ASSISTING IN INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICE (COPPER)

DEFINATION:-

“Introduction of a specially designed device into the uterine cavity of a woman who desires to
prevent conception of pregnancy for a specific period of time.” (Fig.1)

PURPOSE:-

1. To avoid unwanted pregnancy

2. To space the pregnancies.

CONTRAINDICATION:

Absolute:

1. Suspected pregnancy.
2. Pelvic inflammatory disease.
3. Vaginal bleeding of undiagnosed etiology.
4. Previous ectopic pregnancy.
Relative:

1. Anaemia.
2. Mcnorrhagia.
3. History of pelvic inflammatory disease.
4. Distortion of the uterine cavity due to congenital malformation, fibroids.

ADVANTAGES OF IUCD :-

1. Simplicity – No complex procedure are involve in insertion.

2. Hospitalization is not required.
3. IUCD stays in place as long as required (Different types of IUCDs have varying duration
recommended for replacement depending on the amount of impregnated
medications)
4. Inexpensive.
5. Contraceptive effect is reversible by removal of IUCD.
6. Free from systemic metabolism side effects associated with hormonal pills.
7. There is no need for continual motivation.
ARTICLES:-
1. IUCD pre –sterilized insertion package.
2. Sterile tray containing.
 Vaginal speculum (cuscos )- 1
 Vulsellum -1
 Uterine sound -1
 Sponge holding forceps -2(Fig.2)
 Bowl containing cotton swab
 Sterile gloves.
 Scissors.
 Disinfectant solution.
 Kidney tray.

PROCEDURE:

S.No NURSING ACTION RATIONALE

1 Explain the procedure including advantages, -Helps in obtaining co-
disadvantage effectiveness and side effect of operation of patient and
IUCD anxiety

2 Arrange the equipments on examination

3 Instruct woman to empty her bladder.
4 Position woman on her back with knees
flexed and buttocks at the edge of the table.
5 Provide privacy and drape patient -Prevent embarrassment
appropriately .
6 Wash hands and wear the sterile gloves

7 Load the IUCD (Cu-T) inside the applicator -loading in this manner facilities
In the following manner : the threads ,the release of the device as the
vertical stem and then the horizontal stem inserter
folded into the vertical stem through the Is withdrawn.
distal end of the inserted.
8 Inspect external genitalia ,urethra and
vagina for signs of infection ,lesions or
discharge.
9 Cleanse the perineum.

10 Explain to the woman that there will be -Helps in obtaining co-

Slight discomfort during speculum insertion operation.
11 Insert the speculum gently and observed
the cervix for signs of infection and erosion.
12 Clean the external cervical OS with an
antiseptic soaked swab by using sponge
holding forceps.
13 Instruct the patient that will be discomfort -Applies traction to the cervix
(Pinching pain), when applying the vulsellum. and straightens the cervical
Apply vulsellum at the 12 O’clock position canal.
the cervix , grasp the lip of the cervix .
14 Pass the uterine sound into the cervical canal -Determines the length of the
Carefully into the uterine cavity (Fig.3) uterine cavity by nothing the
while pulling steadily downward and outward level of mucous or blood on the
on the vulsellum .(A slide resistance indicates uterine sound.
that the top if the uterine sound has reached
thefundus ), and remove the uterine sound.
15 Measure the length of the device to be
inserted into the uterine cavity ,The depth
of gauge on the inserter-tube is used to mark
the depth of the uterus.
Pull the uploaded inserter tube gently until
the distance between the top of the folded
“ T “ and edge of the depth gauge closed
To the “T” is equal to the uterus as
measure on uterine sound.
16 Carefully peel the clean plastic cover of the
package away from the white packing .
lift the loaded inserter keeping it horizontal
so that neither the “T” nor white rod falls out.
Be careful not to push the white rod towards
the “T”.

17 Grasp the vulsellum and pull firmly

Downwards and outwards to align the uterine
cavity and cervical canal with the vaginal
canal.
18 Gently introduce the loaded inserter assembly
Through the cervical canal.Keeping the
depth gauge into a horizontal position.
19 According to the position and direction of the -Place the loaded application in
Uterine cavity gently and carefully advance the uterine cavity.
the loaded inserter assembly until the depth
gauge comes in contact with the cervix or
resistance of the uterine fundus is felt.
20 Hold the vulsellum and the white rod in one
hand .
 21 Gently and slowly withdraw the inserter -This action frees IUCD into the
keeping the plunger in place. (Fig.4.) uterine cavity.
22 Check for the strings producing from the -The strings can be seen and
uterus .Cut the strings shorter so that they felt in the vagina.
protrude only 3 cm outside the cervix .
(from the external OS).

23 Remove the vulsellum if there is excessive

Bleeding from vulsellum side ,press a sterile
cotton ball to the site using forceps until the
bleeding stops.
24 Remove speculum and drapes.

25 Instruct patient to stay in bed for some time.

26 Wash perineum with soap and water dry it.

27 Remove gloves and discard.

28 Instruct the woman on follow up measure :-

-To confirm presence of IUCD periodically
By feeling the presence of threads in vagina.
-Instruct patient to visit clinic whenever
she experience the warning signs of
problems related to IUCD such as:
P :Delayed period, spotting ,bleeding or
Missing period .
A :Abnormal pain or pain during coitus.
I : Infection any vaginal discharge .
N :Not feeling well ,fever or pelvic pain .
S : Strings (Not feeling the strings in vagina).

SIDE EFFECTS AND COMPLICATIONS:

1. Excessive bleeding.
2. Low back pain during menstruation.
3. Pain during menstruation.
4. Pelvis infection.
5. Uterine perforation.
6. Ectopic pregnancy.
7. Expulsion of device.