Completely submerge tip into a saline-filled bowl.
Fully pull back the plunger handle and hold until the saline chamber completely fills. Do not squeeze the air and saline chambers.
Tips
The device fills with a delay, so keep the tip in the saline for a few seconds after the handle has reached its stop point.
Saline should fill between 9 and 10 mL. A whistling may be heard as it fills.
Video - Prepping FemVue Device
Procedural Guidelines for FemVue Sono HSG
1. Sonographic Landmarking
Conduct a standard ultrasound evaluation per your practice guidelines.
Attempt to locate the following images in
the transverse view:
Endometrial stripe and uterotubal junctions (Fig A)
Position of each ovary relative to the uterus (Fig B)
Tips
Take note of the probe position.
Video - Sonographic Landmarking
2. Insert Intrauterine Catheter per the Catheter Instructions for Use
If desired, first perform SIS with a saline-filled syringe per your practice protocol, because bubbles in the uterus from the FemVue may cause artifact.
3. Inflate Balloon, if applicable
Inflation of the balloon with subsequent placement over the internal cervical os is recommended to prevent retrograde flow.
Video - Balloon Inflation and SIS
4. Prime FemVue and Connect to Catheter
To prime FemVue, submerge the tip in the saline bowl and depress the plunger handle until bubbles are visible. Ensure FemVue is primed just before attachment to avoid delay in contrast visualization.
Tips
Do not overtighten FemVue's spin luer to the catheter. This prevents catheter kinking and luer detachment while ensuring easy device removal for refilling, if necessary.
Video - Priming FemVue and Connecting it to the Catheter
5. Deliver Contrast Slowly
With ultrasound probe in place, slowly and steadily depress the plunger handle to deliver the contrast. Visualize saline-air contrast (bubbles) entering the cavity (distention is not necessary).
Confirm in the sagittal view there is no retrograde flow through the cervix. If needed, adjust the balloon's placement or use a balloon to block the flow.
Start with one fill of the FemVue Saline-Air Device. Use the minimum number of fills necessary to perform tubal assessment. Do not exceed six (6) filled syringe volumes.
Troubleshooting
No contrast exiting catheter and plunger resistance
Make certain that catheter clamp is open, if applicable.
Confirm the catheter is patent.
Ensure FemVue has not been over tightened to catheter luer.
Replace catheter if kinking is suspected.
Video - Delivering Contrast and Confirming No Retrograde Flow
6. Make Tubal Assessment
In the transverse view orient the probe to observe the uterotubal junction to assess contrast flow in one tube. Although flow may be seen bilaterally, evaluate each tube individually.
Locate flow in Zone 1 and
hold view to observe.
Slowly and methodically scan to possibly observe tubal flow in the remaining zones.
Evaluate contralateral tube.
Troubleshooting
No contrast flow visible in Zone 1
Ensure there is no retrograde flow through the cervix.
Consider repositioning ultrasound probe.
Hold probe, maintain plunger handle position and
wait for resolution of possible tubal spasm.
After extensive observation, trace laterally to Zone 3
and observe.
Inadequate visualization of tube
Consider pulling back with probe if tube is viewed anteriorly.
Visit the FemVue Sonographer Blog for more videos and tips & tricks from sonographers, physicians
and clinical experts who have experience with FemVue Sono HSG procedures.
References:
1 Volpi, Ultrasound Obstetrics Gynecology. 1996;7:43-48.
2 Exacoustos, The Journal of the American Association of Gynecologic Laparoscopists. 2003;10(3):367-372.
3 Allahbadia, Fertility and Sterility. 1992;58(5):901-907.
Confirm in the sagittal view there is no retrograde flow through the cervix. If needed, adjust the balloon's placement or use a balloon to block the flow.
