Womens Health Workshop-The Basics Presented by: Laurel Hallock - PowerPoint PPT Presentation

Women’s Health Workshop-The Basics Presented by: Laurel Hallock Koppelman, DNP, FNP-C, APRN Assistant Professor, OHSU School of Medicine

Disclosures • I have nothing to disclose.

Shout out!!! Aimee Holland, DNP, WHNP-BC, FNP-C, FAANP | Associate Professor DNP Program Director UAB School of Nursing | The University of Alabama at Birmingham • You will find the videos on the University of Alabama at Birmingham School of Nursing website: http://www.uab.edu/nursing/home/technology-innovation/faculty- clinician-resources/gyn-np-procedures • • The simulation publications are in Nursing for Women's Health: A Journal for NPs: https://npwomenshealthcare.com/archives/

What we are planning on doing today and objectives • Endometrial Biopsy • Endometrial Polypectomy • Vulvar Biopsy

Reasons for Endometrial Biopsy • AUB • Done with colposcopy – Amenorrhea for a year – Post menopausal bleeding • Cancer screening* (hereditary colorectal) • Endometrial dating • Infertility evaluation.

When not to do an endometrial biopsy • Pregnancy • Clotting disorders • Acute PID • Anatomy – Severe stenosis of • Acute cervical or cervical os vaginal infections.

Equipment Needed • Sterile • Non-Sterile – Sterile gloves – gloves – Speculum – Lubricating jelly – Uterine sound – Chux pad – povidone-iodine – Sampling container – Endometrial suction – 20 percent benzocaine catheter (Hurricaine) spray with the extended – Tenaculum application nozzle* – Ring forceps – Cotton swabs – Sterile 4 × 4 gauze – Sterile scissors

How to perform endometrial biopsy • https://cdnapisec.kalura.com/index.php/extwidget/ preview/partner_id/2007921/uiconf_id/42460231/e ntry_id/1_m6b8avii/embed/dynamic

How to perform endometrial biopsy • Negative HCG and consent signed. • Perform bimanual exam. • Insert speculum. • Cleanse the cervix with betadine using ring forceps • Place tenaculum on anterior edge • Sound uterine depth • Insert endometrial biopsy catheter up to the fundus

How to perform endometrial biopsy • Draw back internal tube on the catheter • Move catheter in and out and twist 360 degrees as you do this w/o tip leaving endometrial cavity. • Place sample in formalin jar • Remove tenaculum, apply pressure if bleeding and remove speculum

Endometrial biopsy PEARLS • Can’t get through: • Always use a leg – Change attachment of – Support don’t strike tenaculem • Ibuprofen • Anterior vs Posterior • Syncope: – Use dilator – It happens – Use OS finder – Still no luck: • Get an ultrasound – What is blocking that OS

Cervical Polyp Removal-Indications • AUB/concern for malignancy • Noted on exam – With or without symptoms • May cause irregular menstrual bleeding • Bleeding after or during sex • Photo from https://planbwellness.com/what-are-cervical-polyps/

Cervical Polyp Removal: Contraindications • Bleeding disorders • Pregnancy • Multiple polyps (too much bleeding) • Endometrial polyps or thick stalk (too much bleeding)

Cervical Polyp Removal: Supplies • Non sterile gloves • Speculum • Betadine • Ring forceps • Formalin jars • Silver nitrate sticks

Cervical Polyp Removal • https://cdnapisec.kaltura.com/index.php/extwid get/preview/partner_id/2007921/uiconf_id/424 60231/entry_id/1_u8g3mix8/embed/dynamic

How to perform cervical polyp removal • Verify neg HCG and consent. • Speculum to cervix and visualize polyp. • Cleanse with antiseptic • Grasp the polyp with the ring forceps and twist the forceps around the stalk until it breaks off • Put tissue in formalin jar • Control bleeding with silver nitrate stick if needed

Vulvar biopsy indications • Vulvar itching • Skin discoloration or texture changes • Vulvar bleeding • Vulvar lesion that does not heal

Vulvar biopsy Equipment • 2 or 3mm skin punch • Lidocaine in a 3cc syringe with 27g needle • Sterile scissors • Skin forceps • Betadine • Antibiotic ointment

Vulvar Biopsy Procedure • https://cdnapisec.kaltura.com/index.php/extwidget /preview/partner_id/2007921/uiconf_id/42460231/ entry_id/1_ow6doefy/embed/dynamic

Vulvar biopsy procedure • Consent • Cleanse area with betadine • Inject 1-2 cc of lidocaine in a wheal at site of concern • Push 2mm or 3mm punch (no bigger or you will need suture) into center and collect specimen • Send to pathology in jar of formalin • Apply abx ointment • Cover with dressing as needed

References • THOMAS J. ZUBER, M.D., Saginaw Cooperative Hospital, Saginaw, Michigan. Endometrial biopsy. Am Fam Physician. 2001 Mar 15;63(6):1131-1135. • https://ir.uiowa.edu/cgi/viewcontent.cgi?articl e=1036&context=fmrc