The responsibility of teaching uterine cavity suction in the obstetrics department still falls on me. Our institution switched from using metal curettes to plastic suction tubes about 15 years ago. Teaching the use of the instruments and the suction method is the key content.
1. It involves an internal examination before the procedure to assess whether it can be done or not.
I asked the students what the major contraindications for uterine cavity suction are.
The answer is if there is an existing pregnancy (if the suction is not for abortion) or if there is an infection in the vagina or cervix at that time.
“Is there anything else?” I asked the students.
“No vagina,” came a voice from the back.
“Wait a minute,” I almost stumbled. “No vagina, and you want us to perform uterine cavity suction for what?” I lamented. But that’s the fun of teaching, believe me.
2. Insert a speculum to open the vagina.
3. Apply antiseptic solution throughout the vagina and cervix.
4. Use a tenaculum to clamp the cervix, as it will make the insertion of the suction tube into the uterine cavity easier.
5. Insert the suction tube through the cervix until the tip reaches the top of the uterine cavity.
6. Attach the vacuum syringe, close the valve, and pull the plunger to reduce the pressure in the syringe.
Have you ever seen a nurse draw medication into a syringe? When we reduce the pressure in a 60 cc syringe, that’s exactly what we do.
7. Connect the syringe to the tube that is now inserted in the vagina and cervix.
8. Release the valve and start suctioning until everything that needs to be suctioned is out. It’s like sucking bubble tea, slurp, slurp, slurp (uh…)
At this stage, the patient will start to feel a cramp in the lower abdomen, indicating that the procedure is about to finish.
9. Remove all instruments and observe for complications. If everything is normal, the patient can go home.
It’s that simple. The patient doesn’t need general anesthesia, spinal block, or hospital stay, saving a lot of costs.
…
“Choosing the size of the suction tube depends on the purpose,” I told the students. “If suctioning for miscarriage treatment or abortion, use a larger size for faster completion. But if suctioning for diagnosis, a smaller size is sufficient because the uterine lining is soft, and just enough tissue for examination is needed.”
That’s a brief before practicing with the mannequin…
During the instrument practice session, a medical student was performing steps 1-4. She was quite adept.
When it came to the process of inserting the suction tube into the uterine cavity, I asked what size she would choose.
The size of the suction tube refers to the diameter, for example, size 4 has a yellow handle with a diameter of 4 millimeters.
“49,” she replied.
Then the conversation in the group fell silent for a moment.
“Um… isn’t that the circumference size of a condom, dear?”
See, I told you my class is really fun.
Thanaphan Chubunsanuknithe
Dec 17, 2024 Source: Asst. Prof. Dr. Thanaphan Chubun
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