Definition
Inserting an intrauterine contraceptive device (IUCD)—commonly known as an IUD—is a clinical procedure performed by trained healthcare providers to offer long-acting reversible contraception.
Purposes
- Provide long-term contraception (3–10 years depending on type)
- Offer non-daily, hormone-free or hormonal birth control
- Manage menorrhagia, dysmenorrhea, or endometrial hyperplasia (hormonal IUDs)
Contraindications
Absolute
- Suspected pregnancy.
- Pelvic inflammatory disease
- Vaginal bleeding of undiagnosed etiology.
- Previous ectopic pregnancy.
Relative
- Anemia.
- Menorrhagia.
- History of pelvic inflammatory disease.
- Distortions of the uterine cavity due to congenital malformations, fibroids.
Advantages of intrauterine contraceptive device
- Simplicity: No complex procedures are involved in insertion.
- Hospitalization is not required.
- Intrauterine contraceptive device stays in place as long as required (different types of IUCDs have varying durations recommended for replacement depending on the amount of impregnated medication).
- Inexpensive.
- Contraceptive effect is reversible by removal of IUCD.
- Free from systemic metabolic side effects associated with hormonal pills.
- There is no need for continual motivation.
Articles
- Intrauterine contraceptive device presterilized insertion package.
- Sterile tray containing:
- Vaginal speculum (Cusco’s)-1
- Vulsellum-1
- Uterine sound-1
- Sponge holding forceps-2
- Bowl containing cotton swabs
- Sterile gloves
- Scissors
- Disinfectant solution
- Kidney tray
Procedure (Insertion of copper – T)
| Nursing Action | Rationale | |
| 1. | Before procedure Explain the procedure including advantages, disadvantages, effectiveness, and side effects of IUCD. | Helps in obtaining cooperation of patient and reduces anxiety. |
| 2. | Arrange the equipment near examination table. | |
| 3. | Instruct woman to empty her bladder. | Avoids discomfort during procedure. |
| 4. | Position woman on her back with knee flexed and buttocks at the edge of the table. | For safe performance of procedure. |
| 5. | Provide privacy and drape patient appropriately. | Prevents embarrassment. |
| 6. | During procedure Wash hands and don sterile gloves. | |
| 7. | Load the IUCD (Cu-T) inside the applicator in the following manner: The threads, the vertical stem and then the horizontal stem folded onto the vertical stem through the distal end of the inserter. | Loading in this manner facilitates release of the device as the inserter is withdrawn. |
| 8. | Inspect external genitalia, urethra, and vagina for signs of infection, lesions or discharge. | Provides comfort and disinfects area. |
| 9. | Cleanse the perineum. | Provides comfort and disinfects area. |
| 10. | Explain to the woman that there will be slight discomfort during speculum insertion. | Helps in obtaining cooperation. |
| 11. | Insert the speculum gently and observe the cervix for signs of infection and erosion. | Avoids discomfort. |
| 12. | Clean the external cervical os with an antiseptic soaked swab by using sponge holding forceps. | Avoids chance of infection. |
| 13. | Instruct the patient that there will be discomfort (pinching pain) when applying the vulsellum. Apply vulsellum at the 12 o’clock position on the cervix, grasp the lip of the cervix. | Applies traction to the cervix and straightens the cervical canal. |
| 14. | Pass the uterine sound into the cervical canal and insert carefully into the uterine cavity while pulling steadily downward and outward on the vulsellum (a slight resistance indicates that the top of the uterine sound has reached the fundus), and remove the uterine sound. | Determines the length of the uterine cavity by noting the level of mucus or blood on the uterine sound. |
| 15. | Measure the length of the device to be inserted into the uterine cavity. The depth of gauge on the inserter tube is used to mark the depth of the uterus. Pull the loaded inserter tube gently until the distance between the top of the folded “T” and edge of the depth gauge closest to the “T” is equal to the depth of the uterus as measured on uterine sound. | Completes loading of the inserter. |
| 16. | Carefully peel the clean plastic cover of the package away from the white packing. Lift the loaded inserter keeping it horizontal so that neither the “T” nor the white rod falls out. Be careful not to push the white rod toward the “T”. | Maintains sterility of the device. |
| 17. | Grasp the vulsellum and pull firmly downward and outward to align the uterine cavity and cervical canal with the vaginal canal. | Steadies the uterus for insertion of the device. |
| 18. | Gently introduce the loaded inserter assembly through the cervical canal. Keeping the depth gauge into a horizontal position. | |
| 19. | According to the position and direction of the uterine cavity gently and carefully advance the loaded inserter assembly until the depth gauge comes in contact with the cervix or resistance of the uterine fundus is felt. | Places the loaded applicator in the uterine cavity. |
| 20. | Hold the vulsellum and the white rod in one hand. | |
| 21. | Gently and slowly withdraw the inserter keeping the plunger in place. | This action frees IUCD into the uterine cavity. |
| 22. | Check for the strings protruding from the uterus. Cut the strings shorter so that they protrude only 3 cm outside the cervix (from the external os). | The strings can be seen and felt in the vagina. |
| 23. | Remove the vulsellum. If there is excessive bleeding from the vulsellum site, press a sterile cotton ball to the site using forceps until the bleeding stops. | Reduces postinsertion discomfort. |
| 24. | Remove speculum and drapes. | Completes the procedure. |
| 25. | Instruct patient to stay in bed for some time. | Helps the patient to relax. Promotes comfort. |
| 26. | After procedure Wash perineum with soap and water and dry it. | |
| 27. | Remove gloves and discard. | Disposes contaminated materials. |
| 28. | Instruct the woman on follow-up measures: To confirm presence of IUCD periodically by feeling the presence of threads in vagina. Instruct patient to visit clinic whenever she experiences the warning signs of problems related to IUCD, such as: P-Delayed period, spotting, bleeding or missing period. A-Abnormal pain or pain during coitus. I-Infection, any vaginal discharge. N-Not feeling well, fever or pelvic pain S-Strings (not feeling the strings in vagina). | Provides reassurance to the client. |
Side effects and complications
- Excessive bleeding.
- Low back pain during menstruation.
- Pain during menstruation.
- Pelvic infection.
- Uterine perforation.
- Ectopic pregnancy.
- Expulsion of device.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
