Culdocentesis

Description:

Culdocentesis is a procedure that checks for abnormal fluid by inserting a long, thin needles through the "cul-de-sac" (French for "bottom of [a] sack") vaginal wall (the rectouterine pouch called the pouch of Douglas) located in the space deep in the vagina behind and under the cervix. A sample is taken of any fluid found in the space and the needle is then withdrawn.
Purpose:

This procedure is done when pain occurs in the lower abdomen and pelvic regions, and other tests suggest that fluid may be present in the cul-de-sac. This test is now performed infrequently because of the availability and effectiveness of ultrasound examinations to detect fluid in the cul-de-sac. Investigation of possible ailments in the abdomen and pelvis include:
·    Bleeding inside the lower pelvic cavity.
·    Ruptured Ectopic Pregnancy.
·    Ruptured Ovarian Cyst.
·    Ovarian Cancer.

Materials/ Equipments needed:

·         Speculum
·         Tenaculum
·         10-ml syringe


INFORMED CONSENT:
A consent form for culdocentesis should include the purpose of the procedure, explanation of what will happen in understandable terms, risks and complication, alternatives, and possible outcomes
 Procedure:
 You may be asked to walk or sit for a short time before the test is done.
 A speculum is inserted into the vagina to hold it open.
 A pelvic exam is usually performed.
 The rear lip of the cervix is grasped with an instrument raised slightly.
 A local anesthetic may be applied to the farthest back portion of the vagina (cul-de-sac).
 The posterior wall of the vagina is penetrated with a needle and syringe.
 Fluid, if present, is aspirated. No sutures are necessary.

There may be an uncomfortable, cramping feeling when the cervix is grasped. There is a sharp brief pain as the needle is inserted.

Diagram/ Illustration:



Nursing Responsibilities:

POST PROCEDURE CARE

GENERAL MEASURES
 You may need someone to take you home after the procedure if you were given a sedative.
 Resume your usual activities as soon as possible.
 Continue to use your usual birth control methods. Your periods should not be disturbed.
 Use sanitary pads for your next menstrual period. Avoid tampons temporarily; they may lead to infection.
MEDICATION
 According to diagnosis.
 You may use non-prescription drugs, such as acetaminophen, to relieve minor pain.
ACTIVITY
 Resume normal activities gradually. Resume sexual relations when able. This will depend on various underlying causes.
DIET
 No special diet. However, a nutritious dietary plan should be followed to build and maintain a healthy immune system and assist in healing.

NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
 You experience vaginal bleeding that soaks more than 1 pad or tampon each hour.
 Symptoms recur or worsen.
 You have any signs and symptoms of infection: fever, body aches, headache, general ill feeling.



Reference:

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