Part 4: GC and Chlamydia

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PAP SMEARS

1) Visualization of the Cervix:

Clinic team must inform TS and attending that patient needs a pap smear
The attending MUST CONFIRM visualization of cervix before Pap and GC testing is done
Grab the attending before placing the speculum (the clinic team can perform this step or ask the TS to teach them/or perform in their place) — This is to prevent the patient from waiting unnecessarily, while exposed

2) Collecting the Specimen:

REMEMBER: Clinic team/TS MUST LABEL Thin Prep Vial with patient MRN, name, and DOB in black ink BEFORE collecting specimen.
No label will print out for Pap smears.
Pap smears are all placed in the ThinPrep Containers. You may use the broom like device to collect endo- and ectocervix cells OR use the separate brush and plastic spatula to collect endo- and ectocervix. SEE THINPREP GUIDE HERE FOR PICTURES: http://www.thinprep.com/pdfs/man-01704-001.pdf

Collect the cells:

Broom: Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix.Push gently, and rotate the broom in a clockwise direction five times.
Spatula/Brush: With the long arm of the spatula towards the os, complete one 360 degree turn maintaining contact with the ectocervix. Insert the brush into the endocervical canal until the bristles just disappear. Rotate clockwise 180 degrees (one half turn).

Transfer the cells to ThinPrep vial:

Rinse the broom or spatula/brush as quickly as possible into the ThinPrep solution vial by pushing the broom into the bottom of the vial 10 times, forcing the bristles apart.
Swirl the vigorously to further release material and then discard the collection device. Do not leave the collection device in the solution.

Assembling specimen w/ documentation:

Locate the order for a Pap in EPIC, it is found under Office Procedures and Pref List
After attending signs the order, a requisition order will print out in the preceptor room printer.
Place the requisition order with the specimen in a hazard bag. LABEL THE BAG EHHOP (either with tape or sharpie)
If the requisition order did not print, you can re-print it by clicking going to Chart Review –> Path/Cyto tab –> double click on the order –> Scroll down to click on “Lab and Collection Information” –> print requisition form
Please check that the Thin Prep Vial is labeled with patient MRN, name, and DOB in black ink

Transport specimen in bag with requisition order:

Turn right immediately to enter the accessioning room

Walk to the back of the room and look for the blue Atran drop box that is labeled “Cytology”.

Open the green log book to the next available page and write the date of specimen drop off, the patient name, and if the specimen is cytology or surgical pathology (this only applies to GYN clinic since we do endometrial biopsies). Also include Yaz’s address, phone number and fax: Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1216. Phone: 212-241-7462, Fax: 212-426-5108
Pap smears will ALWAYS be cytology. The labs TS should also write their name and contact number in the log book so the Atran lab can contact someone if they don’t find the specimen.
On Monday mornings, the Atran 6-10 lab will come pick up the specimens and also check the log book to make sure he has the right number of specimens.

Use pink tube. May be found in GYN cart or labs room.

1) Insert swab into endocervical canal until bristles just disappear.

2) Rotate slowly for 20-30 seconds.

3) Remove swab and place into collection tube. Break off excess swab leaving brush in collection tube and replace lid.

We can now use APTIMA tubes for this. The test comes with a tube and +/- a dropper. If there is no dropper, you can find them in the Labs room.

1) Have the pt void into a sterile urine cup.

2) Firmly tap the bottom of the tube on a flat surface to dislodge any large drops from inside the cap.

3) Transfer the urine into the Aptima tube with the provided dropper, being careful not to touch the walls of the sterile cup.

4) Fill the tube until the urine level is within the label window (see laminated sheets on wall of lab room for pictures of what this looks like).

5) Add the label once it prints out. Drop off with rest of blood samples to 8th Floor Labs in East Building.