🩺 IUD Insertion & Removal Assistance

To establish a standardized process for preparing patients, assisting providers during intrauterine device (IUD) insertion and removal procedures, maintaining sterile technique, ensuring patient comfort, and providing consistent documentation throughout The Neighborhood Clinic.

Purpose

Medical Assistants play an essential role in preparing the patient, assisting the provider, maintaining procedural flow, supporting sterile technique, and monitoring patient safety before, during, and after IUD insertion or removal.

Policy

Only licensed providers credentialed to perform gynecologic procedures may insert or remove an IUD. Medical Assistants assist within their delegated scope of practice and may not independently perform any portion of the insertion or removal procedure.

IUD Procedure Workflow

1️⃣ Verify Patient Identity
2️⃣ Provider Evaluation & Consent
3️⃣ Prepare Patient & Equipment
4️⃣ Assist During Procedure
5️⃣ Monitor Recovery
6️⃣ Provide Education & Documentation

Indications

Common Reasons for Insertion

  • Long-acting reversible contraception.
  • Heavy menstrual bleeding.
  • Dysmenorrhea management.
  • Endometrial protection when clinically appropriate.

Common Reasons for Removal

  • Device expiration.
  • Patient request.
  • Desire for pregnancy.
  • Persistent pain or bleeding.
  • Device malposition or expulsion.
  • Provider recommendation.

Pre-Procedure Assessment

Prior to the procedure, confirm that all provider orders, documentation, and patient preparation requirements have been completed.

  • Verify patient using two approved identifiers.
  • Review allergies.
  • Review current medications.
  • Review relevant medical and gynecologic history.
  • Verify pregnancy status as ordered.
  • Confirm required laboratory testing has been completed when indicated.
  • Review history of vasovagal episodes or syncope.
  • Obtain baseline vital signs.
  • Ensure informed consent has been completed by the provider.

Patient Preparation

  • Explain the general flow of the visit.
  • Answer non-clinical questions within scope.
  • Provide privacy while changing.
  • Assist the patient into the lithotomy position when appropriate.
  • Maintain patient dignity throughout the procedure.

Required Supplies

Procedure Supplies

  • Provider-selected IUD device.
  • Sterile speculum.
  • Sterile gloves.
  • Sterile drapes.
  • Ring forceps.
  • Tenaculum.
  • Uterine sound.
  • Scissors.
  • Antiseptic solution.
  • Cotton swabs or applicators.

Support Supplies

  • Procedure tray.
  • Light source.
  • Sterile gauze.
  • Perineal pads.
  • Biohazard waste container.
  • Sharps container.
  • Emergency supplies.
  • Additional PPE as indicated.

Medical Assistant Responsibilities

  • Prepare the procedure room before the patient arrives.
  • Verify all supplies are available and unopened.
  • Assist with patient positioning.
  • Maintain clean and sterile technique.
  • Hand sterile instruments to the provider.
  • Monitor patient comfort throughout the procedure.
  • Observe for signs of dizziness, anxiety, or vasovagal response.
  • Prepare post-procedure supplies before completion.

Professional Standard

Throughout the procedure, communicate calmly, protect patient privacy, anticipate provider needs, and provide reassurance while remaining within your scope of practice.

Stop the Procedure & Notify the Provider Immediately If:

  • The patient develops severe pain.
  • The patient experiences syncope or near-syncope.
  • Heavy vaginal bleeding occurs.
  • The patient becomes unstable.
  • Sterility has been compromised.
  • Required equipment becomes unavailable.
  • There is any unexpected complication during preparation.

Assisting During IUD Insertion & Removal

The Medical Assistant is responsible for maintaining procedural flow, protecting sterile technique, monitoring patient comfort, and assisting the provider throughout the procedure.

1️⃣ Perform Hand Hygiene & Don PPE
2️⃣ Maintain Sterile Field
3️⃣ Assist Provider with Instruments
4️⃣ Monitor Patient Response
5️⃣ Assist with Recovery
6️⃣ Complete Documentation

Sterile Technique

Maintaining sterile technique throughout the procedure is essential to reduce the risk of infection.

