SOP #2: Hysterosalpingogram (HSG)

Purpose:

To describe the procedures and documentation required for HSG office visits.

Obtain patient’s informed consent for procedure(s).

Complete preliminary testing and preparation.

Safely perform the procedure to evaluate the uterine cavity and tubal patency.

Complete appropriate documentation and procedure coding.

Ensure patient understanding of:

• Exam findings.
• Follow up plan.
• Symptoms that should prompt her to seek urgent medical attention.

Equipment:

• HSG machine
• R or L pelvic markers
• HSG tray (see procedure tray set up manual): Contrast material, Sterile water, speculum, 2 fox swabs, betadine, mineral oil, speculum, syringe and needle
• HSG catheter
• Sterile gloves

Forms/ documents needed:

• NextGen Electronic Health Record (EHR) Patient Chart
• Superbill
• Patient Consent Form for HSG (with or without cathfitting)