CSC CytologyL3

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APGO Clinical Skills Curriculum
Cervical Cytology,
Wet Prep and Cervical
Culture Collection
Association of Professors of Gynecology and Obstetrics (APGO)
Undergraduate Medical Education Committee ©2008
Description of the Cervical Cytology and Cervical/Vaginal Culture
Collection Procedure
General Approach/Communication Skills
The student should:
1. Introduce him‐ or herself to the patient, confirm the patient’s name and how she
wishes to be addressed.
2. Wash hands (or use an alcohol‐based antiseptic) and don non‐latex gloves. If
these are not available, an inquiry about latex allergy is necessary before
proceeding.
3. Explain the purpose of the examination and general steps before beginning. If
this is the patient’s first examination, the student should explain thoroughly, and
show the speculum and cervical cytology collection devices to the patient.
4. Drape patient appropriately.
5. Be sensitive to patient discomfort throughout the examination and provide
opportunities for the patient to ask questions.
Cervical Cytology Collection
The student should:
1. Select the appropriate sized speculum, warm speculum and test speculum on
patient’s leg for comfortable temperature.
2. Inform patient prior to speculum insertion.
3. Insert speculum at 45‐degree downward angle, then rotate and open when
completely inserted.
4. Visualize the cervix by adjusting the speculum anteriorly or posteriorly.
Traditional Slide Cytology Collection
The student should:
5. Use the spatula clover leaf end to collect ectocervical cells, or spatula end for
vaginal cuff cells, and then smear them in a thin layer on the slide.
6. On the same slide, smear endocervical cells collected using a cytobrush. Only
insert cytobrush superficially in pregnancy.
7. The student or assistant should spray the slide with cytology fixative
immediately after cytology collection and place it in the appropriate container.
8. The student or assistant should label the container appropriately.
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Liquid‐Based Cytology Collection:
9. Student should first use the plastic (not wood) spatula to collect ectocervical cells
(rotate 360 degrees), then brush‐like device (rotate 180 degrees) to collect
endocervical cells. Only insert brush superficially in pregnancy.
10. Both spatula and brush should be swept around the inside of the liquid‐based
cytology specimen collection container 10 times to loosen the maximum number
of cervical cells into solution.
11. The student or assistant should label the container appropriately.
Traditional Cytology Smear Collection
Traditional Slide Preparation
Liquid‐Based Cytology
Liquid Cytology Preparation
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Normal Cervix
Cervical/Vaginal Culture Collection
The student should:
1. Select appropriate sized speculum, warm speculum and test speculum on the
patient’s leg for comfortable temperature
2. Inform patient prior to speculum insertion
3. Insert speculum at 45 degree angle then rotate and open when completely
inserted
4. Visualize the cervix by adjusting the speculum anteriorly or posteriorly
5. Use the appropriate collection vial with the correct attached swab for each
culture
6. For Chlamydia and Gonorrhea cervical “cultures,” insert the swab into the
endocervix for approximately 10 seconds (insert only superficially in pregnancy)
7. For vaginal cultures, obtain a specimen from the posterior fornix
8. Insert the swab into the vial, break off the excess swab and cap off the collection
vial/tube securely and label the specimen
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Wet Prep Interpretation
The student should:
1. Proceed as for vaginal culture collection and obtain a sample of vaginal fluid
2. On a single glass slide, place a drop of NaCl. and a drop of KOH
3. Mix a small amount of vaginal fluid with each solution and apply coverslip
4. Immediately after preparation, take the prepared slide to the microscope and use
low magnification (10x) to focus
5. Look for clue cells, white cells and trichomonads on the NaCl field, and for
budding hyphae on the KOH field
6. Perform a whiff test and, if available, check for pH
7. Discuss findings and treatment with supervising clinician and patient
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