Pap Smear for Cytology

Category: Cyto

Mneumonic: PAP

Pap smear

BD SurePath Collection Vial with collection device

Sample Collection Device

Option 1)Pap Perfect Plastic Spatula with Cytobrush Plus GT 

Option 2) BD Rovers Cervex-Brush

BD SurePath Collection Vial

I.1. All specimens must be accompanied by a completed manual or Meditech generated cyto-pathology gynecological requisition. All mandatory fields must be satisfied in order to complete the request. In the case of computer downtime use the standard cytopathology gynecological requisition.

 
The following information is required on the requisition:
(a) Patient identifiers (addressographs may be used)

(i) patient's first and last name
(ii) hospital unique number
(iii) date of birth
(iv) Ontario Health Insurance Number with version code.
(b) Submitting area identifiers: Hospital site (BGH or The Willett) and the submitting department (Emergency, Ambulatory Care etc.).
(c) Submitting physician's name.
(d) Date of specimen collection

(e) Clinical Indication

(f) Last Menstrual Period if available
(g) A brief clinical history, and  relevant pathological and radiological findings.
(h) Specimen information
(i) specimen type/source
(ii) specimen site

1.2.Label the BD Surepath Preservation fluid collection vial with a minimum of two patient identifiers. The meditech generated label is sufficient

I.3. Place specimen container in a biohazard bag. The requisition should be placed in the outer pouch of the biohazard bag.

I.4. Transport specimen to the Triage area of the laboratory as soon as possible

1.5 Patient Instructions:

i) Mid-cycle smears are optimal for cytological evaluluation. 
ii) Do not douche 48 hours prior to the examination.
iii) Avoid  contraceptive foam or jellies 48 hours prior to examination.
 
 

Physician Instructions

There are two collection methods described below for use with the BDSurepath liquid-based Pap test. Conventional pap testing is no longer performed and fixed conventional slides will not be accepted.

Spatula and Cytobrush Collection Method

Option1:

**Do not use Cytobrush Plus GT on pregnant patients or for endometrial sampling.

1) With the patient in the lithotomy position, expose cervix using a vaginal speculum moistened with warm water. Visually examine vaginal mucosa and cervix for lesions, ulceration or dishcarge.

2) Select contoured end of Pap Perfect Plastic Spatual and rotate 360 degrees around the entire exocervix wihil maintaining tight contact with exocervical surface

3) Remove Spatula

4) Visually locate the notched score line on the side of the spatula handle, about 4 cm from the contoured collection end. With gloved hands and one single, quick, and firm SNAP, separate the contoured end from the rest of the spatula handle.  Do not touch collection end. Drop this contoured collection end into a vial of BD Surepath Preservative Fluid Collection Vial. Discard remaining device handle end of the spatula after each use.  Place cap on vial until step 7 . Do not tighten cap

5) Insert Cytobrush Plus GT device into the endocervix until only the bottom-most bristels are exposed at the os. Slowly rotate 1/4 to 1/2 turn in one direction. To reduce unnecesary bleeding, do not over-rotate brush. Over rotation may result in poor sample collection.

6)Remove cytobrush device

7)Visually locate the notched scoreline on the side of the cytobrush handle about 4 cm from the brush tip. With gloved hands and one single, quick and firm SNAP, separate the brush head-short handle from the rest of the brush handle. Do not touch collection end. Drop brush head-short handle into the same BD Surepath Preservative Fluid Collection Vial. Discard remainin device handle end of cytobrush

8)Tighten the BD Surepath vial cap so the torgue line on the cap passes the torque line on the vial.

Rover's Cervex-Brush collection method

Option 2:

 Pregnant Patients **Do not use Cervex-brush on patients after the first 10 weeks of pregnancy. If performed, the central bristles of the brush should not be inserted deep into the canal but by firm pressure and rotation in a clockwise direction, the device may be used to sample the external os and ectocervix. A vaginal pool sample may also be obained.

For other patients - Routine procedure:

1) Insert the central bristles of the brush into the endocervical canal. The lateral bristles should be visible bend agains the ectocervic

2) Maintaining gentle pressure, rotate the cervex brush five times in clockwise direction

3) Insert the Cervex-brush head into the large opening of the BD Surepath vial rotating 1/4 turn

4) Using the inner edge of the insert, pull off the brush head and deposit directly in the BD Surepath vial.

Monday to Friday prior to 1:00 pm