Taking a quality sample

Step 1: Check that the patient is eligible for screening 

This can be done by using the online eligibility checker and entering their PPSN and DOB. Use the CervicalCheck website before confirming an appointment.

Step 2: Check patient history & preferences.

• Ask about previous experiences – Did a particular position or speculum work well before?
• Be mindful of previous negative experiences or adverse sexual experiences that screening tests may remind patients of.

Step 3: Ensure patient comfort through Trauma Informed practices

• Ask about any fears and concerns the patient may have regarding cervical screening.
• Encourage the patient to ask questions to reduce fear and anxiety.
• Show the patient the equipment that will be used and offer her time to handle them..
• Reassure the patient that they can ask you to stop at any time if they feel discomfort.
• Offer option of toilet to empty bladder prior to test.
• Reassure the woman that the door will be locked to ensure privacy.

Resource to help you: Trauma informed care clinical update

Step 4: Prepare for the procedure.

• Prepare the couch and trolley prior to the woman entering the room. 
• Ensure all supplies are all in date and  within easy reach.
• Give clear instructions regarding:
  • use of a privacy cover, 
  • the need to undress from the waist down, 
  • advise where the woman can put her clothes 
  • and her position on the examination table.
• Ensure adequate lighting,  a headlight can be used if needed.

Step 5: Selecting & preparing the speculum.

• Choose the appropriate size based on: 
  • Age
  • Parity (number of births)
  • Vaginal anatomy
•  Available sizes: Extra small, small, medium, medium long, and broad.
•  Lubricate the speculum (if needed) – avoid applying lubricant to the tip.
• Ensure you use a carbomer free lubricant. Please refer to Guidance note on use of lubricants, moisturisers and vaginal oestrogens.

Step 5: Speculum selection & technique

• Keep a range of speculae available on a tray/trolley.
• Use the largest size that can be comfortably inserted—this helps retract the vaginal walls for better visibility.

Speculum choice Considerations:

• Tall women  or women with Posterior lie to cervix → Use a medium long speculum.
• Lax vaginal walls: Sheath the speculum with the thumb digit from a surgical glove. This can be used by cutting off the tip of the finger digit and sliding the speculum inside which will prevent the vaginal walls from obscuring the cervix. Lubricate before and after applying the glove finger for smooth insertion into the vagina. 
• Lubrication: Always choose a carbomer-free lubricant, as products containing carbomer can interfere with the sample and risk producing invalid results. 
• How to apply lubricant properly: Use minimal amount (pea sized amount) of lubricant – too much can interfere with the sample. Apply only to the outside portion of the speculum, avoiding the tip and the area that will contact the cervix or the sampling device.

Key responsibilities of the sample taker

• Record all mandatory demographic details in the woman’s presence.
• Ensure legibility, accuracy, and completeness of information.
• Take extra care if multiple patients with similar details attend (e.g. mother/daughter, twins, sisters).
• Accurately label the vial with the woman’s name and DOB and complete all the mandatory demographics on the screening form (see below).

Mandatory demographic details

These must be recorded on the cervical screening form:
 ✔ Forename & Surname.
 ✔ Full residential address (for result delivery).
 ✔ Date of birth.
 ✔ Sample taker’s name.
 ✔ Contract holder/CRD name (clinically responsible doctor).
 ✔ Registration numbers (Sample taker & CRD).
 ✔ First day of last menstrual period (LMP).
 ✔ Sample site (Cervix or Vault).
 ✔ Relevant medical history.

Unique Identifiers (At least one required, but all recommended)
To avoid mix-ups, CervicalCheck recommends completing all of the following:

 Personal Public Service (PPS) number.

• Cervical Screening Programme Identification (CSP ID).
• Surname at birth.
• Mother’s maiden name.
• Permanent Identifiers (do not change in a woman’s lifetime):
  • PPS number & CSP ID.
  • Surname at birth & Mother’s maiden name (when combined with Date of Birth).

💡 Tip: Many practice management systems allow patient records with similar demographics to be flagged to reduce the risk of selecting incorrect details.

Obtaining consent

The woman must sign the cervical screening form, make a witnessed mark, or provide witnessed verbal consent 
Before proceeding with screening, ensure all questions and concerns have been addressed and obtain  consent from the patient.

Ask the woman to check all demographic details are correct on form before she signs consent.

The form can be found here. 

Please click here to view Best practice in Cervical screening form completion video

The position of a woman is important, and the time spent ensuring she is in the correct position will make finding the cervix easier.

Dorsal Position (Most Common)

✔ Best for communication & observation between sample taker and patient.

✔ The woman lies with:

• Buttocks towards the light source for better visibility.
• Soles of feet together, knees bent, legs relaxed but open.

Troubleshooting Tip:

If visualisation is difficult, ask the woman to place her fists under her buttocks to adjust positioning.

Left lateral position:

✔ The woman lies on her left side with her knees drawn towards her chest.
✔ The right buttock is slightly raised to allow for better access and visibility.
✔ The sample taker should position themselves behind the woman for optimal technique.

When to use the left lateral position:

✔ If the woman finds the dorsal position uncomfortable.
✔ If she has difficulty maintaining the dorsal position due to mobility issues.
✔ If the cervix is difficult to visualise in the dorsal position, particularly in cases of acutely anteverted or retroverted uterus.

Please refer to CervicalCheck’s Clinical guidance note on the use of lubricants.

