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Information ⬇

Synonym/Acronym

N/A

Rationale

To visualize and assess the endometrial lining of the uterus to assist in diagnosing disorders such as fibroids, cancer, and polyps.

Patient Preparation

There are no activity or medication restrictions unless by medical direction. Instruct the patient not to douche or use tampons or vaginal medications for 24 hr prior to the procedure. The patient may be instructed to be NPO at midnight before the procedure. Otherwise, instruct the patient that to reduce the risk of aspiration related to nausea and vomiting, solid food and milk or milk products are restricted for at least 6 hr, and clear liquids are restricted for at least 2 hr prior to general anesthesia, regional anesthesia, or sedation/analgesia (monitored anesthesia). The American Society of Anesthesiologists has fasting guidelines for risk levels according to patient status. More information can be located at https://pubs.asahq.org/anesthesiology/article/126/3/376/19733/.

Regarding the patient’s risk for bleeding, the patient should be instructed to avoid taking natural products and medications with known anticoagulant, antiplatelet, or thrombolytic properties or to reduce dosage, as ordered, prior to the procedure. Number of days to withhold medication is dependent on the type of anticoagulant. Note the last time and dose of medication taken. Protocols may vary among facilities.

Patients on beta blockers before the surgical procedure should be instructed to take their medication as ordered during the perioperative period.

Normal Findings

  • Normal uterine appearance

Critical Findings and Potential Interventions ⬆ ⬇

N/A

Overview ⬆ ⬇

(Study type: Endoscopy; related body system: Reproductive system.)

Hysteroscopy is a diagnostic or minor surgical procedure of the uterus. It is done using a thin telescope (hysteroscope), which is inserted through the cervix with minimal or no dilation. Normal saline, glycine, or carbon dioxide is used to fill and distend the uterus. The inner surface of the uterus is examined, and laser beam or electrocautery can be accomplished during the procedure. Diagnostic hysteroscopy is used to diagnose uterine abnormalities and may be completed in conjunction with a dilatation and curettage (D&C). This procedure is usually done to assess abnormal uterine bleeding or repeated miscarriages. An operative hysteroscopy is done instead of abdominal surgery to treat many uterine conditions such as septums or fibroids (myomas). A resectoscope (a hysteroscope that uses high-frequency electrical current to cut or coagulate tissue) may be used to remove any localized myomas. Local, regional, or general anesthesia can be used, but usually general anesthesia is needed. The procedure may done in a health-care provider’s (HCP) office, but if done as an outpatient surgical procedure, it is usually completed in a hospital setting.

Indications ⬆ ⬇

Contraindications ⬆ ⬇

Patients with bleeding disorders or receiving anticoagulant therapy (related to the potential for continued bleeding as a result of the procedure).

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Abnormal Findings Related to

  • Areas of active bleeding
  • Adhesions
  • Displaced intrauterine devices
  • Fibroid tumors
  • Polyps
  • Uterine septum

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Review the procedure with the patient.
  • Discuss how this procedure can assist in assessing uterine health.
  • Explain that the procedure takes 30 to 45 min and is performed in a surgery suite or medical office. Pregnancy testing may be required.
  • Discuss how there may be moments of discomfort or pain when the IV line is inserted allowing for infusion of fluids such as saline, anesthetics, sedatives, medications used in the procedure, or emergency medications. A local anesthetic spray or liquid may be applied to the cervix to ease insertion of the hysteroscope if general anesthesia is not used.

Procedural Information

  • Baseline vital signs are recorded and monitored throughout the procedure.
  • The patient is asked to void prior to the procedure to reduce the risk of perforating a distended bladder.
  • Positioning for the procedure is in the lithotomy position on an examination table where the vaginal area will be cleansed and draped.

Potential Nursing Actions

Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

Safety Considerations

  • Anticoagulants, aspirin, and other salicylates should be discontinued by medical direction for the appropriate number of days prior to a procedure where bleeding is a potential complication.

After the Study: Implementation & Evaluation Potential Nursing Actions

Avoiding Complications

  • Monitor for complications related to the procedure including bleeding. Stress immediately reporting symptoms such as excessive uterine bleeding or fever.

Treatment Considerations

  • Follow postprocedure vital sign and assessment protocol.
  • Resume the usual diet, fluids, medications, and activity as directed by the HCP. Advise wearing a sanitary pad for vaginal bleeding. Refrain from sexual intercourse until the uterus is confirmed to be healed.

Clinical Judgement

  • Consider cultural barriers that may exist toward a procedural visual examination of the uterus.

Follow-Up Evaluation and Desired Outcomes

  • Understands that additional testing, treatment, or referral may be necessary to monitor and treat the disease process.