IUC Placement Packs- wrapping and setting up a sterile tray

Preparing your IUC placement pack for sterilization, you will need:

  • Autoclave wrapping paper
  • 1 graves speculum
  • 1 tenaculum
  • 1 ring forcep
  • a cotton ball bowl with 3 cotton balls
  • 3 4x4 gauze
  • autoclave sterilization indicator strip
  • autoclave sterilization indicator tape
  • a marker
  • a metal sound (not needed if your site uses disposable plastic sounds)
  1. Lay 2 sheets of autoclave paper out so that the corners of the paper are on the top and bottom of your work surface.
  2. Tape a sterilization indicator strip near the middle of the pack.
  3. You want the strip to be visible when the pack is opened so you don’t want to cover it with instruments.
  4. Place 3 pieces of 4x4 gauze in the middle of the pack.
  5. Place the cotton ball bowl on top of the gauze.
  6. Don’t place instruments or gauze on top of the cotton ball bowl as we will need to put a disinfecting agent on the cotton balls during set up. You will not be able to touch anything inside the pack during setup, unless you take the time to put on sterile gloves.
  7. Place the speculum so it curves around the cotton ball bowl into the pack.
  8. Place the tenaculum, ring forceps and metal sound together on the other side of the cotton ball bowl from the speculum
  9. Keep instruments unhinged; do not keep the instruments locked during the autoclave process
  10. To wrap the pack, take the corner closest to you and fold it up to the opposite corner to make a triangular shape, covering the items. Double back to make a small fold to use as a pull corner for when the pack is opened later.
  11. Fold the right and left corners in and fold back the edges to make easy corners to grasp and pull on.
  12. Fold the last side towards the center, and tuck the flap under the right and left folds. This will leave a small corner that can be used as a tab for opening the pack.
  13. Place sterilization indicator tape on the pack to secure it
  14. Label the pack with your marker:
  15. write your initials
  16. what the pack is for (IUC Pack)
  17. the date you wrapped the pack
  18. the expiration date of the pack
  19. Place pack in autoclave for sterilization and run appropriate cycle.

As you prepare to setup for an IUC placement keep a few things in mind:

  1. At no time is anything on a sterile field to be touched by any unsterile object.
  2. Never reach across the sterile field.
  3. Do not lean against, or over, sterile field or allow hair or clothing to come into contact with it.
  4. Do not cough, sneeze or talk directly over a sterile field.
  5. Two (2) inches around the perimeter of the sterile field is considered contaminated. The clinician may pull the tray over, using the sterile inside of the Dennison wrap so its sterility must be maintained.
  6. If your back is turned on an exposed tray, it is automatically considered contaminated because you cannot see what might have happened with your back turned.
  7. If you are setting up a tray and you find you need something not immediately available, put a sterile barrier over the tray before getting the item you need.
  8. Excessive movement of air currents around an exposed sterile field increases the likelihood of bacterial contamination. Do not allow others close by while you are setting up.
  9. Make sure the area you are setting up in is clean and free of clutter, within reaching distance of where the clinician will be working.
  10. Walk around your pack as you open it instead of reaching over it. You want to avoid reaching over the pack for any reason.
  11. Be honest with yourself. It is better to lose time by re-sterilizing a pack than to endanger a patient with a contaminated tray.

Preparing for an IUC insertion, you will need:

  • Sterilized IUC insertion pack
  • Uterine sound (disposable plastic if your site does not use metal sounds)
  • Client’s desired IUC (Mirena, Paragard, Skyla, Liletta, etc.)
  • Disinfectant (Hibiclens, for example)
  • A flat area to place the IUC pack on like a Mayo Stand
  • A flat area for the IUC to wait where the clinician can prepare the IUC before insertion
  • A set of extra sterilized instruments, or second pack just in case something falls on the floor or malfunctions (doesn’t have to be kept in each exam room, but nice to have nearby)

Before setting up the placement pack:

  • Wash hands thoroughly. Assemble all needed equipment.
  • Disinfect instrument stand tray and wipe dry. A wet tray contaminates sterile pack by soaking up through wrapping

Opening the IUC placement pack:

  1. Ensure you have a sterile pack:
  2. Indicator tape has changed appropriately on pack
  3. No rips or tears on pack
  4. Ensure you have any other necessary equipment listed above.
  5. Check expiration dates on pack, IUC, sound and disinfectant.
  6. Open the pack by breaking the tape with your hands or a pair of scissors.
  7. Grasping just the tip of the corner, pull back the first fold far enough so that it does not fall back into place. Repeat this for each side of the pack. Take care not to touch anything on the inside of the pack, including the wrapping paper.
  8. From this point on, work only with dominant hand, other hand placed behind you (this is to prevent a reflex-type of reaching into sterile field with unsterile hand
  9. Once instruments are visible, carefully pour a disinfectant like Hibiclens over the cotton balls. Take care not to touch the bottle of disinfectant to the cotton balls, or bowl as this will contaminate your pack and you will need to start over.
  10. Open a sterile sound, if needed, and drop it on to the instrument tray.
  11. Place a sterile field over the instruments. Working only at corners, open sterile barrier and place over contents of tray, working away from you so that you are not reaching across sterile field.
  12. Leave the IUC unboxed, but still in it’s sterile packaging, to the side for the clinician. If the clinician cannot get through the client’s os then the device wont have to be wasted.
  13. If whole tray, or part of wrap, is contaminated, remove to lab and replace with new tray.
  14. Set up trays as close to starting time of procedure as possible. Do not set up more packs than will be used in the next hour. Remember that even though the trays are covered, it is still possible to contaminate them and time is an enemy.

If in doubt about the sterility of a tray, do not use it.