Republic of the Philippines
UNIVERSITY OF EASTERN PHILIPPINES
University Town, Northern Samar
Webite: [Link] Email: uepnsofficial@[Link]
COLLEGE OF NURSING AND ALLIED HEALTH SCIENCES
PERFORMANCE EVALUATION CHECKLIST
D AND C INSTRUMENTS
Name of Instrument Description Function 3 2 1 0
SIMS BIVALVED VAGINAL Made of stainless Non self-retaining vaginal
SPECULUM steel and/or plastic speculum used for the
and is reusable inspection of cervix for
growth, erosion, or
discharge or for the
inspection of vaginal for
any type of vaginal
infection.
Also used to depress the
posterior vaginal wall and
it can be used different
procedures on the uterus,
such as in Dilation and
Curettage for obstetrician
to dilate a woman’s vagina
so that the cervix and the
vagina can be examined for
a better view.
CUSCO'S BIVALVED SELF- Has Fixation Screw, Self-retaining vaginal
RETAINING SPECULUM Anterior and speculum used for
Posterior Blade, examination in obstetrics
and handle. to visualize the cervix as
well as the vagina for any
Fixation screw is type of discharge or
used to make the erosion
speculum self-
retaining.
The handle is used
to make move the
Anterior Blade and
Posterior blade like
a jaw that opens up
like a duckbill.
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SIMS ANTERIOR VAGINAL A long instrument Used to retract the
WALL RETRACTOR that has shaft and anterior vaginal wall to
oval shaped ends. expose and visualize the
It has loops in with cervix.
atraumatic
serration on the Used in the Dilatation and
end of both sides of curettage procedures, sims
the retractor so operation for VVF-
that a proper grip Vesicovaginal
could be Fistula and fistula surgery.
maintained.
TEALS VULSELLUM A long instrument Used primarily in
that is used to hold gynecologic procedures
the anterior lip or like in Dilation and
the posterior lip of Curettage to grasp slippery
the cervix and is tissues and provide
usually 20cm in traction or torsion
length.
Has interlocking
sharp teeth for a
firm grip when
holding the cervix
aided with the lock
for the procedure
to be done easily
SIMPSON UTERINE SOUND A long angulated The sound is used to
instrument. The calibrate or dilate the
sound features a cervical canal or to hold
flat handle and a the uterus in various
malleable shaft positions during
that is available in gynecologic procedures.
graduated
centimeters or It is also commonly used
inches. for probing the uterus
through the cervix and to
measure the length of the
cervical canal and uterus.
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HEGAR'S DILATORS Come in different Used in Dilation and
types of sizes and curettage and other
diameters. These gynecologic and obstetric
are double ended procedures to gently dilate
curved dilators the mouth of the cervix.
with rounded ends
When inserting the
dilators, always start with
the smallest size then
gradually increase to the
desired opening of the
cervix.
UTERINE CURETTE A long and double It is used for scraping
ended instrument endometrial cavity to
(There are also one obtain sample for
sided uterine histopathology.
curettes).
It is used to remove
It has two ends, conception products from
one with sharp and the uterine cavity and to
smaller end and remove endometrial tissue
one with blunt and for diagnostic purposes.
larger end. The sharp, smaller end is
used during dilation and
curettage, with the blunt,
larger end is used during
evacuation and dilation for
pregnant woman.
HAYWOOD SMITHS OVUM It is a metallic Ovum Forceps to grip,
FORCEPS instrument that has hold, manipulate and
spoon shape blades remove tissue in the
and fenestration uterus, including the ovum
and the placenta.
Ovum forceps are used in
procedures such as
cesarean section,
hysterectomy, uterine
repair, sometimes as a
hemostat and clamps and
evacuate products of any
conception especially in
the secondary postpartum
hemorrhage.
KIDNEY TRAY A kidney Basin or Kidney Basin are mainly
tray is a kidney used in hospital, family,
shape container and surgical care words to
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with a kidney- collect or collect dirty
shaped bottom and dressings and other
inclined walls that medical waste.
comes in many
different sizes.
RAMPLEY'S SPONGE It has blades with Rampley’s Sponge Holding
HOLDING FORCEPS serrations to firmly Forceps is a multipurpose
grasp swaps and surgical tool that surgeons
sponges and lock frequently use to grab and
for effecting hold swabs and sponges,
holding which help in cleaning the
blood and other fluids from
the operating site.
Remarks:
Grade: ____________
Name and Signature: _________________________________ ________________________
Clinical Instructor Student’s Signature
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