Standards for Female and Male Sterilization Services - STATE ...

More documents

Recommendations

Info

10Standards for female and male Sterilization services1.4.8. Surgical Techniquesa)b)c)General Requirementsi)ii)iii)iv)The client’s bladder must be empty. If there is a doubt, the client must be askedto void urine immediately before the procedure and should be catheterized,if indicated.The operating surgeon should identify each fallopian tube clearly, following itright up to the fimbria. The site of the occlusion of the fallopian tube mustalways be within 2–3 cm from the uterine cornu in the isthmal portion (thiswill improve the possibility of reversal if required in the future). Care must betaken to avoid damage to the blood vessels, ovaries, and surrounding tissues.Excision of 1 cm of the tube should be done. Use of cautery and crushingof the tube should be avoided.The skin incision is to be closed with an absorbable or non-absorbable suture,and a small dressing or bandage applied.Minilaparotomy Requirementsi)ii)iii)An interval minilaparotomy procedure would benefit from the use of auterine elevator to bring the fallopian tubes into the operative field.The incision for a minilaparotomy (interval, post-abortal, or post-partum)may be transverse or longitudinal.Modified Pomeroy’s procedure should be followed for excision and ligationof tube, using a square knot with 1 ‘0 chromic catgut.Laparoscopy Requirementsi)ii)iii)iv)v)To avoid hypoventilation, the patient must not be placed in the Trendelenburgposition in excess of 15 degrees.An uterine elevator should be used to visualize the fallopian tube.Pneumoperitoneum should be created with veres needle.Insufflation of abdomen with carbon dioxide is the preferred method. Intraabdominalpressure must not exceed 15 mm of mercury. Slow insufflationswith graded insufflator and gradual de-sufflation should be done.The skin incision should not exceed the diameter of the trocar.
Standards for female and male Sterilization services 11The trocar is to be angled towards the hollow of the sacrum. The operatormust lift the anterior abdominal wall before introducing the trocar.Tubal occlusion must always be done with Falope’s rings (no cautery is to beused). The following precautions are to be followed in applying Falope’s rings:Draw the tube slowly and smoothly into the sleeve of the laparoscopeafter proper identification (include only the amount of tube necessaryto provide adequate occlusion). Refer to para 1.4.8.a (ii) for appropriatesite occlusion.To prevent injury to the mesosalpinx/tube, avoid pulling up or back onthe laparocator.Do not apply the rings in case of thick, oedematous or fixed tubes. Insuch cases, tubal occlusion should be done with laparotomy under GAby conventional method.viii) After applying the second ring, the operator should systematically inspect thepelvis to verify that both tubes are now occluded, that there is no unusualbleeding, and that there is no visceral injury.The surgeon should expel all the gas from the abdominal cavity slowly beforeremoving the trocar.1.5. Post-operative Carea)b)c)d)vi)vii)ix)The client is monitored as described in 1.4.7.c (iii).The client may be discharged when the following conditions are met:i)ii)After at least 4 hours of procedure, when the vital signs are stable and theclient is fully awake, has passed urine, and can walk, drink or talk.The client has been seen and evaluated by the doctor. Whenever necessary,the client should be kept overnight at the facility.The client must be accompanied by a responsible adult while going home.Analgesics, antibiotics, and other medicines may be provided and/or prescribedas required.1.5.1. Post-operative and Follow-up InstructionsThe client is to be provided with a discharge card indicating the name of the institution,the date and type of surgery, the method used, and the date and place of follow-up
Page 6: DR. (SMT.) M.S. JayalakshmiDeputy C
Page 14: Standards for female and male Steri
Page 18 and 19: Standards for female and male Steri
Page 22 and 23: 12Standards for female and male Ste
Page 45: Standards for female and male Steri
Page 58: 48Standards for female and male Ste
Page 71 and 72:
Standards for female and male Steri
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
show all

Standards for Female and Male Sterilization Services - STATE ...

Create successful ePaper yourself

Delete template?

Save as template?