Reference Manual - IARC Screening Group

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Technical Overview of the Cryotherapy SystemFigure D-1. Cryotherapy System 3Figure D-2. Choosing an Appropriate Gas CylinderGas cylinders can be obtained from a local vendor. Here are some tips for choosing an appropriate gas cylinder for usewith the cryotherapy system:• The gas cylinder may contain either compressed carbon dioxide (CO 2 ) or nitrous oxide (N 2 O) gas as the coolant;whether to use CO 2 or N 2 O gas depends on local cost and availability of the gases. Whenever feasible, “medicalgrade” gas should be used; if not available or affordable, “food/service” grade (CO 2 ) or industrial grade gas maybe substituted. Gases other than CO 2 and N 2 O should never be mixed in or used with the cryotherapysystem.• Gas cylinders can be purchased in several different sizes:– Cylinders measuring about 1.2 to 1.5 meters tall are best for clinic use.– Smaller gas cylinders may contain only enough gas for a few procedures and are appropriate for occasional,mobile use only.• Only “non-siphon” gas cylinders should be used (i.e., cylinders without a tube that extends inside from thecylinder valve at the top to the bottom of the cylinder). Siphon cylinders should never be used.Note: For complete information on handling compressed gas cylinders, refer to C.G.A. Pamphlet P-2,available from Compressed Gas Association, 1725 Jefferson Davis Highway, Suite 1004, Arlington, VA22202, USA.3There are two types of fittings used to connect the regulator to the gas cylinder. In this picture, the United States (US)fitting is shown. A British fitting may also be used. For more information about the US and British fittings, see FigureD-3.D-2 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Technical Overview of the Cryotherapy SystemPREPARING FOR USEBefore cryosurgical treatment procedures are performed each day, thecryotherapy system must be prepared for use—according to the followingguidelines—to help ensure safe, proper functioning.Note: Before preparing the system for use, it is important to ensure thatit was appropriately processed after last use for infection prevention.For more information, see Post-Procedure Processing (page D-6).Checking the GasCylinderConnecting theRegulator to the GasCylinder• Ensure that the gas cylinder is not warm/hot to the touch beforeattaching it to the system. Do not use (or store) the cylinder nearheat sources (e.g., radiators, furnaces). Heat increases the pressureof the gas in the cylinder. This pressure can, in turn, damage thecryotherapy unit or break the rupture disk in the safety valve,causing the system to stop working. If the cylinder is warm/hot to the touch, move it to a cool placeand let it stand overnight, if possible. If the cylinder is still warm to the touch, wrap it in wet clothsuntil cool.• Connect the regulator to the gas cylinder.• Tighten the US fitting by hand only. If you are using a British fitting,which requires a wrench, tighten only until secure. Be careful not toover-tighten. (For more information about tightening the regulatorfittings, see Figure D-3.)Figure D-3. Additional Instructions for Tightening Regulator FittingsThere are two different types of fittings (Figure D-4) for connecting the regulator to the gas cylinder:• The British fitting (left) requires a separate washer. Before connecting the regulator to the cylinder via theBritish fitting, place the washer over the brass nipple that extends from the fitting.– Slide the brass connecting-nut over the nipple and hand-tighten to the cylinder connector.– Using a spanner wrench, tighten the brass nut only until secure. Be careful not to over-tighten.• The US fitting (right) does not need a separate washer, as a white plastic insert is permanently installed in theend of the nipple.– Slide the black hand-wheel with the brass nut over the nipple end and connect to the cylinder connector.– Tighten by hand only. Be careful not to over-tighten.Cervical Cancer Prevention Guidelines for Low-Resource Settings D-3
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Cervical Cancer PreventionGuideline
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TABLE OF CONTENTSPREFACE AND ACKNOW
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How to High-Level Disinfect Surgica
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Table C-2Figure C-1Preparing a Dilu
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PREFACE AND ACKNOWLEDGMENTSThis ref
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ONEINTRODUCTIONMAGNITUDE OF THE PRO
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IntroductionFigure 1-3. Incidence o
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Introductionprevalence areas, a sta
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Table 1-2. Reduction in Cumulative
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Introductiontheir performance was t
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Introductionlesions, or a false pos
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IntroductionCompared to other metho
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Introductionsignificantly to women
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IntroductionBelinson JL et al. 2001
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IntroductionMitchell MF et al. 1998
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IntroductionYlitalo N et al. 1999.
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TWOHUMAN PAPILLOMAVIRUS AND CERVICA
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Human Papillomavirus and Cervical C
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THREEPATHOPHYSIOLOGY OF CERVICAL CA
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With the onset of puberty, whichis
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Pathophysiology of Cervical Cancerp
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Pathophysiology of Cervical CancerP
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Pathophysiology of Cervical CancerI
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Pathophysiology of Cervical CancerR
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FOURTALKING WITH WOMEN ABOUTCERVICA
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Talking with Women About Cervical C
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FIVEPREVENTING INFECTIONS INHEALTHC
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Preventing Infections in Healthcare
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SIXCLIENT ASSESSMENT AND VIA TESTIN
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Client Assessment and VIA TestingFi
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Client Assessment and VIA TestingIN
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Client Assessment and VIA Testingst
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Client Assessment and VIA Testingsp
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Page 93 and 94: Treatment and Followupregardless of
Page 95 and 96: Treatment and FollowupFigure 7-1. L
Page 97 and 98: Treatment and FollowupTable 7-6. Co
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Page 101 and 102: Treatment and Followup• Regulator
Page 103 and 104: Treatment and FollowupCRYOTHERAPY P
Page 105 and 106: Treatment and FollowupStep 6 Point
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Page 109 and 110: Treatment and FollowupStep 5Advise
Page 111 and 112: Treatment and FollowupBerget A, B A
Page 113 and 114: APPENDIX ATESTS FOR CERVICAL CANCER
Page 115 and 116: Tests for Cervical Cancer Screening
Page 121 and 122: APPENDIX BSCREENING TEST QUALITIES
Page 123 and 124: Screening Test Qualities and Their
Page 125 and 126: APPENDIX CINFECTION PREVENTION PROC
Page 127 and 128: Infection Prevention Processesfor m
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Page 133 and 134: Table C-4. Preparing and Using Chem
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Page 139: APPENDIX DTECHNICAL OVERVIEW OF THE
Page 143 and 144: Figure D-5. Removing Protector Tube
Page 145 and 146: Technical Overview of the Cryothera
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Page 149 and 150: APPENDIX ETROUBLESHOOTING WITH THEC
Page 151 and 152: Table E-1. Following-Up on Commonly
Page 153 and 154: APPENDIX FPROCESSING SURGICAL GLOVE
Page 155 and 156: Processing Surgical GlovesTable F-1
Page 157 and 158: Processing Surgical GlovesSTEP 10:
Page 159 and 160: APPENDIX GPERFORMING BREAST AND PEL
Page 161 and 162: Performing Breast and Pelvic Examin
Page 163 and 164: Figure G-2. Breast Puckering or Dim
Page 165 and 166: Figure G-5. Checking for Nipple Dis
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Performing Breast and Pelvic Examin
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APPENDIX HPERCEIVED BARRIERS TO PRO
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AVAILABILITY OF BASIC SUPPLIES AND
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GLOSSARYAcetic AcidAcetowhite Chang
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PatulousSquamocolumnarJunction (SCJ
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ADDITIONAL READINGAlliance for Cerv
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Reference Manual - IARC Screening Group

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