IUD Protocol

This protocol provides basic requirements for implementing IUD services at a family medicine teaching site. This interactive version also includes pop-up citations and practice tips. A print-ready/PDF version of the protocol is also available.

Scheduling

Patients who request appointments for IUD insertion or removal should be scheduled as soon as possible — but no later than 7 days after the appointment request.

Priority should be given to patients requestingremoval due to symptoms.
Try to obtain prior authorization for devices as quickly as possible (per clinic protocol).
If no appointments are available, a provider should be consulted.

Patient eligibility

There are very few contraindications to using an IUD. However, the provider must be reasonably certain the patient is not pregnant before initiating contraception.

Further eligibility considerations can be addressed using these resources:

Staffing clinic coverage

A medical provider needs to be credentialed prior to performing IUD procedures. Residents may perform IUD insertions only if a credentialed physician is present during the procedure.

In addition to the credentialed medical provider performing the IUD insertion, an additional person, such as a medical support person (LPN, PCT, MA, etc.) must be available in the room during the procedure. A family member may be present but does not replace the need for one of the above personnel.

The medical support person can have the role(s) of:

Witnessing the consent form
Retrieving instruments or supplies as needed during the procedure
Helping to keep the patient stable during a vasovagal or vomiting episode
Providing additional emotional support for the patient

A learner (resident, medical/nursing student, etc.) may be in the room and/or involved in the procedure only if the patient agrees to their participation. If a learner is present, an additional LPN/PCT/MA support person may not be needed.

Recommended roles for learners include:

Medical students/NP students: observation only
Medical residents: observation and hands-on training.

Storage space

An instrument cart can be used for storage of both instruments anddevices.The cart can also serve as a surface for instruments during the procedure. The cart should remain locked when not in use. Sterilized instruments can be pre-packed and kept in the instrument cart along with devices and other necessary supplies.

No touch technique

Preventing infection is an important goal during uterine instrumentation. During the procedure, the provider and staff will use a“no touch” techniqueto handle the instruments. This means having supplies on a sterile tray, keeping sterile and non-sterile instruments separate, and handling instruments in a way that avoids contact with the tips that enter the uterus.

Single-use items

Chux for patient table

GC/C, pap if needed

Sterile drape for tray

Sterile lubricating gel

Sterile 4×4 gauze

Sanitary pad

Hot Pack

Reusable Items

Specula in multiple sizes

Single-toothtenaculum

Serrated ring forceps

Disposable uterine sound

Scissors

13/15 Pratt dilator (optional)

Light source

Medications

IUD

Ibuprofen

Offer paracervical block prn

Vaginalantisepticandapplicator

Useful documents

Institutional consent form
Information for Patients after IUD Insertion
LARC comparison chart (Interactive and PDFs in English and Spanish.)

On the day of the IUD insertion:

Collect urine
- for pregnancy test
- for GC/CT screen, if appropriate
Document blood pressure
Print and have patient sign consent form and have itwitnessed
Offerfollow-upplan with the patient

On the day of the IUD removal:

Document blood pressure
Print and have patient sign consent form and have it witnessed
Confirm that patient knows how to contact the medical team if needed
Determine if the patient prefers to start a new contraceptive today ornot.Offer follow up appointment based on patient’s preferences and health needs.

"Time out" protocol

Consult with your institution to determine whether you must followJoint Commission regulations regarding “time out”prior to a LARC insertion. Obtaining consent in the presence of the involved staff may serve as an appropriate substitute. Otherwise, “time out” may include verifying the patient’s name and DOB prior to the procedure.

Document the patient encounter per clinic protocol.

Before the patient leaves:

Take post-procedural VS
Ensure patient has a way to reach the clinic
Make sure patient has received the post-procedure information

Clean-up per clinic protocol.

Preparedness for fainting/vomiting

Direct the patient to wiggle fingers and toes and/or clench fists and feet to redistribute blood flow peripherally, which can prevent syncopal episodes.

If fainting does occur, the following are appropriate interventions:

Observation (most patients recover without any intervention)
Administer ammonia inhalant
Apply cool towel to forehead
If patient vomits, this will most likely resolve with observation (no intervention)

Management of IUD instruments

LPN/PCT should soak dirty instruments in enzymatic cleaner, scrub any visually bloody areas, then rinse the instruments and let them air-dry. All used medical instruments must be kept in a “used instruments” area of a room. Once dry, the instruments should then be packaged into bags to be autoclaved.

Autoclaving on-site:

Document training and certification in sterilization/infection control procedures.
Maintain a log for machine runs, cleaning schedule; attest results.

Sterile instruments can then be stored in the instrument cart.