/policies/,/policies/clinical/,/policies/clinical/uwhc-clinical/,/policies/clinical/uwhc-clinical/department-specific/,/policies/clinical/uwhc-clinical/department-specific/surgical-services/,/policies/clinical/uwhc-clinical/department-specific/surgical-services/clinical/,

/policies/clinical/uwhc-clinical/department-specific/surgical-services/clinical/253.policy

20170382

page

100

UWHC,

Policies,Clinical,UWHC Clinical,Department Specific,Surgical Services,Clinical

Hysteroscopy - Management of Uterine Distention Fluid (2.53)

Hysteroscopy - Management of Uterine Distention Fluid (2.53) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Clinical

2.53

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE
MARCH 2001
ORIGINAL
 REVISION

FEBRUARY 2017
PAGE 1
OF 2
POLICY #

2.53
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
HYSTEROSCOPY - MANAGEMENT OF
UTERINE DISTENTION FLUID



I. PURPOSE

To manage fluid use during hysteroscopy procedure.

II. PROCEDURE


A. The patient is positioned in low lithotomy.

B. A plastic collection pouch should be properly placed underneath the patient's buttocks and
connected to the Aquilex pump.

C. A controlled flow pump is used to deliver .9% Sodium Chloride and measure deficit from I and O.
Default alarm is set at 1000 ml. Alarm can be adjusted down to 700 ml.
1. Using gravity flow or cuff pressure will be discouraged due to increased risk of intravasation
under unknown and potentially very high intrauterine pressure.
D. Uterine distention fluid of .9% Sodium Chloride is hung. The pump will automatically calibrate to
within 20 ml prior to the procedure.

E. Pump default for intrauterine pressure is 80 mm Hg. Some surgeons may want to set pump
based on patient’s Mean Arterial Pressure (MAP). Note the MAP of the patient and set the
pump pressure at 10 mm Hg above MAP. Pump pressure can be increased to 100mm Hg and
inflow can be controlled by the surgeon at inflow port.
1. Blood pressure and pump pressures are both measured in mm Hg. If the pump pressure is
higher then the patient's MAP fluid, it is likely to be pushed into the patient’s vasculature,
especially if it is compromised as during resection, ablation, and dilation.
2. The pump pressure may be increased if the surgeon is having difficulty visualizing or working
but be aware of increased potential for intravasation of fluid.
F. Announce deficit over 100 ml and every 100 ml thereafter. Document the total deficit in
perioperative notes at the end of the case.
1. Inform surgeon and anesthesia personnel of sudden changes in the deficit.
G. If a deficit of 2,500 ml. occurs, the procedure should be stopped. The staff anesthesiologist should be
notified and an assessment of the patient should be done.
1. Complications may include: hyponatremia, pulmonary edema, and hemo-dilution.
2. Labs must be drawn: Na, Hct.
3. Check urine output, patient temperature, auscultate lungs. Patient may have to be taken out of
Trendelenburg and have a urinary catheter inserted.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE
MARCH 2001
ORIGINAL
 REVISION

FEBRUARY 2017
PAGE 2
OF 2
POLICY #

2.53
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE
HYSTEROSCOPY - MANAGEMENT OF
UTERINE DISTENTION FLUID



H. The surgeon and the anesthesiologist will jointly determine if the surgery may continue.

REVIEWED BY

Surgical Services Policy and Procedure Committee 3/2017
Lynn Linton, Surgical Services Supervisor 12/2016
Cindy Battista, Nurse Clinician, Outpatient Surgery 12/2016
Rita Webber, Nurse Clinician, Outpatient Surgery 12/2016
Jeff Lee, MD 12/2016


SIGNED BY

Anne Mork, MHCDS, MS, RN 3/2017
Interim Director, Surgical Services Department