Infusions, or subcutaneous injections of saline solutions, are also frequently given to eclamptic patients with beneficial results. About 1000 cubic centimetres at 105° F. is introduced slowly into the tissues, and the solution may be normal saline, consisting of two drams of common salt to a litre of distilled water, filtered and sterilized; or possibly one containing five grains each of sodium bicarbonate and sodium chloride to the litre.
The articles necessary, in addition to the soap and solutions for cleaning up the skin, are a small rubber to protect the bed; three or four sterile towels; a flask of the solution at 105° F.; sterile infusion bottle, or can, with rubber tubing fitted with a piece of glass tubing at some point in its length, through which the flow of the solution may be watched, a stopcock, and an infusion needle (I cannot refrain from cautioning the nurse to be sure that the tubing does not leak; is not collapsed and stuck together at any point along its length, and that the needle is sharp, free from rust and contains a wire as evidence of not being clogged); two hot water bottles about half full, with air expelled; a pole or stand upon which to hang the bottle; a package of gauze sponges, or squares, and narrow strips of adhesive.
The fluid is usually introduced between the breast tissues and underlying muscles; the area to scrub up in preparation being just below the breast, where the curve begins, and toward the axilla. The bottle which contains the solution should be stoppered with sterile cotton, or, if a can, covered with a sterile towel, and hung between the hot water bottles, to keep the fluid warm, and held in place with a towel pinned around them, top and bottom. (Fig. [49].)
If the nurse is to give the infusion, she should grasp the end of the needle, to which the tubing is attached, with her right hand, pierce a piece of sterile gauze; open the stop cock and allow the air and cold fluid to escape, leaving a drop on the point of the needle; lift the patient’s breast with her left hand and quickly plunge the needle in just under it. The direction of the needle should be parallel to the chest wall to insure its running below the breast tissue, and above, not between the ribs. The needle, and the gauze through which it runs, may be held in place by means of narrow strips of adhesive plaster. The stop cock should be so adjusted that the warm fluid will flow into the tissues very slowly, about an hour being required to introduce 1000 cubic centimetres. During this time the patient must be kept well covered and the solution kept at about 105° F. as some of the heat is lost in its course through the tubing. A hot water bag placed upon the bed, over a coil of the tubing, is another means of maintaining the desired temperature, but it must be watched and moved from time to time, to guard against burning the patient. In hospitals where the infusion apparatus is equipped with a heater, hot water bags are, of course not needed, but they are of practical service in a patient’s home.
Fig. 49.—Infusion being given under breast; needle held in place by strips of adhesive and the solution kept warm by hot-water bottles suspended on each side of the infusion bottle.
Termination of pregnancy is resorted to much less frequently than formerly, because it is believed that an eclamptic patient is particularly susceptible to infection and also that the shock of an induced labor is serious to so ill a woman.
The method of terminating pregnancy, when this is finally deemed necessary, depends upon the condition of the cervix; the size of the child; and upon the patient’s general condition. The method may be simple induction of labor, by the introduction of a bougie, if haste is not imperative; introduction of a bag; manual dilation of the cervix, if it is soft and partly obliterated; vaginal hysterectomy, or even cesarean section.
Chloroform is not used as an anesthetic, in eclampsia, nor to relieve the labor pains nor control the convulsions because of its tendency to increase the liver necrosis which is incidental to the disease.
Recovery is comparatively rapid, when it occurs. The blood pressure drops to normal; the albumen and casts disappear from the urine and all symptoms subside in from two to four weeks. (Chart [1].) And, happily, since one attack confers an immunity, the patient who recovers from eclampsia need not fear a recurrence of the disease.