Cervical screening can be uncomfortable for many women and painful for some. Using a small amount of carbomer free lubricant can ease discomfort, reduce anxiety, and improve the overall experience

Always choose a carbomer-free lubricant, as products containing carbomers can interfere with the sample and risk producing invalid results

There are many other lubricants available. Please check the carbomer content of other lubricants with the supplier.

Key messages regarding lubricant use: 

1. Do not use water as a lubricant.
   Water does not provide adequate lubrication, evaporates quickly, and can actually increase discomfort for women during the test.
2. Always choose a carbomer-free lubricant, as products containing carbomers can interfere with the sample and risk producing invalid results.
3. Correct  application of lubricant:
   •  Use minimal amount (pea sized amount) – too much can interfere with the sample.
   •  Apply only to the outside portion of the speculum, avoiding the tip and the area that will contact the cervix or the sampling device.

1. Inspect the vulva and gently separate the labia.
2. Insertion
   • Insert the speculum gently but firmly along the axis of the introitus, angling downwards and backwards.
   • When the speculum is halfway in, rotate it gently 90 degrees.
   • Angle the speculum towards the coccyx and do not open it until fully inserted.
3. Positioning
   • Opening and closing the speculum while adjusting the angle should bring the cervix into view.
   • Common error: Not inserting the speculum far enough.
   • Allow the patient a moment to relax after speculum insertion.
     
4. Adjustments 
   • 📌 Using a Medium Long Speculum
   •  Avoid inserting too far—it may open in the fornix.
   • A slight withdrawal usually brings the cervix into view.
   • 📌 Dealing with Flaccid Vaginal Walls

 Tip: Cut the tip of the thumb digit off a glove and place it over the speculum blades.
✔️This helps retract the vaginal walls and improves visibility.

 Examine the cervix carefully, noting any features such as:

• Eversion.
• Polyps.
• Nabothian follicles.

Collecting the sample

• Identify your landmarks, ensuring you sample the SCJ, squamous and columnar cells and the transformation zone.
• Insert the long central bristles of the cervex brush (broom with green handle and white tip) into the cervical os.
• Rotate the brush 360° five times clockwise, applying gentle "pencil" pressure for optimal contact with the ectocervix. 
• Ensure full sampling of:
  •  ✔ Cervical os.
  •  ✔ Transformation zone (TZ).
  •  ✔ Squamocolumnar junction (SCJ).

🚫 Incomplete sampling can lead to false negatives!

If eversion is present, spiral the brush outward in a circular motion to ensure the entire area is sampled effectively.

Transferring the sample:

Immediately transfer the collected cervical cells into the vial. Vigorously mash and bash the broom against the bottom of the vial to release the cells.

🚫 Do NOT stand the broom in the vial

Tighten the cap of the vial just past the torque line to ensure a secure seal.

Double-check that the lid is fully closed to prevent leakage or contamination.

Speculum removal & aftercare

✔️ Loosen the speculum: gently release the screw to fully relax the blades before removal.

✔️ Ensure the cervix is not pinched when closing the speculum
✔️ Check for contact bleeding: inform the patient if present and offer a light sanitary pad.
✔️ Dispose of equipment: place used materials in the clinical waste bin.
✔️ Label the vial: ensure proper identification for accurate processing

✔️ Remove the detachable vial sticker identifying vial number and attach to screening form (upper right hand corner of screening form)

Sample handling & final steps

✔️ Check all details on the form and ensure the vial is correctly labelled.
 ✔️ Attach the vial label to the form. 

 ✔️ Place the sample in the transport box.
 ✔️ Complete the surgery log.

Please click here to view Taking a Quality Cervical Screening Sample video

 📌 Speculum size: record if relevant.
 📌 Cervical position: document the position of the cervix and the patient.
 📌 Cervical appearance:

• Cervix visualised? describe its appearance.
• Bleeding on contact if present.
• Abnormal discharge if noted.
• Physiological changes (e.g., eversion, post-menopausal changes).
• Cervical anomalies.

Samples must reach the laboratory within 3 working days from the date of collection.

Prompt dispatch ensures timely results for the patient.

Maintain a written record of the date the sample was sent from the practice in your sample log.

Key responsibilities

• Women must never be asked to post their own samples.
• Clinics/practices are responsible for dispatching samples.
• Postage costs are included in the contractor’s CervicalCheck fee.

✅ Sample dispatch checklist

1. Forms fully completed (including MCRN/NMBI numbers).
2. Each form matches a vial and is fully labelled (surname, forename, DOB). 
3. Vial label attached to the form.
4. Informed consent recorded (signature, witnessed mark, or verbal consent).
5. Vials must have at least 6 weeks expiry.
6. Sample expiry date format: YY:MM:DD.
7. Use CervicalCheck transport boxes for sample dispatching

Keeping a practice sample log.

A sample log ensures:
 ✔️ A visual record of samples taken.
 ✔️ Tracking from test to dispatch to identify missing results.
 ✔️ Clinic-wide review of results and referrals.
 ✔️ Failsafe system to confirm all samples have been processed.

How to maintain the log.

• Can be a hardback A4 notebook or an Excel spreadsheet.
• Record samples on the day of collection.
• Match samples in the dispatch box before sending.
• Update the log with results when received.
• Follow up on missing results by contacting the lab.
• All staff must be trained in proper log management.

🔑 Key takeaway

A well-maintained sample log and clear dispatch process help ensure accuracy, efficiency, and patient safety in cervical screening.

Example of what a log may look like.