Cervical Smear

Introduction
Wash hands, Introduce self, ask Patients name, Explain examination, why its necessary and get consent
Get chaperone
Explain smear programme
Explain procedure
o Be impersonal e.g. it will involve placing a small plastic tube inside the vagina to look at the cervix
o It shouldnt be painful but, if at any point you are uncomfortable or want to stop, just say so. One of the nurses will
also be present to ensure you are comfortable and act as a chaparone
o Patient should be lying flat in lithotomy position but cover up until needed You will need to undress from the waist
down, put your heels together and touching your bottom then flop your knees down
A few questions before starting: LMP, intra-menstrual bleeding, discharge, contraception, last smear
Ask if patient wants to go to the toilet first
NB. Keep talking to and reassuring patient, using their name throughout.

Gather equipment
Gloves
KY lubricating gel
Speculum
Cervical smear brush
Cervical smear sample bottle
Wash tray and place equipment inside in partially open packets

Performing the smear

Apply gloves
Lubricate speculum and warn the patient
Part labia and insert speculum with screw sideways
Rotate speculum so screw is facing upwards and open it and tighten screw
Hold in place (so it doesnt slide out) with your left hand
Use light to visualise cervix - look for erosions, ulcerations, growths, cervicitis, blood, polyps, ectropion
Use your right hand to open the sample pot and place it in your left hand (which is also holding the speculum)
Take the smear using your right hand
o Place the centre piece of the brush in the endocervical canal and rotate the brush 5 times in the endocervix
o Remove and, depending on type of brush, either snap it into the pot in your left hand or turn it in the bottle 10 times
Place the lid on the sample pot with your right hand and place the pot back in the tray
Close speculum blades (but leave open slightly so dont pinch vaginal walls) and remove speculum while rotating it back
sideways.

To Complete
Thank patient and cover them and give them a tissue and ask them to get dressed
Fill in the sample pot and details on request form
o Name, DOB, hospital/clinic number, address, GP name and address
o Date of last smear
o Reason for smear (e.g. routine recall, first smear etc)
o Sampling device
o Specimen site
o Condition (pregnant, postnatal, IUCD, other hormones, oral contraceptives, postmenopausal)
o Appearance of cervix
o Clinical details
Document in patients notes
Advise patient results will take approximately 2 weeks and will be sent by letter

2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision