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Disposable IUD set fits the surgery bill

Equipment Review - A reluctant expert in women's anatomy Dr Gwen Lewis reviews an IUD fitting set.

I am beginning to see a pattern. First I was asked by GP to review disposable plastic specula, then in September last year I was invited to trial disposable metal specula. And, now, I am giving my opinion on a disposable IUD fitting set.

My partners think that I do nothing other than examine women's anatomy, and on some days this is near the truth.

Having been asked to do this review, I set about a search of IUD and Mirena fittings that I had undertaken in the surgery in the past 12 months and found there to be 73 fittings. Each of these disposable kits costs £22.03, but of course IUD fitting is lucrative for GPs: an IUD fitting rewards us with £79.92 and an annual IUD check with £21.32.

Our PCT has decreed that only disposable instruments may now be used for any procedure undertaken in the surgery.

Previously our surgery we had all its surgical and gynaecology equipment sterilised by the local hospital central sterile supplies department service and returned in marked packs.

This level of sterilisation seems more than adequate to me. I wonder what our hospital consultant colleagues use in the operating theatre.

Guaranteed sterility
This IUD fitting set is called Opera, which thrilled me - I wondered if I should be playing some Puccini while I did the IUD fitting. It did not take very long for me to use all five of the sets I was sent.

As well as providing guaranteed sterility, the set provides a very easy-to-use, instantly accessible kit comprising all that is needed for an IUD fitting, except for the IUD or Mirena itself, sterile gloves and sterilising solution with which to clean the cervix.

In addition, a chlamydia swab is needed. The kit certainly makes the procedure very speedy and I was not left wasting time looking for individual instruments.

The set comprises a Cusco medium speculum; a uterine sound; a sponge forceps; an excellent and sharp pair of Mayo scissors; a vulsellum; cotton wool balls presented in a small gallipot; a kidney dish and paper towels.

All are presented on an operating tray. All you need to do is open the sterile wrapping, add your gloves, the IUD or Mirena and sprinkle the cotton wool balls with the sterile fluid and you are away.

There is no need for the instruments to be washed and packed away to be sterilised again after use.

Most of the instruments are excellent. The Mayo scissors are fantastically sharp for trimming the IUD threads, unlike most of the scissors that I have used previously, which had obviously seen better days and were more often than not extremely blunt, making trimming the IUD threads often the hardest part of the procedure.

My only real dislike about the set was the vulsellum.

I know doctors are trained to use this instrument to stabilise the cervix prior to inserting the IUD, but I was trained to use an Allis forceps, which always seems to me a lot less savage than the vulsellum with its several teeth, so I found this rather difficult to use.

My other concern was having to throw all the instruments away after a single use, which does not seem very good for the environment, although collection of used metal instruments on an annual contract can be arranged.

All in all the set is excellent. It makes IUD fitting easy and quick and satisfies all of the requirements of the PCT.

The set will be an asset for your surgery if you fit IUDs.

- An independent review by Dr Gwen Lewis, a GP in Windsor, Berkshire

- Equipment provided by Williams Medical Supplies

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