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out these arrangements. She should learn from Arrangehim in what position the patient is desired when patient. placed upon the table. The dorsal position—the patient lying upon her back with the limbs flexedis that usually required for operations upon the vagina or the perineum. The patient's clothing in

Fig. 61.



this position should be well drawn up from under the hips and pushed above the operating-pad, which is then placed under her. The limbs, being flexed, may be fixed in position by the leg-holder, as Leg holder. shown in the cut, or held by assistants. The leg

holder, being thrown around the patient's neck, is fastened, just above the knee, to each limb.

A sheet should be so draped over the person as to cover the limbs and protect the patient so far as possible from unnecessary exposure. Some operators use loose bags of muslin, which have been previ

FIG. 62.



Dorsal Position and Arrangement for Operations on Floor of Pelvis.

ously sterilized, for encasing the limbs during operations.

A double fold of sterilized gauze, about a yard square, with a slit cut in it, through which the special site of operation may be exposed, is used by some surgeons as a further protection against exposure, being draped from beneath the sheet over



the vulva and buttocks, the operator carrying on his manipulations through the opening which exposes the special site to be operated upon.

The Sims position is frequently used in cervical Sims's operations, for fistulæ, or for operations about the anus, as for hemorrhoids.

The knee-chest position is but seldom used for Genu.pesia operation except in certain forms of fistulæ. The tion. patient's chest in such cases may need to be supported by a thick pillow or a padded stool, to bring her into proper position for the operator.

The nurse should in every case aim to keep the patient's clothing out of the way of the operator and from contact with the discharges, but she should so adjust sheets, towels, etc., as to save the patient any unnecessary exposure.

The preparation of the operator and assistants Preparawill be practically the same as that observed in operator preparation for abdominal section.

Any open surface upon the patient's body may become a source of infection, therefore the requirements of asepsis and antisepsis should be as rigidly observed as possible in the preparations for any operative procedure.




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“ sponges.

The patient being placed, and the operation to sponges. begun, the nurse, unless directed otherwise, will

need to station herself by the stand which contains the vessels for cleansing the sponges. Several

. Mounted "mounted sponges” should be prepared, that is,

sponges cut about the size of a walnut, placed on stems of metal or rubber, called sponge-holders. Forceps with catches may be used when these are not on hand.

For operations in the vagina or on the cervix, etc., these mounted sponges are especially necessary.

The nurse, while attending to the sponges, espe

cially, should be ready to respond to any demand Changing of the surgeon-changing the water in the basins,

refilling the irrigator, removing soiled towels and Cleansing replacing them with fresh. Her own hands should

be carefully cleansed after each of these services, in
a basin containing some antiseptic solution, as
1-4000 bichloride of mercury, before she again
touches the sponges.
The sponges should be thoroughly cleansed of

to surgeon's

in basins,


ment of


blood in the basin of cold water and allowed to lie Managein warm water until wanted. They should be squeezed until as free of moisture as possible, and should be handed in quick succession to the assistant nearest to her who will have the sponging to attend to. At no time in any operation should the nurse

of curiosity. allow herself to become so engrossed in watching the operation as to forget that there are duties incumbent upon her. She should give her sole to duty. attention to the performance of her own duties, and no more think of watching the operation (except as she may need to do so for the proper appreciation of the special duties that may devolve upon her at each step), than should the etherizer, whose sole attention should be engrossed in the proper performance of his work. At the completion of the operation, the nurse Duties at

complemay assist in slipping the rubber pad from beneath

operation the patient. It may be placed in the waste bucket temporarily, while she proceeds with a sponge and a dry sterilized towel to prepare the parts for the

Application application of the dressings. When entirely dry of dressings. the powder, boric acid, or iodoform may be applied by the surgeon, and then the dressings are put in place and fastened down by a bandage. A blanket is then wrapped around the patient and she may be lifted into the bed which the nurse, just before the patient to

tion of

Removal of


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