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57
Obtaining a Specimen for
Papanicolaou (Pap) Diagnostic
Evaluation
There are two methods of specimen collection for remaining cellular material. This material can also
Papanicolaou (Pap) screening for cancer: (1) the be used for human papillomavirus (HPV) testing.
conventional Pap smear, in which a slide is made di- Both methods involve a speculum examination but
rectly from the specimen collected at the cervix, and there are variations in the collection and disposition
(2) the ThinPrep Pap Test, in which the specimen of the specimen. The following procedure details
collected at the cervix is first processed in the labo- both the commonalities and the variations in the
ratory to reduce blood, mucus, other debris, and two methods of obtaining a specimen for
obscuring artifacts and then a slide is made of the Papanicolaou microscopic analysis.
Procedure Rationale
1. Before starting the procedure be sure that the 1. Labeling before the procedure helps make sure the
specimen container label is filled out. If you are specimen is properly labeled with the womans
doing a Pap smear, be sure that the slide is la- name and the date and reduces the risk in a busy
beled in pencil with the date and the womans office or clinic of specimens from different women
name and number. getting mixed up. Ink may smear or wash off dur-
ing fixation of the slide, thus making it difficult to
read. The fixative also makes it difficult to label
the slide after it has been sprayed.
2. Put on gloves. 2. Universal precaution to protect you from expo-
sure to any body fluid/discharge or bloodborne
pathogens.
3. Insert the appropriate size speculum, visualize 3. If a total pelvic examination is being done, in-
the cervix, and fix the speculum for appropriate spect the external genitalia and check the ure-
exposure. (See Preparatory and General thra and the Bartholins and Skenes glands
Procedures and The Speculum Examination prior to the speculum examination. The biman-
in Chapter 56.) Be sure to gently remove any ual examination follows the speculum exami-
material that obscures visualization of the nation. It is imperative that no lubricating
cervix or may interfere with the cytological material except water be used prior to obtain-
study (e.g., mucus, discharge, blood) with a 2 ing the Pap smear because lubricant may render
2 or 4 4 gauze on a sponge stick. this cytological study invalid.
Cleaning the cervix too vigorously will re-
move the epithelium.
1195
1196 Part VIII Skills
There are individual and institutional variations in rior vaginal fornix or vaginal vault either by aspira-
the procedure for obtaining a Papanicolaou smear. tion or with a cotton-tipped applicator, or with the
The variations relate to the number of slides made blunt end of a wooden spatula.
with specimens from the different locations. Some
protocols require two slides: one made from a spec-
imen taken with the wooden spatula swept circum- Reference
ferentially at the os, and the second made from a
specimen taken with the cotton-tipped applicator or 1. Bauman, B. J. Use of a cervical brush
cervical brush inserted into the cervical canal. Still for Papanicolaou smear collection: A meta-
other protocols require the examiner to make a analysis. J. Nurse-Midwifery 38(5):267275
third slide from a specimen taken from the poste- (September/October) 1993.