about the advance procedure of pap smear

1. NIGHTINGALE INSTITUTE OF NURSING, NOIDA
ADVANCE PROCEDURE
PRESENTATION
ON
PAP SMEAR
SUBMITTED TO: SUBMITTED BY:
Ms. JOLLY SAHANI Ms. RUPALI ARORA
ASST. PROFESSOR MSc. NURSING 2ND YEAR
NIN, NOIDA NIN, NOIDA

2. ADVANCED PROCEDURE- PAP SMEAR
DEFINITION
A Pap smear, also called a Pap test, is an exam a doctor uses to test
for cervical cancer in women. It can also reveal changes in cervical cells
that may turn into cancer later.
PURPOSE
 A Pap smear is used to screen for cervical cancer.
 The Pap smear is usually done in conjunction with a pelvic exam.
 In women older than age 30, the Pap test may be combined with a test for
human papillomavirus (HPV) — a common sexually transmitted infection that
can cause cervical cancer. In some cases, the HPV test may be done instead
of a Pap smear.
 A pap smear is done to look for changes in cervical cells before they
turn into cancer.

3. WHEN TO HAVE A PAP SMEAR?
 You should have the test every 3 years from ages 21 to 65.
 You may choose to combine your Pap testing with being tested for the human
papillomavirus (HPV) starting at age 30.
 If you do so, then you can be tested every 5 years instead.
 HPV is the most common sexually transmitted infection (STI), and it’s linked
to cervical cancer.
 If you have certain health concerns, your doctor may recommend you
have a Pap more often. Some of these include:
 Cervical canceror a Paptestthat revealedprecancerouscells
 HIV infection
 A weakened immunesystemdue toan organ transplant, chemotherapy,orchronic
corticosteroiduse
 Havingbeenexposedtodiethylstilbestrol(DES) beforebirth
TO WHOMPAP SMEAR TEST TO BE STOP ?
In certain situations a woman and her doctor may decide to end Pap testing, such
as:
 After a total hysterectomy: After a total hysterectomy — surgical
removal of the uterus including the cervix — ask your doctor if you need
to continue having Pap smears.
If your hysterectomy was performed for a noncancerous condition, such
as uterine fibroids, you may be able to discontinue routine Pap smears.
But if your hysterectomy was for a precancerous or cancerous condition
of the cervix, your doctor may recommend continuing routine Pap
testing.
 Older age: Doctors generally agree that women can consider stopping
routine Pap testing at age 65 if their previous tests for cervical cancer
have been negative.
Discuss your options with your doctor and together you can decide
what's best for you based on your risk factors. If you're sexually active
with multiple partners, your doctor may recommend continuing Pap
testing.

4. RISK
It's possible to receive false-negative results — meaning that the test indicates no
abnormality, even though you do have abnormal cells.
A false-negative result doesn't mean that a mistake was made. Factors that can
cause a false-negative result include:
 An inadequate collection of cells
 A small number of abnormal cells
 Blood or inflammatory cells obscuring the abnormal cells
Although it's possible for abnormal cells to go undetected, time is on your side.
Cervical cancer takes several years to develop. And if one test doesn't detect the
abnormal cells, the next test most likely will.
ARTICLES
 Vulva swabbing set
 Container
 Vaginal speculum
 Mask
 Receiver
 Savlon
 Torch light
 Perianal drapes
 Cytobrush,Thin prep
 Sterile glove
 Incopad
 KY jelly
 Swab sticks for HVS
 Specimen Form

6. PREPARATION FOR PAP SMEAR
 You shouldn’thaveaPap smearduringyour period.Heavybleedingcan
affecttheaccuracy of thetest. If testendsupbeingscheduledfor that
timeof month, ask your doctorif hecan reschedule.
 For themostaccuratePap smear, doctorsrecommendtaking the
followingsteps,starting48 hoursbeforeyourtest.
 Don’thave sexor uselubricants.
 Don’tusespraysor powdersnearthe vagina.
 Don’tinsertanythinginto thevagina, includingtampons, medications,
creams, and suppositories.
 Don’trinsethevaginawithwater,vinegar, or other fluid(douche).
PRE PROCEDURE
1. Inform and explain the procedure to patient
2. Advice patient to void.
3. Provide privacy.
4. Assistant position Lithotomy to her on examining table
5. Drape patient permit minimal exposure.
DURING PROCEDURE
1. Patient in lithotomy position.
2. Good illumination is necessary
3. Cusco’s speculum is inserted to visualise & fix the cervix
4. Inspection of cervix done & findings are noted
5. Ayres spatula is inserted first. It is placed at cervical os so that longer end goes into
cervical canal and smaller end rests on ectocervix
6. Spatula is rotated through 360 degrees maintaining contact with ectocervix
7. Do not use too much force [bleeding /pain]
8. Do not use too less force [inadequate sample]
9. Sample is smeared evenly on the slide and fixed immediately
10. Both sides of spatula are to be smeared
11. Endocervical sample is collected using an endocervical brush
12. Insert the cytobrush into canal, so that last bristles of brush are visible
13. Rotate the brush through 180 degrees. [more rotations increase the chance of bleeding]
14. Sample is rolled on the slide and fixed.
15. Fixation of smear : Fixation is done immediately with fixative like 95% alcohol or cytofix
spray to avoid air drying
16. Spray should be kept at 10 inches, to avoid destruction of cells by propellent in the spray
17. Smear should monolayer for proper penetration of cell surface by fixative
AFTER PROCEDURE

7. 1. Slide should be labeled properly with patients name, identification no. and details
2. Detailed history and clinical examination findings are to be mentioned
3. Patient details and clinical findings are to be maintained in a register
4. Advice is given regarding further followup and treatment
5. Observe for any discharge from vagina.
6. Perineal care as needed.
FINDINGS / RESULTS
A) Normal: negative means there is no identifiable infection.
B) ASCUS :presence of a high-risk infection with HPV.
C) Low-Grade changes: frequently due to infection with HPV, which in some instances can
be a risk for cervical cancer.
D) High-Grade changes: very atypical cells that may result in cancer
E) Squamous cell carcinoma or adenocarcinoma: cancer is evident and requires immediate
attention.