IUS Insertion Workshop

this is an example of one type of setup

that you could use when teaching the IUD

insertion this is a GYN simulator Zoey

model and we are set up in just any

typical clinic exam room this particular

one has a window cut out of it in which

the observers can go ahead and view the

inside the uterus with this one we have

inserted a transparent uterus notice

that the simulator comes with two types

one with anti verted position and

there's also one that has a retro hurted

position and they can be easily inserted

within the model itself suspended and

protected students residents can then

practice their bimanual exam identify

the location of the uterus and one can

also observe the insertion of the IUD

and any kind of equipment learners other

learners can certainly circle around

Zoey and a faculty member can look over

and get an idea if the insertion is at

the proper location as well with this

particular model the skin is fairly

fragile it's important to make sure that

one uses either a lukewarm soapy water

or one can use a water-based lubricant

as well you can use either a metal or a

plastic speculum we prefer the metal

it's a little bit easier for insertion

and it's nice and stable typically a

medium size for either one graves or

peterson is appropriate additional

things that we have setup within our

teaching room we have other equipment

for a typical IUD insertion and if

someone does not have as always

simulator there's certainly other models

that we've used in the past we have used

some homemade models which are

demonstrated in our other

in addition to an exam room such as this

you could certainly do this in a work

ship type style whether it is circular

tables or setting up rectangular tables

in a u-shape in which one instructor can

circulate around and be able to really

oversee 6 8 10 learners and watch them

do that on solely simulators or other

homemade models as well there are many

things that you can deal with as far as

just the formatting of this particular

workshop for the model itself we will

demonstrate just a briefly the quick

insertion visualization of the cervix

and whether it is using a clinic floor

light or whether it is using a pen light

or you in a flashlight if need be

it is quite easy for one to change out

the cervix in the viewer's models

learners can practice their speculum

insertion and for this particular one

I'm just going to use a little bit of a

warm water for the sake of time and the

insertion one thing about Zoey is that

her cervix is fairly superficial and

using the light one can just visualize

the cervix fairly easily in order to be

able to perform procedures and in this

case if the IUD insertion


while the residents are waiting their

turn to work on the Zoe gynaecological

simulator one option they can have is to

become familiar with the equipment so

notice some various examples of IUDs

just having them get familiar with how

to move the slider to secure unsecure

the string these come with the IUD

models and they can certainly practice

inserting the IUD to the correct length

watching how the phalanges open watching

how to gently move it up into the fundus

and looking carefully at the IUD to make

sure that they're in the right position

and they release for the IUD insertion

workshop aspect this can be done whether

it's seated in the clinic or certainly

as mentioned previously in a conference

room standing at the side of a table so

initially what we'll want to do is we

will have a learner stand and perform a

bimanual exam this particular sewing

model has a retro verted uterus in place

as noted it's helpful to talk through

some technique tips on how to determine

whether one is anta Berger ret reverted

and certainly the Zoe comes with either

one once the position of the uterus is

clearly identified the next step would

then be insertion of the speculum we'd

have both metal as well as plastic

available using a little water-based KY

jelly to decrease the trauma on the

actual Zoe tissue feedback can be given

with regard to the speculum insertion


and once the cervix is fully a visual

price next giving a little bit of

feedback to learner about sterile exam

on the table someone in the order in

which the provider will be going through

the steps and that level to have various

glove sizes available still have a mix

of different learners most likely so

having all sizes available it's helpful

prior to the workshop as well so once we

have this quite the next step is to

utilize whether it is a betadine

solution whether it's a hepa cleanse the

four by four and also then the rain

forceps to have that available you would

not want to use iodine with is that way


it certainly could talk through that

step as well the other thing that could

be optional and discussed - depending on

faculty preference is the use of any

type of anesthetic whether it's

injecting the lidocaine is demonstrated

in the teaching video whether it is

using a cervical block any of those are

certainly possibilities in which one

could practice at this stage of the

workshop next after that step is the use

of the tenaculum this is something that

you can use with the GYN stimulator

model just carefully doing it snack

young placement and then sounding the

uterus metal sound one could highlight

and teach perhaps how to adjust this

depending on if one palpated an anti

verted or any ret refer to uterine and

watching the students do this in a

sterile manner as well and this is a

time when you as a faculty member you

can be looking through that window the

other learners can be talking through

that as well instructing their peer and

then the learner themselves can stand up

and actually see what it is the

placement and correlate that with what

their palpating on the other side so

once that sound is fully in place the

next step within

using the IUD itself another thing you

can do is you can have someone be the

assistant in their nursing role as a

role model and practice through opening

up the IUD I think it's helpful to have

actually the box of an IUD as one of the

teaching instruments so that way the

students can open that up and get an

idea in addition to the IUD itself what

else is included within that box

pointing out that it comes with a

patient information booklet a packet in

which the lot number is placed and you

can sign your name the patient can sign

their name that's just another piece of

material that you can give them there's

also some information as far as from the

provider if the residents that are

around when I spent some time looking

through this that can be done as well

it's hopeful in addition to have

examples of ones that are packaged

completely to have some other ones

available at this step so that each one

doesn't have to be open for every single

resident talking through how to make

sure that the slider is firmly at the

top to be able to make sure that the

IUDs arms are positioned horizontally in

the proper position that the string is

secure that the finger is at the correct

location those are all teaching points

in which a faculty can go through as

well and certainly moving back to the

model itself it's easy through this to

be able to insert the IUD through the

model and to be able to visualize on the

other side exactly what is going on to

talk the learner through opening it up

for to the first line for the release of

the arms being able to gently advance

that to the fundus and being able to

have them actually stand up and take a

look and see what that looks like on the

other side and then finally to be able

to completely release the IUD we don't

recommend the students practicing

cutting the strings

because otherwise you can't use them

again it's certainly talking through the

lengths in which you would want that

string to be cut is also helpful to

discuss and certainly the same workshop

can be be used for IUD removal and very

simple to be able to talk them through

how to do that to finally at the end a

one can highlight what to do if there's

any bleeding from the Chocula besides

whether its application of Samantha's

solution and then certainly the removal

of the speculum as well and then

afterwards what's helpful to go through

is what patient instructions would you

give this particular person what are

some things that they should be looking

for when would you want to see them back

and being able to talk through at the

end of the workshop some of the patient

instructions and warning signs in which

you wouldn't want the provider to go