#ExistPATIENTPREP>Patient Prep: 1. For premenopausal patients, obtain specimens during the second half of the menstrual period to avoid contamination by obscuring blood.
2. Instruct the patient not to douche or engage in sexual intercourse within 24 hours of the procedure.
#ExistCollect>Collect: 1. Label the vial(s) with the patient's first and last name, date of birth, and specimen source before beginning the procedure.
2. Obtain all specimens prior to bimanual examination.
3. Place the patient in the lithotomy position. Using an unlubricated vaginal speculum (saline may be used as a lubricant) visualize the cervix as fully as possible.
4. Follow the instructions for the specific collection kit used.
#ExistSPECIMENPREPARATION>Specimen Preparation: Supplies: This test requires a SurePath collection kit, which includes a preservative fluid collection vial and sampling device(s). Kits may be ordered separately through ARUP Client Services at (800) 522-2787 or (801) 583-2787. Also required: ARUP Cytology test request form, permanent marker.
Collection Procedure: Obtain cervical specimen prior to bimanual examination. Use an unlubricated speculum (saline or warm water may be used). Vaginal discharge or secretion, when present in large amounts, should be removed before obtaining the cervical sample so as not to disturb the epithelium (i.e., cellulose swab). Small amounts of blood will not interfere with the cytologic evaluation; however, large amounts of blood as present during menses may interfere with cytologic evaluation because cells may be obscured by blood. Use of liquid-based specimen collection minimizes the interference from these factors. If testing for sexually transmitted disease is indicated, the cervical cytology sample should be taken first. After visualization of the cervix is accomplished, collect the sample. Obtain an adequate sampling from the cervix using the Rovers Cervex-Brush or Cervex-Brush Combi or the Pap Perfect plastic spatula with the Cytobrush Plus GT.
ROVERS CERVEX-BRUSH Collection (Kit #22216): Device may be referred to as broom. Position the tip of the longer bristles into the cervical os/endocervical canal. Begin rotating in a clockwise direction (one-quarter to one-half turn). The bristles will begin to stiffen. Continue rotating in a clockwise direction and gently push towards the cervix until the shorter bristles begin to bend extending over the ectocervix. Complete five 360-degree rotations. Direction must be consistent. Do not alter or vary the direction of the broom during sampling. Transfer the entire sample by placing your thumb against the back of the brush pad, and simply disconnect the entire brush from the stem into the preservative vial. Contraindication: Do not use on pregnant patients after the first 10 weeks of gestation.
PAP PERFECT PLASTIC SPATULA AND CYTOBRUSH PLUS GT Collection (Kit #41126): Insert the contoured end of the Pap Perfect plastic spatula and rotate 360 degrees around the entire exocervix. Disconnect the spatula head and place it in into the vial. Insert the Cytobrush Plus GT into the endocervix until only the bottom most fibers are exposed at the cervical os. Slowly rotate or turn one half turn in one direction. To reduce unnecessary bleeding, DO NOT over rotate. Disconnect the brush head and place in the preservative vial. Contraindication: Do not use the Cytobrush Plus GT (endocervical brush) on pregnant patients or for endometrial sampling.
ROVERS CERVEX-BRUSH COMBI Collection (Kit #45031): Insert central bristles into the endocervical canal. Use gentle pressure on the cervix until the lateral bristles bend against the ectocervix. Maintain gentle pressure and rotate two times in a clockwise direction by rolling the stem between the thumb and forefinger. Disconnect the brush head and place in the preservative vial. Contraindication: This device should not be used during pregnancy.
For all kits, recap the preservative vial and tighten. Record the patient's information and medical history on the ARUP Cytology test request form. Place the vial and test request form in a specimen bag for transport to the laboratory.
#ExistSPECTRANSPORT>Storage/Transport Temperature: Room temperature.
#ExistConditions>Unacceptable Conditions: Specimens not collected in a SurePath collection kit. Expired preservative vials or vials received without the collection devices.
#ExistStability>Stability (collection to initiation of testing): Ambient: 1 month; Refrigerated: 6 months; Frozen: Unacceptable