Policy Title: Vasectomy

POLICY TITLE: VASECTOMY

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

Procedure: A. Purpose 1. To be prepared for the scheduled procedure.

B. Equipment and Supplies 1. #11 scalpel blade 2. 1 pack of 5.0 Vicryl 3. 2 packs sterile gloves 4. 2 pathology jars 1 labeled "right", 1 labeled "left" 5. chux 6. 4 packs of 5.0 Ethi1on sutures 7. Alcohol swabs 8. Bacitracin ointment 9. Basin with hot water 10. Consent form 11. Extra sterile gauze 12. Gowns for practitioners 13. Hyfrecator and hyfrecator tips 14. Lab slip and 2 sterile specimen cups 15. Liquid betadine (not swabs) 16. Mayo stand 17. Paper bag 18. Pathology slip 19. Patient gown 20. Procedure cart 21. Semen analysis instructions 22. Sterile fenestrated drape 23. Syringe 3 cc, 25 gauge 5/8" needle 24. Tape 24. Two exam lights 25. Two paper drapes 26. Vasectomy discharge instructions 27. Vasectomy kit-- 28. Xylocaine 2% without Epinephrine

C. Steps 1. Lay 2 chux side by side on the exam table. Layer the 3rd chux over top of the others. 2. Layout patient gown and drape on the exam table. 3. Position exam lights. One on either side of the table. 4. Tape the paper drape top the exam lights so that it crosses over the table at what will be the patient's abdominal level. Turn the lights on to help warm the table. 5. Lay the sterilized vasectomy kit on the mayo stand and open maintaining sterility. Drop the fenestrated drape onto the sterile field. 6. 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. 7. On the counter have the consent form, pathology jars and slip. 8. Place the basis in the sink and fill with hot water. Place the Betadine bottle in the water allowing it to warm. 9. Place hvfrecator tin in handle and plug machine into the electrical socket. 10. Adjust the thermostat to at least 75 degrees. 11. Bring patient to the room and obtain vital signs. 12. Review the consent form and have the patient sign. 13. Instruct him to get undress and put the patient gown on. Give the Patient the drape to cover legs. 14. Assist with procedure as needed. 15. During the procedure, prepare the discharge bag. Place gauze, Bacitracin 16. ointment and sterile specimen jars, semeJ1 analysis instructions and discharge instructions. Also include a lab slip for semen analysis @ 8- 10 weeks post vasectomy. 17. After the procedure is complete, give the bag to the patient and explain the contents. 18. Obtain vital signs. If stable, the patient can be discharged The patient must have a driver.