My patient has an intrauterine device (IUD). How does this affect the nongynecologic nursing care I give?-N.E., WIS.
Julia Phillippi, RN, CNM, MSN, replies: The IUD is gaining popularity as a reversible contraceptive method; the two used in the United States are the ParaGard and the Mirena. If a woman received her IUD in another country, she may have a slightly different style of IUD, but the mechanisms of action and nursing implications will be similar. If your patient is being treated for a nongynecologic problem, your nursing interventions won't change much.
Both IUDs used in the United States are flexible T-shaped devices measuring about 3.5 cm long (shorter than your thumb) and 3.2 cm wide at the top of the T. A filament string (which resembles fishing line) extends from the base of the T into the vagina to aid in placement assessment and removal.
A well-placed IUD shouldn't cause pelvic pain or be dislodged during abdominal palpation, so its presence doesn't affect your basic nursing assessment of the patient. If you perform a speculum exam, you should see two strings coming out of the cervical os. The strings are palpable during a vaginal bimanual exam.
Few women with IUDs need special preoperative or postoperative care. Nongynecologic surgery shouldn't affect the IUD, and no special presurgical preparation is needed. In general, drugs don't decrease IUD effectiveness and your patient won't need to use backup contraception if new drugs are prescribed for her.
The ParaGard doesn't increase the risk of blood clots after surgery or prolonged immobilization. Because the Mirena releases progesterone, however, it can increase clot risk following prolonged immobilization, so assess all patients thoroughly to rule out thrombosis.
The IUD won't interfere with diagnostic tests, so it needn't be removed before procedures. No shielding is needed before X-ray or ultrasound, and the patient can have magnetic resonance imaging with the IUD in place.
If your patient or her health care provider decides to remove the IUD during hospitalization, make sure she has a birth control plan in place before discharge.
Hatcher R, et al. A Pocket Guide to Managing Contraception. Tiger, Ga., Bridging the Gap Foundation, 2005.
Zierman M, Kanal E. Copper T380A IUD and magnetic resonance imaging. Contraception. 75(2):93-95, February 2007.