CooperSurgical Milex Anleitung Seite 10

1. Wear dry gloves. When necessary,
lubricate only the entering end of
the pessary with TRIMO-SAN
as illustrated in Figure 1.
2. The pessary is folded by bringing the
small round holes together. The arch
formed points downward as shown
with the RING pessary (see Figure 2).
3. Direct the pessary past the cervix into the posterior fornix. Allow
the pessary to open again into the ring shape after passing the
introitus.
4. The index finger is inserted deep
into the vagina to turn the pessary
approximately 90° (see Figure 3).
The RING pessary in this position
cannot be folded and pushed out.
5. Have the patient sit, stand and
bear down slightly. If there is no
leakage of urine and the patient
is comfortable with the pessary in
position, have her empty her
bladder. A properly fitted pessary takes up slack in redundant
tissue, holding the uterus high, in a sort of sling.
Note:
•
If she is unable to urinate with the pessary in position, remove the
pessary and fit her with a smaller size and repeat Step 5.
•
If the patient is able to void, continue with Step 6.
6. If she can void without difficulty and the pessary remains in
position upon re-examination, and the patient is comfortable with
the pessary in place, you have a good indication that you have
selected the correct size.
7. Examine the patient while she is in the standing position to
ensure the pessary has not shifted position. The patient should
not feel the pessary once it is in position. The pessary should not
be too loose as it may turn or be expelled, and it should not be
too tight as it may cause discomfort.
8. The health care professional should be able to sweep one finger
between the pessary and the vaginal walls. If there is not enough
space to do this, the next smaller size should be tried. If
excessive space exists, the pessary will not be effective and may
rotate or even be expelled (see Figure 3).
9. It is sometimes necessary to refit the patient with a different size
or type of pessary after a period of time. Do not assume that a
replacement will always be the same size as the previous one.
Check the fitting to ensure continued patient comfort and relief
of symptoms. The use life of a pessary is limited. Examine
frequently for signs of deterioration.
PATIENT FOLLOW-UP:
Have the patient:
•
Report immediately any difficulty in urinating
•
Report immediately any dis com fort
•
Return within 24 hours for first examination
TM
. Hold
Figure 1
Figure 2
Figure 3
•
Return for second examination within 3 days
•
Return for examination every 4 to 6 weeks
Note: Above schedule of follow-up examinations may be al tered to
fit the needs of the individual patient.
At each checkup, the pessary should be removed and cleaned. If no
contraindications are present, the pessary is reinserted.
TO REMOVE:
Use one finger to depress the perineum. Turn the pessary until the
notches face the introitus. Fold the pessary and gently ease it out.
Note: If necessary, irrigate the vagina after removal of the pessary
(and before reinsertion) to cleanse the vagina of excess discharge
and secretions. HCPCS Supply Number A4320 (Irrigation Tray
with Syringe, any purpose).
During each visit, the vagina should be carefully inspected for
evidence of pressure or allergic reaction. The patient should be
questioned concerning douching, discharge, disturbance of bowel
function or urination. It may be necessary to fit another size or an
entirely different type of pessary.
DO NOT assume that a replacement will be the same size as the
previous one. Check the fitting to ensure patient comfort and relief
of symptoms.
At each checkup, the pessary is removed and cleaned. If there are
no contraindications, the pessary is reinserted.
6