POLICY TITLE: VASECTOMY

POLICY STATEMENT: The Health Center will be adequately prepared for the vasectomy procedure.

Procedure:

  1. Purpose
  2. To be prepared for the scheduled procedure.
  1. Equipment and Supplies
  2. #11 scalpel blade
  3. 1 pack of 5.0 Vicryl
  4. 2 packs sterile gloves
  5. 2 pathology jars 1 labeled "right", 1 labeled "left"
  6. chux
  7. 4 packs of 5.0 Ethi1on sutures
  8. Alcohol swabs
  9. Bacitracin ointment
  10. Basin with hot water
  11. Consent form
  12. Extra sterile gauze
  13. Gowns for practitioners
  14. Hyfrecator and hyfrecator tips
  15. Lab slip and 2 sterile specimen cups
  16. Liquid betadine (not swabs)
  17. Mayo stand
  18. Paper bag
  19. Pathology slip
  20. Patient gown
  21. Procedure cart
  22. Semen analysis instructions
  23. Sterile fenestrated drape
  24. Syringe 3 cc, 25 gauge 5/8" needle 24. Tape
  25. Two exam lights
  26. Two paper drapes
  27. Vasectomy discharge instructions
  28. Vasectomy kit--
  29. Xylocaine 2% without Epinephrine
  1. Steps
  2. Lay 2 chux side by side on the exam table. Layer the 3rd chux over top of the others.
  3. Layout patient gown and drape on the exam table.
  4. Position exam lights. One on either side of the table.
  5. Tape the paper drape top the exam lights so that it crosses over the table at whatwill be the patient's abdominal level. Turn the lights on to help warm the table.
  6. Lay the sterilized vasectomy kit on the mayo stand and open maintaining sterility. Drop the fenestrated drape onto the sterile field.
  7. On the second mayo stand or on top of the procedure cart have the sterile scalpel blade, roll of tape, Xy1ocaine, syringe, alcohol swab, suture materials, sterile gloves, extra gauze and Bacitracin ointment.
  8. On the counter have the consent form, pathology jars and slip.
  9. Place the basis in the sink and fill with hot water. Place the Betadine bottle in the water allowing it to warm.
  10. Place hvfrecator tin in handle and plug machine into the electrical socket.
  11. Adjust the thermostat to at least 75 degrees.
  12. Bring patient to the room and obtain vital signs.
  13. Review the consent form and have the patient sign.
  14. Instruct him to get undress and put the patient gown on. Give the Patient the drape to cover legs.
  15. Assist with procedure as needed.
  16. During the procedure, prepare the discharge bag. Place gauze, Bacitracin
  17. ointment and sterile specimen jars, semeJ1 analysis instructions and discharge instructions. Also include a lab slip for semen analysis @ 8-10 weeks post vasectomy.
  18. After the procedure is complete, give the bag to the patient and explain the contents.
  19. Obtain vital signs. If stable, the patient can be discharged The patient must have a driver.