Tenaculum Placement for IUD

1. Hold the tenaculum with the dominant hand and place your thumb in one ring and middle or ring finger in the other

2. Holding your hand with the palm up for placement allows you to see above the hand to where the tenaculum is grasping the cervical tissue

3. Capture 1.5-2 cm of tissue with adequate depth to hold the tenaculum in the tissue

4. When the tenaculum is being placed, some ways to decrease pain are:

  • The tenaculum only needs to be closed until it clicks once or twice

  • Close the tenaculum very very slowly

  • Have the client cough (but hold onto the speculum to prevent the speculum from expelling during the cough)

  • Instill 1cc of local anesthetic at the tenaculum site

5. Try to keep the click quiet/soundless by manipulating the ratchet with your dominant hand while closing it. This is accomplished by creating slight up and down distance between the two segments while bringing the teeth together without making a clicking sound

 

6. Once the tenaculum is in place, switch hands and hold it in the non-dominant hand

 

7. Place the thumb of the non-dominant hand over the ratchet area and the rest of the fingers on the other side of the ratchet area

 

8. Remember to use the tenaculum to assist in sounding and placement of the IUD. It is easy to forget to apply traction with the tenaculum while also focusing on getting through the internal os with the sound or the IUD with the other hand

9. When the tenaculum is being used, some ways to decrease pain are:

  • Each time the tenaculum is moved, it can be felt by the patient, so make use of the tenaculum deliberate and avoid extraneous movements

  • Avoid looping your fingers through the rings so as not to move the tenaculum inadvertently

10. When removing the tenaculum some ways to decrease bleeding are:

  • Take it off slowly

  • Use gentle, firm, constant pressure with a scopette (OB swab)

  • Removing the speculum will naturally put pressure on the site to stop bleeding

  • In very rare instances of heavy bleeding, touch the area with silver nitrate or monsels

To download a free PDF version of this page, click here.

 

Los Angeles, CA
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