Removal of Sutures.—On, or about, the tenth day the removal of sutures is required.
The nurse will sterilize by boiling, 1 pair of long-handled, sharp-pointed scissors, 1 pair of tissue forceps, and if the sutures extend far into the vagina, a vaginal retractor.
A basin of lysol solution (1 per cent) with cotton sponges, a sterile towel to lay the instruments on, a dish to receive the soiled dressings, sutures and discarded sponges, completes the arrangement.
The patient is now draped with sheets as for examination. The doctor prepares his hands as for operation. The nurse holds the limbs of the patient in lithotomy position and the operation is begun.
Uterine Tampon.—Packing the uterus is mostly employed for hæmorrhage after labor. The patient, therefore, has been prepared and only fresh sponging with lysol solution is required.
The instruments are, 1 vaginal retractor, 1 pair of dressing forceps, 1 vulsellum forceps and a jar of gauze, four to six inches wide and ten or twelve feet long. Always use a single continuous strip. A very large quantity is necessary to fill the uterine cavity. Any sterile gauze may be used, but weak iodoform is satisfactory.
Fig. 87.—Tampon of the uterus. (Hammerschlag.)
The vagina is held open with retractors, the cervix seized with a tenaculum and pulled down, the end of the gauze strip is then carried into the uterus as far as the fundus, the dressing forceps withdrawn and a new length carried in until the cavity is packed tightly from the fundus clear to the os.
Care must be taken that the strip of gauze is not contaminated by vaginal contact during the introduction. A pad and binder are now applied. If no instruments are at hand, or there is not time to sterilize, then the nurse can grasp the fundus through the abdominal wall with her hand and push the cervix down to the vulva where the gauze can be pushed in by the doctor’s fingers, if necessary.