date: August 2015 Clinical Guidelines Written by:/Authorised by: OGCCU King Edward Memorial Hospital Review Team: OGCCU Perth Western Australia DPMS Ref: 7498 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 4 of 4 7 After hours specimen collection If a swab is taken after normal laboratory hours, the transtube swab may be used to inoculate a blood agar plate, and then the swab is placed in the transport medium as normal. See KEMH Pathology Handbook. 
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