Collecting fFN without speculum?

[klone, MSN, RN]

Do any of you work at facilities where fFNs are collected without speculum? Our current policy states that a speculum must be used, but there have been a few travel nurses or nurses new to this hospital who have said that at other facilities they've worked at, they've been able to do a "blind" collection without a speculum. Fullterm's ™ instructions say that a speculum must be used, but nurses have stated that Fullterm reps have told them that it's not necessary. I was able to find ONE study online that compared collection results with and without speculum, but I was unable to view it without paying. If anyone can find study information, it would be much appreciated.

[imenid37]

We guide the swab in w/ our golved fingers, advance swab to the very back of the posterior fornix, rotate it, leave in place to slow count of ten, and withdraw. I did ask company rep when I was at a seminar and he said this was acceptable and felt to be accurate. This was about two years ago. We have collected this way for 4-5 years. We do not have 24/7 docs in house.

[klone, MSN, RN]

Which brand do you use? I assume it's different than Fullterm? Because I would question why their written instructions say a speculum must be used if their reps are saying differently.

We don't have docs in house 24/7 either. At our facility, RNs are allowed to perform SSEs.

[imenid37]

The Green Journal Supplement Vol 193 issue 6 p s.63 decscribes a study conducted at LSU which concluded "excellent" agreement between FFN collected by speculum and that collected in a "blind swab of the fornix". I probably can't quote directly w/o their permission. We use "Fullterm". The rep I talked to was from Adeza, who used to market the product. I do not think anyone else produces this do they?

This is not full text, but does discuss conclusions of another study which again finds a high level of agreement between the two techniques.

http://www.greenjournal.org/cgi/content/full/105/2/285

[JenTheRN]

I hate to be a pot-stirrer, but the Fullterm policy states that a sterile speculum must be used. Until they change their written policy, a speculum should be used. Otherwise, the results may be invalid.

Basically just a CYA kind of thing...take it from someone who has been to a deposition.

[mitchsmom]

Our rep told us you could do it without a speculum too (and we do).

But it is interesting that the website doesn't say that. I wonder if it's an update that the site hasn't relfected or ???

[imenid37]

It's like using cytotec, but a lot less risky. The manufacturer may not spell out that it is done this way, but there is evidence in support of using it in this manner. Again, the company's rep has told me and the physicians it was okay also. The company is NOT going out of its' way to tell anyone not to do this, as is the case w/ cytotec, for example. (I wish I could think of a better example-Cytotec is in a different level of risk than this). I feel a lot more comfortable doing this than many of the other things I have done. I guess it's just a difference of opinion, comfort level, or whatever. No big deal to me to keep doing this.

[klone, MSN, RN]

I hate to be a pot-stirrer, but the Fullterm policy states that a sterile speculum must be used. Until they change their written policy, a speculum should be used. Otherwise, the results may be invalid.

Basically just a CYA kind of thing...take it from someone who has been to a deposition.

This makes a lot of sense to me. Better to use a speculum and avoid potential litigation. Thanks for the input.