CHECK LIST FOR IUCD (CU-T 380A) REMOVAL CLINICAL SKILLS
This is a learning tool for trainees/participants on the standard IUCD (Cu-T 380A) removal procedures.
The trainee/participant uses the learning guide as a tool to practice on anatomic models, rate his/her
performance of each step during simulated and clinical practice; and even as a job aid upon return to
the workplace. [Mark the top of the column accordingly – M (M-1, M-2, ..) for Model and C (C-1, C-
2, …) for client practice]. In order to provide quality IUCD (Cu-T 380A) removal service, trainees
need to perform each step correctly.
Use the following rating scale (0, 1 or 2):
2 - Competently performed: Step or task performed correctly and in proper sequence
1 - Needs Improvement: Step or task performed correctly but out of sequence
0 - Not done or done incorrectly: Step or task omitted or not performed correctly
PARTICIPANT _________________________Course Dates________________
CHECK LIST FOR REMOVAL OF COPPER-T 380A IUCD: CLINICAL SKILLS
CASES
STEP/TASK
Remark
CLIENT ASSESSMENT
1. Greet client politely and introduce oneself; offer a seat,
ensure privacy; assure client of confidentiality
2. Ask the client her reason (s) for removing the IUCD
3. Verify that the client has received counseling and has made
an informed decision about removing the IUCD
4. Explain to the client what will be done and ask her what
questions she has
5. Check that the client has emptied her bladder
PRE-REMOVAL TASKS
6. Ensure that needed supplies and equipment are available in
the procedure room
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7. Help the client onto the examination table and start
explaining the procedure as you perform it in order to
avoid surprising her; explain to client importance of being
relaxed, and taking deep breaths
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CHECK LIST FOR REMOVAL OF COPPER-T 380A IUCD: CLINICAL SKILLS
CASES
STEP/TASK
Remark
CLIENT ASSESSMENT
8. Wash hands thoroughly with soap and water and dry with
clean, dry cloth or air dry
9. Put new examination gloves on both hands
10.Arrange the instruments and supplies on high-level
disinfected or sterile tray or drape
REMOVAL OF THE COPPER T 380A IUCD
11.Insert the bivalve speculum to:
check for vaginal lesions or discharge
see the cervix and the IUCD strings
clean the cervix and vagina with the antiseptic solution
2 times with 2 gauzes
wait for 2 minutes for the antiseptic solution to act
12.Grasp the strings close to the cervix with hemostat or other
narrow forceps
13. Pull on the strings slowly but firmly to remove the IUCD
14. Show the IUCD to the client
15.Immerse the IUCD in 0.5% chlorine solution and dispose it
in a leak proof container or plastic bag. If the woman
wants a new IUCD inserted follow the steps in the
insertion guide from this point.
16. Gently remove the speculum and place in 0.5% chlorine
decontamination solution
POSTREMOVAL TASKS
17. Before removing gloves, place all instruments in 0.5%
chlorine solution for 10 minutes for decontamination
18. Dispose of waste materials by placing in a leak proof
container or plastic bag
19. place them in a leak proof container or plastic bag
20. Wash hands thoroughly with soap and water and dry with
clean, dry cloth or air dry
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21. Encourage client to rest as needed, help her from the
examination table, ensure she has received needed
services and referral; encourage questions
22. Record the IUCD removal in the client record and
register (if and when applicable)
23. After the client has left, wearing utility gloves clean
the examination table with the 0.5% chlorine solution
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