Reference Manual - IARC Screening Group

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Troubleshooting with the Cryotherapy SystemTable E-1. Following-Up on Commonly Encountered Problems (continued)PROBLEM4. Gas leaks from theregulator.5. When the gas isturned on, thepressure gaugeneedle moves intothe red-shaded area.6. When the gas isturned on, thepressure gaugeneedle is in theyellow-shaded area(or at or below thegas pressureindication line in thegreen-shaded area).7. When turning on thegas from a newcylinder for the firsttime, there is a loudnoise and gasescapes loudly fromthe safety valve onthe regulator. Afterthis, the cryotherapyunit will not workand gas continues toescape.(table continued on next page)POSSIBLEEXPLANATIONValves in the regulatorare jammed or worn.The gas pressure in thecylinder is too high.The gas pressure in thecylinder is too low.The gas pressure in thecylinder is too high; therupture disk in the safetyvalve broke to releasepressure and preventdamage to thecryotherapy system.APPROPRIATE ACTIONReturn the system to the manufacturer.Vent the cylinder as follows:• Close the main cylinder valve.• Slowly disconnect the regulator from the cylinder torelease the gas in the hose.• Ensure that the main cylinder valve is not pointingtoward anyone.• Slowly open the main cylinder valve just until youcan hear gas escaping. Let a small stream of gasescape for 8 to 10 seconds.• Close the cylinder valve.• Reattach the regulator to the cylinder connector(Figure D-3, page D-3).• Open the main cylinder valve again. If the pressure is still too high, repeat theprocedure.Replace the cylinder with a full one before proceeding.Close the main cylinder valve. Remove the regulator andvent the cylinder, as recommended for Problem 5(above). Then replace the broken rupture disk-nut with anew one as follows:• Using a crescent wrench, remove only the end part ofthe brass safety valve—the hexagonal nut with thetwo holes in the sides (i.e., the rupture disk-nut,which includes a small rubber O-ring).• Do not remove the entire brass fitting from the bodyof the regulator.Note: Two crescent wrenches may be required toremove the brass nut, one to prevent the part that isnearest to the regulator from turning and another toremove the end part.• Dispose of the old rupture disk-nut.• Install the new rupture disk-nut (Wallach Item#400285). Make sure the small rubber O-ring is onthe replacement rupture disk-nut.• Tighten the rupture disk onto the safety valve.E-2 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Table E-1. Following-Up on Commonly Encountered Problems (continued)Troubleshooting with the Cryotherapy SystemPROBLEM8. When the freezetrigger is depressed,no gas flows.9. When the defrosttrigger is depressed,no gas flows.10. The freeze anddefrost triggers willnot move.11. While performing acryosurgicalprocedure usingCO 2 , gas flowsputters/stops andthe cryotherapy unitstops working.POSSIBLEEXPLANATIONPieces of CO 2 ice haveblocked the flow of gasin the inlet/exhaust tubeof the cryotherapy unit.Pieces of CO 2 ice haveblocked the flow of gasin the inlet/exhaust tubeof the cryotherapy unit.The freeze and defrosttriggers are jammed orbroken.Pieces of CO 2 ice haveblocked the flow of gasin the inlet/exhaust tubeof the cryotherapy unit,or there is no more gas.APPROPRIATE ACTION• Check gas pressure (Problem 6, above) and, ifappropriate, clear the inlet/exhaust tube, asrecommended for Problem 11 (below). If the problem is not resolved, proceed as shownbelow.• If qualified to perform basic repairs andmaintenance, replace the spring (Wallach Item#111001), O-rings (Wallach Item #107500), retainerseals (Wallach Item #200004), and valve cores(Wallach Item #108519). If not qualified or problem not resolved, returnthe system to the manufacturer.• Check gas pressure (Problem 6, above) and, ifappropriate, clear the inlet/exhaust tube, asrecommended for Problem 11 (below). If the problem is not resolved, proceed as shownbelow.• If qualified to perform basic repairs andmaintenance, replace the spring (Wallach Item#111001), O-rings (Wallach Item #107500), retainerseals (Wallach Item #200004), and valve cores(Wallach Item #108519). If not qualified or problem not resolved, returnthe system to the manufacturer.If qualified to perform basic repairs and maintenance,replace the O-rings (Wallach Item #107500), retainerseals (Wallach Item #200004), and valve cores (WallachItem #108519). Replace the spring (Wallach Item#111001) only as needed. If not qualified or problem not resolved, returnthe system to the manufacturer.• Check the gas pressure (Problem 6, above). If the gas pressure is normal, proceed as shownbelow.• Close the main cylinder valve. Allow thecryotherapy unit to warm up. If the FREEZE (left)trigger remains locked down, there will be a loud,but harmless, “POP” sound when the unit haswarmed up enough to thaw the ice and clear theinlet/exhaust tube (about 1 minute). After the “POP”sound, briefly press the DEFROST (right) triggerand then resume the cryosurgical procedure using thefreeze-clear-freeze technique (Figure D-7, page D-6).Cervical Cancer Prevention Guidelines for Low-Resource Settings E-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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Client Assessment and VIA Testingth
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SEVENTREATMENT AND FOLLOWUPBACKGROU
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Treatment and Followupregardless of
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Treatment and FollowupFigure 7-1. L
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Treatment and FollowupTable 7-6. Co
Page 99 and 100: Treatment and FollowupFigure 7-2 is
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
Page 107 and 108: Treatment and FollowupNote: When CO
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
Page 129 and 130: Infection Prevention Processeswith
Page 131 and 132: Infection Prevention ProcessesFigur
Page 133 and 134: Table C-4. Preparing and Using Chem
Page 135 and 136: Infection Prevention ProcessesStora
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Page 139 and 140: APPENDIX DTECHNICAL OVERVIEW OF THE
Page 141 and 142: Technical Overview of the Cryothera
Page 143 and 144: Figure D-5. Removing Protector Tube
Page 145 and 146: Technical Overview of the Cryothera
Page 147 and 148: Figure D-11. Gas Cylinder Secured t
Page 149: APPENDIX ETROUBLESHOOTING WITH THEC
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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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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