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Trick of the Trade: No pelvic bed? No problem

Posted Mar 26 2013 12:00am

Often finding a pelvic examination bed for a female patient needing a speculum exam can be challenging. Without the elevated foot stirrups, the bed under the patient's buttocks obstructs the pelvic speculum handle so that it can't rotate completely into a 6 o'clock position. 

Some people place an upside-down bed pan to elevate the patient's buttocks slightly in order to create more space for the speculum. Not only is the position uncomfortable for the patient, it seems a waste of a perfectly good bed pan. Fortunately there is an alternative approach.

Trick of the Trade:
Rotate the pelvic speculum handle towards ceiling instead of floor
  1. Place the patient in a "frog leg" position.
  2. Insert the speculum with the handle facing to the right (patient's left thigh).
  3. Rotate the speculum so that the handle points toward the ceiling.

Caution: Do not lift the speculum anteriorly like you would a largynoscope blade. When widening the speculum view, err on the side of applying posterior pressure against the rectovaginal wall. This is much less painful than compressing the anterior structures.

Thanks to Dr. Siamak Moayedi (University of Maryland) for this trick!

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