Reference Manual - IARC Screening Group

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Client Assessment and VIA TestingStep-by-StepInstructionsClient Assessment and Getting ReadyStep 1Before performing the VIA test, discuss the procedure with thewoman. Explain why the test is recommended and exactly whatwill take place during the examination. Also discuss with herthe nature of the most likely findings and the followup ortreatment that might be required.Step 2 Make sure that all necessary instruments and supplies areavailable, including a high-level disinfected or sterile speculum,cotton swabs in a clean container, a bottle of dilute acetic acidand adequate light source. Test the light source to be sure it isworking.Bring the woman into the examination area. Ask her to emptyher bladder if she has not already done so. If her hygiene ispoor, have the woman thoroughly wash and rinse her genitalarea. Ask her to remove only enough clothing (includingundergarments) so that the pelvic examination and VIA testmay be performed.Step 3Step 4Step 5Step 6Assist the woman with positioning herself on the examiningtable and drape her for the pelvic examination.Wash hands thoroughly with soap and water and dry with aclean, dry cloth or air dry. Palpate the abdomen.Put a pair of new examination or high-level disinfected surgicalgloves on hands. 1Arrange the instruments and supplies on a high-leveldisinfected tray or container, if not already done.VIA TestStep 1Step 2Inspect the external genitalia and check the urethral opening fordischarge. Palpate the Skene’s and Bartholin’s glands. Tell thewoman that the speculum is about to be inserted and that shemay feel some pressure.Gently insert the speculum fully or until resistance is felt andslowly open the blades to reveal the cervix. Adjust thespeculum so that the entire cervix can be seen. This may bedifficult in cases where the cervix is large or extremely anterioror posterior. It may be necessary to use a clean cotton swab,1 If additional gloves are available, put a second glove on one hand so that when you are ready to use the lightsource, you can remove the outer glove and move the light source with a clean glove.6-8 Cervical Cancer Prevention Guidelines for Low-Resource Settings
Client Assessment and VIA Testingspatula or other instrument to gently push the cervix down orup into view.Note: If the walls of the vagina are very lax, use a cotton swab orwooden spatula to push away any tissue protruding between the bladesof the speculum. Alternatively, prior to insertion of the speculum, acondom can be rolled over the blades and the tip of the condom cut off.When the speculum is inserted and the blades are opened, the condomwill prevent the walls of the vagina from pushing into the space betweenthe blades.Step 3When the cervix can be seen in its entirety, fix the blades of thespeculum in the open position so that it will remain in placewith the cervix in view. Doing this enables the provider to haveat least one hand free.Note: Throughout the procedure, it may be necessary to repeatedlyadjust either the angle from which the cervix is viewed or the lightsource in order to achieve the best view of the cervix.Step 4Step 5Move the light source so that you can see the cervix clearly.Look at the cervix and check for evidence of infection(cervicitis) such as whitish purulent discharge (mucopus);ectopy (ectropion); grossly apparent tumors or Nabothian cysts,ulcers or “strawberry” lesions (Trichomonas infection).Step 6 Use a clean cotton swab to remove any discharge, blood ormucus from the cervix. Dispose of the swab by placing it in aleakproof container or plastic bag.Step 7Step 8Step 9Identify the cervical os and SCJ and the area around it.Soak a clean swab in dilute acetic acid solution and apply it tothe cervix. If necessary, use clean swabs to repeat applicationsof acetic acid until the cervix has been thoroughly washed withacid. Dispose of used swab(s).Once the cervix has been washed with the acetic acid solution,wait at least 1 minute, and observe the cervix for acetowhitechanges.Step 10 Inspect the SCJ carefully. Check to see if the cervix bleedseasily. Look for any raised and thickened white plaques oracetowhite epithelium.Cervical Cancer Prevention Guidelines for Low-Resource Settings 6-9
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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
Page 35 and 36: IntroductionYlitalo N et al. 1999.
Page 37 and 38: TWOHUMAN PAPILLOMAVIRUS AND CERVICA
Page 39 and 40: Human Papillomavirus and Cervical C
Page 47 and 48: THREEPATHOPHYSIOLOGY OF CERVICAL CA
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Page 51 and 52: Pathophysiology of Cervical Cancerp
Page 53 and 54: Pathophysiology of Cervical CancerP
Page 55 and 56: Pathophysiology of Cervical CancerI
Page 57 and 58: Pathophysiology of Cervical CancerR
Page 59 and 60: FOURTALKING WITH WOMEN ABOUTCERVICA
Page 61 and 62: Talking with Women About Cervical C
Page 69 and 70: FIVEPREVENTING INFECTIONS INHEALTHC
Page 71 and 72: Preventing Infections in Healthcare
Page 79 and 80: SIXCLIENT ASSESSMENT AND VIA TESTIN
Page 81 and 82: Client Assessment and VIA TestingFi
Page 83 and 84: Client Assessment and VIA TestingIN
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Page 91 and 92: SEVENTREATMENT AND FOLLOWUPBACKGROU
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
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
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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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Infection Prevention Processes• h
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APPENDIX DTECHNICAL OVERVIEW OF THE
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Technical Overview of the Cryothera
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Figure D-5. Removing Protector Tube
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Technical Overview of the Cryothera
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Figure D-11. Gas Cylinder Secured t
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APPENDIX ETROUBLESHOOTING WITH THEC
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Table E-1. Following-Up on Commonly
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APPENDIX FPROCESSING SURGICAL GLOVE
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Processing Surgical GlovesTable F-1
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Processing Surgical GlovesSTEP 10:
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APPENDIX GPERFORMING BREAST AND PEL
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Performing Breast and Pelvic Examin
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Figure G-2. Breast Puckering or Dim
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Figure G-5. Checking for Nipple Dis
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Figure G-18. Speculum in Place with
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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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