Reference Manual - IARC Screening Group

Treatment and FollowupCRYOTHERAPY PROCEDUREGeneral ProcedureFirst, a vaginal speculum is inserted to look at the cervix. Once the lesionhas been identified, the healthcare provider places the tip of thecryoprobe against the cervix, covers the entire lesion, and applies gentlepressure. The “trigger” of the cryotherapy instrument is depressed andlocked in place, allowing the coolant gas to flow to the tip. Thehealthcare provider freezes the cervical lesion with applying the coolantcontinuously for 3 minutes, allows the lesion to thaw for 5 minutes andthen applies the coolant for another 3 minutes. For maximumeffectiveness, the ice ball forming on the cervix should be at least 4 mmthick and extend outside the lesion by 3–5 mm.Note: The following instructions are modeled on the use of a WallachLL100 Cryotherapy System. 7 While the principles of cryotherapy arethe same regardless of the system used, other systems may differ inappearance, operating features, and procedures for proper use.Appendix D contains additional information for using the LL100Cryotherapy System—including preparing for use, performing thefreeze-clear-freeze technique, and post-procedure processing. AppendixE provides guidance for troubleshooting problems commonlyencountered when using the LL100 Cryotherapy System.Step-by-StepInstructionsClient Assessment and Getting ReadyStep 1Prior to performing cryotherapy, discuss the procedure with thepatient. Explain why the treatment is necessary, what thealternatives to cryotherapy treatment are and why abstinence(or use of condoms) is important following the procedure. Tellher about the steps of the procedure, the loud sound emitted bythe equipment, any discomfort she may feel and the side effectsshe will encounter after the procedure. If she is pregnant, besure she is less than 20 weeks gestation.Step 2 Make sure that all necessary instruments and supplies areavailable. This includes a high-level disinfected speculum,cotton swabs in a clean container, a bottle of dilute acetic acid,a wooden spatula and adequate light source (test the lightsource to be sure it is working). The gas should be turned on atthe master cylinder valve and the pressure should read at least40–70 kg/cm 2 . Finally, the timer, if available, should be set tozero.Step 3 Insert a high-level disinfected cryotip into the clear plasticprotective sleeve. Align the small plastic tabs on the sleeve with7Wallach Surgical Devices, Inc., 235 Edison Road, Orange, CT 06477, USA. www.wallachsd.com.Cervical Cancer Prevention Guidelines for Low-Resource Settings 7-13