Hysterosalpingogram Test

Supplies needed:

1.) Informed consent form 2.) Hystero tray 3.) 20 cc LL syringe 4.) 2 19 gauge needle 5.) Disposable speculum 6.) Sholkoff Balloon catheter (14 Fr to 18 cm) 7.) Betadine 8.) Short stop 9.) Sterile gown 10.) Sterile gloves 11.) Sterile labels 12.) 3 blue caps & masks 13.) 3 way stopcock 14.) KY jelly 15.) Sterile pen 16.) Light 17.) Omnipaque 300 18.) Sanitary napkin 19.) Sterile half sheet 20.) Sterile towels

Why is a hysterosalpinography performed?

Determines the presence and severity of congenital acquired abnormalities of the uterus Also determines: -submucous tumor masses -fistula tracts -uterine fibroids -openness (aka patency) of the fallopian tubes -any adhesions (scarring) within uterine or peritoneal cavity -shows injury or abnormal structure of uterus or fallopian tubes -shows blockage preventing egg from moving through the fallopian tube to uterus

What can patient expect to feel or experience during and/or after exam?

Discomfort and cramping during catheter insertion, balloon inflation, or injection of contrast w/ minimal spotting or bleeding

Contraindications/Precautions

Pregnancy Active pelvic infection Recent uterine or tubal surgery

Indications

To assess the fallopian tube patency and intrauterine contour

Who is this exam usually performed on?

most often done on women who are having difficulty becoming pregnant

What is a hysterosalpingogram?

-An exam that shows the size, shape, and location of the uterus and fallopian tube. -Performed by a radiologist using fluoroscopic guidance -Contrast medium is required and is performed under aseptic conditions

What is the patient preparation?

-Should be scheduled 10 days after the onset of menstruation (endometrium is less congested during this time and before ovulation normally occurs ) -Patient may be instructed to take laxative or enema to empty bowels so structures can be seen more clearly -Patient empties bladder before exam: prevents pressure displacement and superimposition on the pelvic genitalia -patient in lithotomy position

Procedure Steps:

-Technologist to screen patient: patient history, pregnancies, allergies, last period) -Radiologist explains procedure to patient: patient signs consent form -Pad on table, slider board underneath -Attach handles: wrap towels around -Set up tray using sterile technique -Radiologist wears sterile cap, sterile gown, and mask -Patient wears cap Procedure pause is done AFTER radiologist dawns sterile gown, cap, and mask -Fluroscopy drape in place -set up fluoro panel (70 kVp, 500 mA) -Instruct patient to empty bladder before lying on table -Patient supine resting on bolster (3 stacked blankets) -radiologist will drape patients lower body with sterile towels -Radiologist will prepare hystero tray -Technologist to assist radiologist to assist in aseptic technique for sterile tray set up and drawing up contrast -check contrast expiration date-show to radiologist, break seal on contrast bottle and use a 10 second wipe of rubber stopper before radiologists inserts needle -syringe is filled with contrast (omnipawue 300) attached to catheter tubing -Radiologist will check catheter for usage, remove air, and check balloon quality prior to insertion into cervix -Cervix is prepared w/ an antiseptic (Betadine) -Specculum is inserted into the vagina w/ light attached -Catheter is inserted into the opening of the cervix, balloon is inflated to hold catheter in place -Contrast material begins to fill the uterine cavity, fallopian tubes, and periotenial cavity, through the catheter and fluoroscopic images are taken -Radiologist may instruct patient to roll on each side (oblique views) for optimal visualization of contrast spillage -Due to pain and cramping during procedure patient may experience vasovagal reaction-patient to rest on table for 5 to 10 minutes

How is contrast medium used during this exam?

-Uterus and fallopian tubes are filled with a water soluble contrast material -contrast flows through the patient tubes and "spills" into peritoneal cavity -spot images are taken

What are the benefits of having a hysterosalpingogram?

-minimally invasive procedure -provides valuable information about structural problems that can affect infertility