Collection Manual: Pap Test


Description: Pap tests may be collected for ThinPrep™ processing or for conventional smear preparation. In either case, the routine sampling targets are the ectocervix and endocervix. Vaginal samples are usually obtained only for patients with hysterectomy and the occasional instance where direct vaginal collection is clinically indicated.

MATERIALS

ThinPrep: PreservCyt™ Solution (CAUTION: POISON, FLAMMABLE).
Cytobrush, plastic spatula, requisition form, biohazard transport bag. Smear: Pap kit (glass slide, cytobrush, wooden spatula, slide mailer), spray-fix (CAUTION: POISON, FLAMMABLE), requisition form, biohazard transport bag.

PREPARATION

1. Instruct patients to:
• Avoid douches and intercourse 24 hours prior to examination.
• Try to schedule the exam for the non-menstrual portion of her cycle.

2. Complete a requisition form. White copy to the lab. Lack of data may result in specimen delay or rejection.
Include:
• Clinician: name, location and date of service.
• Patient demographics; name, address, phone number, date of birth and social security number.
• Insurance information: copy of insurance card(s) or face sheet.
• Type of Pap test: Screening Pap Low-risk, Screening Pap High-risk, Diagnostic Pap.
• Source(s). Check all that are sampled: VAGINAL, CERVICAL, ENDOCERVICAL.
• Menstrual status: Provide LMP date if cyclic. Indicate if pregnant, post partum, menopausal, total or partial
  hysterectomy and hormonal therapy.
• Relevant clinical history and/or symptoms
• Medicare ABN for all Medicare patients and all patients 65 and older (see section 4.0, FORMS).

3. Label the vial with the patient’s first and last name.
• Smears: Label the slide (not the slide mailer) in pencil. Ink dissolves from slides in processing.
• The lab is required to return unlabeled samples to the clinician.

4. Do not apply lubricant to the speculum.
• Moisten the speculum with water. Lubricant interferes with the processing of the cells.

5. Visualize and prepare the cervix.
• Describe visible cervical abnormalities on the requisition form.
• To improve epithelial cell collection, remove excess mucous, inflammatory exudate and blood by gently dabbing
  away with gauze.
• Perform other GYN procedures after sampling for the Pap test.

COLLECTING THE SAMPLE

6. Collect a cervical sample.
• Gently rotate the spatula 360 around the face of the ectocervix. Include borders of “erosions”.
• ThinPrep: Use a plastic spatula. Immediately swirl the spatula 10 times in the vial.
• Smear: Use a wooden or plastic spatula. Smear thinly and evenly across ½ of the slide (thick areas cannot
  be interpreted). SPRAY FIX IMMEDIATELY!

7. Collect an endocervical sample.
• Insert the cytobrush into the endocervical canal until only a few brush bristles remain exposed.
• Slowly rotate ¼ turn. Added rotation is unnecessary and may cause obscuring blood.
• ThinPrep: Rinse the brush by rotating it 10 times while pressing it against the inner vial wall. Then swirl the
  brush vigorously to further release material.
• Smear: Spread the collected material thinly and evenly by rolling the brush over another 1/3rd of the slide.
  Thick areas cannot be interpreted. SPRAY FIX IMMEDIATELY!

8. A vaginal sample is not routinely collected, except for:
• Hysterectomy patients.
• Visualized lesions; scrape vaginal lesions directly and follow with a biopsy.
• Suspected endometrial lesions; sample the vaginal pool (where exfoliated endometrial cells tend to collect).

• ThinPrep: Use a plastic spatula. Vigorously swirl the spatula 10 times in the vial.
• Smear: Use a wooden or plastic spatula. Spread the collected material thinly and evenly across ½ of the slide
  (thick areas cannot be interpreted). SPRAY FIX IMMEDIATELY!

PACKAGING FOR TRANSPORT

9. Secure the sample.
• ThinPrep: Tighten the vial cap until the torque line on the cap passes the line on the vial.
• Smear: Submit the slide in the cardboard mailer that is part of the Pap smear kit.

10. Submit in a biohazard transport bag.
• Submit the sample in the zip-loc portion of the bag and the requisition form in the outer sleeve.
• Smears Only. Important! Never submit biopsy specimens and Pap smears together in the same zip-loc portion of
  a transport bag. Formalin fumes will adversely affect the staining capability of the smear.
  Instead, place the Pap smear in the outer pouch with the requisition form.

11. Refrigeration is not required.