This protocol provides basic requirements for implementing IUD services at a family medicine teaching site. This interactive version also includes pop-up citations and practice tips. A print-ready/PDF version of the protocol is also available.
Patients who request appointments for IUD insertion or removal should be scheduled as soon as possible — but no later than 7 days after the appointment request.
There are very few contraindications to using an IUD. However, the provider must be reasonably certain the patient is not pregnant before initiating contraception.
Further eligibility considerations can be addressed using these resources:
A medical provider needs to be credentialed prior to performing IUD procedures. Residents may perform IUD insertions only if a credentialed physician is present during the procedure.
In addition to the credentialed medical provider performing the IUD insertion, an additional person, such as a medical support person (LPN, PCT, MA, etc.) must be available in the room during the procedure. A family member may be present but does not replace the need for one of the above personnel.
The medical support person can have the role(s) of:
A learner (resident, medical/nursing student, etc.) may be in the room and/or involved in the procedure only if the patient agrees to their participation. If a learner is present, an additional LPN/PCT/MA support person may not be needed.
Recommended roles for learners include:
An instrument cart can be used for storage of both instruments anddevices.The cart can also serve as a surface for instruments during the procedure. The cart should remain locked when not in use. Sterilized instruments can be pre-packed and kept in the instrument cart along with devices and other necessary supplies.
Preventing infection is an important goal during uterine instrumentation. During the procedure, the provider and staff will use a“no touch” technique
Chux for patient table
GC/C, pap if needed
Sterile drape for tray
Sterile lubricating gel
Sterile 4×4 gauze
Specula in multiple sizes
Serrated ring forceps
Disposable uterine sound
13/15 Pratt dilator (optional)
Offer paracervical block prn
Consult with your institution to determine whether you must followJoint Commission regulations regarding “time out”
Document the patient encounter per clinic protocol.
Clean-up per clinic protocol.
Direct the patient to wiggle fingers and toes and/or clench fists and feet to redistribute blood flow peripherally, which can prevent syncopal episodes.
If fainting does occur, the following are appropriate interventions:
LPN/PCT should soak dirty instruments in enzymatic cleaner, scrub any visually bloody areas, then rinse the instruments and let them air-dry. All used medical instruments must be kept in a “used instruments” area of a room. Once dry, the instruments should then be packaged into bags to be autoclaved.
Sterile instruments can then be stored in the instrument cart.