  • Perform hand hygiene before preparing supplies.
  • Wear appropriate PPE.
  • Open sterile supplies without contaminating contents.
  • Maintain the sterile field throughout the procedure.
  • Hand sterile instruments to the provider without contamination.
  • Replace contaminated supplies immediately.
  • Dispose of contaminated materials appropriately.
Remember

If sterility is compromised at any point, immediately notify the provider and replace contaminated equipment before continuing.

Patient Monitoring During the Procedure

Patients may experience cramping, anxiety, dizziness, or a vasovagal response during IUD insertion or removal. Continuous observation is essential.

  • Observe facial expression and comfort level.
  • Monitor breathing and responsiveness.
  • Watch for pallor or diaphoresis.
  • Monitor for dizziness or nausea.
  • Observe for excessive bleeding.
  • Provide reassurance throughout the procedure.

Immediately Notify the Provider If:

  • Loss of consciousness.
  • Near-syncope or vasovagal episode.
  • Heavy vaginal bleeding.
  • Severe pelvic pain.
  • Signs of allergic reaction.
  • Patient requests to stop the procedure.
  • Any unexpected complication occurs.

Post-Procedure Recovery

After insertion or removal, allow the patient adequate time to recover before discharge.

  • Assist the patient into a comfortable position.
  • Allow the patient to remain lying down if dizzy.
  • Obtain repeat vital signs when indicated.
  • Assess pain level.
  • Monitor for continued bleeding.
  • Ensure the patient can safely stand and ambulate before leaving.

Patient Safety

Patients experiencing dizziness or vasovagal symptoms should never leave the clinic unassisted. Continue monitoring until symptoms have resolved or the provider determines the patient is stable for discharge.

Patient Education

Review provider-approved discharge instructions before the patient leaves the clinic.

  • Mild cramping and spotting may occur for several days.
  • Use sanitary pads rather than tampons immediately after the procedure unless otherwise instructed.
  • Take medications as directed by the provider.
  • Follow any activity restrictions provided.
  • Attend recommended follow-up appointments.
  • Review instructions regarding checking IUD strings if applicable and as directed by the provider.

Seek Medical Care Immediately If:

  • Heavy vaginal bleeding develops.
  • Severe abdominal or pelvic pain occurs.
  • Fever or chills develop.
  • Foul-smelling vaginal discharge occurs.
  • The patient suspects IUD expulsion or displacement.
  • Pregnancy is suspected.

Documentation Requirements

  • Date and time of the procedure.
  • Procedure performed (Insertion or Removal).
  • Provider performing the procedure.
  • Medical Assistant assisting.
  • Patient tolerance.
  • Vital signs when indicated.
  • Presence or absence of complications.
  • Patient education completed.
  • Follow-up instructions provided.
  • Any provider notifications.
Documentation should accurately reflect the patient's condition before, during, and after the procedure, including any interventions performed and discharge status.

Quality Assurance

Medical Assistant

  • Prepare the procedure room.
  • Maintain sterile technique.
  • Monitor patient safety.
  • Assist the provider efficiently.
  • Provide discharge education.
  • Complete documentation.

Provider

  • Evaluate the patient.
  • Obtain informed consent.
  • Perform insertion or removal.
  • Manage complications.
  • Determine follow-up care.

Leadership

  • Maintain staff competency.
  • Ensure required equipment and supplies are available.
  • Monitor infection-control compliance.
  • Audit documentation and procedural quality.

IUD Procedure Checklist

✅ Verify patient using two identifiers
✅ Confirm provider evaluation and informed consent
✅ Review allergies and pregnancy status as ordered
✅ Prepare all sterile supplies
✅ Perform hand hygiene and don PPE
✅ Maintain sterile technique throughout the procedure
✅ Assist provider with instruments and supplies
✅ Monitor for vasovagal symptoms or excessive bleeding
✅ Assess recovery before discharge
✅ Provide patient education and written instructions
✅ Schedule follow-up if ordered
✅ Complete RXNT documentation

Sawubona Standard

IUD insertion and removal can be an anxiety-provoking experience for many patients. Every member of the care team has a responsibility to provide a calm, respectful, and supportive environment. By maintaining excellent sterile technique, anticipating provider needs, protecting patient dignity, and responding quickly to any change in the patient's condition, we deliver safe, compassionate reproductive healthcare that reflects The Neighborhood Clinic's commitment to exceptional patient care.