Specimen Collection and Transport

Patient Preparation:

The patient should avoid the following for at least 48 hours prior to the collection of the Pap test: Intercourse, douches, vaginal medications (except as directed by your doctor), vaginal contraceptives (birth control foams, creams or jellies), and personal vaginal lubricants.

Collection of Specimen:

1. With the patient in lithotomy position, expose cervix using a vaginal speculum
   1. a. If desired, use lukewarm water to warm and lubricate the speculum
   2. b. Water-Soluble gel lubricant sparingly applied to the posterior blade of the speculum can be used if necessary
   3. c. Even though lubricant gels are water soluble, excessive amounts may compromise the test and possible lead to an unsatisfactory result.
2. Visually examine vaginal mucosa and cervix for lesions, ulcerations or discharge.
3. Remove excess mucus or other discharge present before taking the sample.
4. If there is excess mucus or other discharge present, remove it gently with a cotton swab.
5. Excess cervical mucus, inflammatory exudates and blood is essentially devoid of meaningful cellular material and when present in the sample vial may yield a slide with little or no diagnostic material present.
   1. a. The cervix should not be cleaned by washing with saline or it may result in a relatively acellular specimen.
   2. b. The sample should be obtained before the application of acetic acid.
   3. c.  Document findings of the examination on patient’s record, and communicate the relevant clinical findings to laboratory for optimum cytological interpretation.

Using Endocervical Brush/Spatula Protocol:

1. Obtain a specimen from the exocervix:
   1. a. Select contoured end of plastic spatula and rotate it 360 degrees around the entire exocervix while maintaining tight contact with exocervical surface.
   2. b. Remove spatula and rinse contoured end of plastic spatula into the ThinPrep® Pap Test Solution vial by swirling the spatula vigorously in the vial ten (10) times.
   3. c.  Discard the spatula.
   4. d.  Place cap on the vial until Step 2.
2. Obtain an adequate sampling from the endocervix using an endocervical brush device:
   1. a.  Insert the brush into the cervix until only the bottom most fibers are exposed.
   2. b.  Slowly rotate ¼ or ½ turn in one direction. DO NOT OVER-ROTATE.
      1.  i. Additional rotation may cause bleeding and contaminate the specimen and could result in an unsatisfactory test result.
   3. c.  Rinse the brush in the ThinPrep® Pap Test vial by rotating the devise in the solution ten (10) times while pushing against the Pap test vial wall.
   4. d.  Swirl the brush VIGOROUSLY to further release material.
   5. e.  Discard the brush.
3. Tighten the cap of the vial so that the black torque line on the cap passes the black torque line on the vial.
4. Record the patient’s name and date of birth on the vial
5. Record all pertinent patient information and medical history on the appropriate electronic or paper requisition form.
6. Place the vial and/or paperwork in a specimen biohazard transport bag for transport to the laboratory.

Using Wallach Papette protocol (Broom-Like device):

1. Obtain an adequate sampling from the cervix using a broom-like device:
   1. a.  Insert the central bristles of the broom into the endocervical canal deep enough to allow the shorter bristles to fully contact the ectocervix.
   2. b.  Push gently, and rotate the broom in a clockwise direction five (5) times.
   3. c.  Rinse the broom into the ThinPrep® Pap Test vial by pushing the broom into the bottom of the vial ten (10) times forcing the bristles apart.
   4. d.  As a final step, swirl the broom VIGOROUSLY to further release material.
   5. e.  Discard the collection device.
2. Tighten the cap of the vial so that the black torque line on the cap passes the black torque line on the vial.
3. Record all pertinent patient information and medical history on the appropriate electronic or paper requisition form.
4. Place the vial and/or paperwork in a specimen biohazard transport bag for transport to the laboratory.