Identifier: principlespracti00dudl (find matches)
Title: The Principles and practice of gynecology : for students and practitioners
Year: 1904 (1900s)
Authors: Dudley, E. C. (Emilius Clark), 1850-1928
Subjects: Gynecology
Publisher: Philadelphia : Lea Brothers & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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used,they all should be passed first and then secured by twisting. In usingsilkworm gut, one usually should tie each suture as it is passed. Letthe sutures be tied just tightly enough to hold the parts together.If tied too tightly, they strangulate the tissues, cut out, and fail togive union. A clot of blood, if left in the bladder after closure, may causegreat vesical tenesmus and possibly imperil the result. It is well,therefore, before tying the final sutures to throw a quantity of steril-ized water through the urethra into the bladder. This water will passthrough the fistula into the vagina and wash out anything remainingin the bladder. 6. After-treatment.—The patient is placed in bed on the back, witha roll under the knees for support. A self-retaining Sims sigmoidcatheter is placed in the urethra; it should be made of block-tin or ofglass, bent by the flame of a spirit lamp. The curves should beadjusted to the individual case. The urine passes through the catheter Figure 326.
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Sims sigmoid catheter. and is collected in a urinal placed between the thighs. The catheteris apt to become clogged with mucus or blood-clots, and, therefore,should be removed and cleaned every few hours. A second catheter isdesirable, in order that one may always be introduced as soon as theother is removed. In case of a small fistula we may dispense some-times with the self-retaining catheter altogether and permit the patientto pass the nrine in the natural way. Both patient and nurse shouldbe cautioned to see that the flow of urine is not interrupted. Thecatheter should remain about fourteen days. The sutures, unlessremoved earlier on account of suppuration or failure of union, mayremain two or three weeks. The woman should be kept in bed aweek longer, and during this time should be catheterized at frequentintervals. During convalescence the urine should be kept normally acid,otherwise phosphatic deposits may form in the line of union and onthe sutures and prevent or destroy union.

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