WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memorial Hospital

DPMS
Ref: 7498
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 1 of 4
CLINICAL GUIDELINES
SECTION A : OBSTETRICS AND GYNAECOLOGY


5 VAGINAL PROCEDURES
5.2 SPECIMEN COLLECTION

Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs
Date Revised: August 2012 Section A
Review Date: August 2015 Clinical Guidelines
Authorised by: OGCCU King Edward Memorial Hospital
Review Team: OGCCU Perth Western Australia
5.2.2 LOW VAGINAL, HIGH VAGINAL, ENDOCERVICAL AND
RECTAL SWABS
KEY WORDS
Low vaginal, high vaginal, rectal, speculum, swab, smear, transtube, pathology, chaperone
AI M
The correct collection of vaginal and rectal specimens.
EQUI PMENT
Sterile swab
Transtube swab (with transport medium)
Glass slide in a slide carrier
Blood agar plate (for after hours specimens only)
Bi-Valve speculum if required
Unsterile examination gloves
Patient identification labels
Adjustable light source
Biohazard labelled bag


PROCEDURE


ADDITIONAL INFORMATION
1 Consent
Obtain verbal consent before the procedure
is commenced.
Offer a chaperone to all women.
It is recommended for practitioners
conducting vaginal examinations or
procedures to have another practitioner in
attendance. See clinical guideline B 1.6.4
Performing a Vaginal Examination
The additional chaperone / practitioner
provides security for both the examiner
and the woman
may give assistance if required.
7

If the offer of a chaperone is declined
document in the womans medical records.



Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs
Date Revised: August 2012 Section A
Review Date: August 2015 Clinical Guidelines
Written by:/Authorised by: OGCCU King Edward Memorial Hospital
Review Team: OGCCU Perth Western Australia

DPMS Ref: 7498 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 2 of 4



PROCEDURE


ADDITIONAL INFORMATION
2 Explanation of the procedure
Explain the procedure to the woman, and
offer her the option of self-collection of swabs
if appropriate.
1, 2

Assess if the woman has had previous pelvic
examinations and her knowledge of the
procedure. Explanation of the procedure and
a chance for her to ask questions eases
anxiety.
3

3 Preparation
3.1 Ensure the bladder is empty. An empty bladder increases the womans
comfort and allows a more accurate
assessment of the pelvic organs.
3

3.2 Ensure the woman is adequately covered
and comfortable.

3.3 Position the woman for speculum
examination with her head on one pillow,
lying in a dorsal position with the knees
flexed and hips abducted.

3.5 Position the light.
3.6 Hand hygiene should be performed before
and after patient contact.
See Infection Control Policy, 2.4 Hand
Hygiene.
4 Inspection
Part the lips of the labia minora with the non-
dominant hand and inspect the external
meatus, and vulva.
Enables detection of:
abnormal skin conditions
lesions
vaginal discharge or bleeding
scar tissue
skin piercing
evidence of female genital mutilation.
4

5 Insertion of the speculum

See Clinical Guidelines, Section A, 5.2.1
Speculum Examination.




Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs
Date Revised: August 2012 Section A
Review Date: August 2015 Clinical Guidelines
Written by:/Authorised by: OGCCU King Edward Memorial Hospital
Review Team: OGCCU Perth Western Australia

DPMS Ref: 7498 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 3 of 4



PROCEDURE


ADDITIONAL INFORMATION
6 Collection of the swabs
6.1 Low / High Vaginal and Endocervical
swabs
A smear and a swab must be collected when
performing a LVS/HVS or ECS
Smear
Swab the area using the sterile swab. Gently
roll the swab 2-3 timed in non overlapping
passes on to the middle of the glass slide.
Discard this swab. Write the patients name
on the ground glass end of the slide with a
pencil or use a patient ID sticker around the
slide carrier. Allow the smear to dry in air
before closing the slide carrier.

Swab for Culture
Use the transtube swab.
Insert the sterile swab 1-2cm into the lower
entrance of the vagina, and swab the sides of
the vagina. The woman may prefer to collect
her own (Low vaginal swab only), with
instructions from the medical / midwifery /
nursing staff.


Women in studies have shown that they
prefer non invasive techniques rather than a
pelvic examination
1, 2

Insert the swab into the transport medium
and label with the womans identification
sticker and indicate the site of collection.

Place the slide and the transtube in a
specimen bag with the request form in a
separate pocket and send to the Specimen
Centre KEMH


6.4 Rectal Swab

Pre moisten the swab with the transport
medium.
Allows easier insertion of the swab.
See Clinical Guidelines, Section B, 1.4.1
Group B Streptococcal Disease

The woman may prefer to collect her own
swab, with instructions from the medical /
midwifery / nursing staff.

The swab is inserted into the rectum past
external anal sphincter and the specimen is
collected.


The swab is then inserted into the Transport
medium and labelled with the womans
identification sticker and indicate the site of
collection.





Date Issued: August 1999 5.2.2 LVS,HVS,Endocervical and Rectal swabs
Date Revised: August 2012 Section A
Review Date: August 2015 Clinical Guidelines
Written by:/Authorised by: OGCCU King Edward Memorial Hospital
Review Team: OGCCU Perth Western Australia

DPMS Ref: 7498 All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual Page 4 of 4

7 After hours specimen collection

If a swab is taken after normal laboratory
hours, the transtube swab may be used to
inoculate a blood agar plate, and then the
swab is placed in the transport medium as
normal.
See KEMH Pathology Handbook.