Re: Hysterosonography Protocol
From: Dr Fazeel uz Zaman (fazeel@atd.hazara.net.pk)
Mon Mar 26 12:19:14 2001
WELL DONE.....charter.net
........dr.fazeel
"charter.net" wrote:
> Greetings,
> I will give it a shot, by enumerating the steps we use in doing the
> procedure. I hope it is helpful.
> Sharon Durbin RDMS
>
> SONOHYSTEROGRAM
>
> POLICY
> Physician to be assisted with procedure by sonographer
>
> DEFINITION
> Instillation of sterile saline through a catheter into the uterus under
> real-time vaginal transducer observation for enhancement and assessment of
> endometrial cavity. This procedure is done on day 3 - day 7, near end of
> menstrual bleeding, when endometrium is thin (Day 6 is generally the "ideal
> day.")
>
> EQUIPMENT
> 1. Tray with barrier drape (approx. 16"x29")
> 2. Sterile container (i.e. sterile urine specimen container).
> 3. Hibiclens in specimen container
> 4. 60 cc syringe
> 5. Sterile saline solution (100 cc bag)
> 6. Three OB/GYN swabs
> 7. Open-sided speculum
> 8. KDF 2.3 intrauterine cannula
> 9. Ring forceps
> 10. Tennaculum
> 11. Portable light source
> 12. Stool (for physician)
> 13. Catch basin positioned in leg rest on exam table.
>
> PROCEDURE
> 1. Set out sterile gloves for physician. Have flashlight or another light
> source available for use during procedure.
> 2. Arrange blue Chux (tripads) on both exam table and step.
> 3. Explain procedure to patient to allay any anxiety. Have patient void to
> assure an empty bladder. Be sure patient has taken Ibuprofen before coming
> to appointment.
> 4. Assist patient in assuming lithotomy position and follow procedure as
> described under endovaginal scans, obtaining views of cervix. Uterus, both
> ovaries and cul-de-sac. This is the baseline study ---an unenhanced
> pre-instillation pre-evaluation.
> 5. Once physician is gloved, he/she draws the sterile saline solution into
> the 60 cc syringe, attaches the catheter and flushes saline solution through
> catheter. Syringe and catheter are set on sterile field.
> 6. Physician is ready to begin sonohysterogram: Open-sided speculum is
> inserted.
> 7. Cervix is cleansed with a betadine solution (HIBICLENS)
> 8. An intrauterine catheter is then threaded into the endometrium
> 9. Speculum is removed carefully so as not to dislodge the intrauterine
> catheter.
> 10. Vaginal transducer is re-inserted.
> 11. Using a 60 cc syringe, saline solution is instilled under direct
> real-time observation. (One should have had flushed the catheter prior to
> using it, to get rid of echogenic artifact.)
> 12. Obtain hard copy views from cornua to cornua, coronal plane; cervix to
> fundus. Continue obtaining views to reconstruct a 3-dimensional anatomy of
> the intrauterine cavity.
> COMMENTS:
> This procedure is useful in any case where better endometrial detail will be
> helpful. For example, to distinguish dysfunctional uterine bleeding from
> patients with myomas or polyps, thus dismissing or allowing appropriate
> surgical intervention. Infertility patients' endometrium can be evaluated
> for the presence of polyps. It does not replace the HSG, but the presence
> of free fluid in the cul-de-sac proves, at least, unilateral tubal patency.
> Sonohysterography is also useful in women on Tamoxifen therapy, especially
> if they have a history of vaginal bleeding. (Tamoxifen is used extensively
> in women with breast cancer, with reports of it causing hyperplasia or even
> adenocarcinoma of the endometrium).
>
>> ----- Original Message -----
> From: "Terry J DuBose" <tjdubose@juno.com>
> To: "Multiple recipients of list ULTRASOUND"
> <ultrasound@mail.medispecialty.com>
> Sent: Sunday, March 25, 2001 4:50 PM
