Reference Manual - IARC Screening Group

Client Assessment and VIA TestingINSTRUMENTS AND SUPPLIESVIA can be performed in any clinic that have the following items:• Examining table• Light source• Bivalve speculum (Cusco or Graves)• Instrument tray or containerThe examining table should allow the examiner to insert the speculumand see the cervix.Light from a window is usually not sufficient to see the cervix, so use alight source, such as a goose-necked lamp or a flashlight (torch), ifavailable. The light must be strong enough for the examiner to see theupper end of the vagina where the cervix is located. Inspection cannot beperformed if there is not enough light to see the entire cervix. It is alsoimportant that the light source not be too hot. A lamp that is too hot willbe uncomfortable for both the woman and the provider. A high-qualityflashlight provides adequate light without too much heat. In addition, theflashlight does not require a source of electricity, is portable and can beplaced in whatever position allows the best view of the cervix.A Graves bivalve speculum is preferred because it is more effective atexposing the cervix, but either Cusco or Graves can be set and left openwhile the cervix is being examined. This leaves the provider’s hands freeto swab the cervix, adjust the light source and manipulate the cervix andspeculum in order to see the cervix fully. A Simms speculum is notrecommended because it has only one blade and has to be held by anassistant.In addition, if cryotherapy is to be coupled with VIA testing, thenecessary instruments for cryotherapy should be ready and available (seeChapter 7).The few supplies needed for performing VIA should all be availablelocally:• Cotton swabs• New examination gloves or high-level disinfected surgical gloves• New wooden spatula and/or condom• Dilute (3–5%) acetic acid solution (clear vinegar is acceptable)• 0.5% chlorine solution for decontaminating instruments and gloves• A record form for recording the findingsCervical Cancer Prevention Guidelines for Low-Resource Settings 6-5