Text book of abdominal surgery : a clinical manual for practitioners and students . st convenient and least painful; and thiswill be usually through the umbilicus. After having ascertainedby percussion that the intestine is not lying against the seatof puncture, the trocar is pushed through the abdominal wall.The point of the instrument should be sharp, so as to penetratethe peritoneum, and not simply push that membrane away infront of it. The trocar is withdrawn, and the end of the rubbertube at once slipped on to the cannula, the small quantity offluid which escapes falling on the towel. The

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Text book of abdominal surgery : a clinical manual for practitioners and students . st convenient and least painful; and thiswill be usually through the umbilicus. After having ascertainedby percussion that the intestine is not lying against the seatof puncture, the trocar is pushed through the abdominal wall.The point of the instrument should be sharp, so as to penetratethe peritoneum, and not simply push that membrane away infront of it. The trocar is withdrawn, and the end of the rubbertube at once slipped on to the cannula, the small quantity offluid which escapes falling on the towel. The Stock Photo
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Text book of abdominal surgery : a clinical manual for practitioners and students . st convenient and least painful; and thiswill be usually through the umbilicus. After having ascertainedby percussion that the intestine is not lying against the seatof puncture, the trocar is pushed through the abdominal wall.The point of the instrument should be sharp, so as to penetratethe peritoneum, and not simply push that membrane away infront of it. The trocar is withdrawn, and the end of the rubbertube at once slipped on to the cannula, the small quantity offluid which escapes falling on the towel. The
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Text book of abdominal surgery : a clinical manual for practitioners and students . st convenient and least painful; and thiswill be usually through the umbilicus. After having ascertainedby percussion that the intestine is not lying against the seatof puncture, the trocar is pushed through the abdominal wall.The point of the instrument should be sharp, so as to penetratethe peritoneum, and not simply push that membrane away infront of it. The trocar is withdrawn, and the end of the rubbertube at once slipped on to the cannula, the small quantity offluid which escapes falling on the towel. The other end of therubber tube lies in a basin on the floor, and the fluid is allowedto run until the peritoneal cavity has been emptied. As itcomes near to an end the patient is rolled round gently on tothe face, so that the opening will be the most dependent partof the abdomen. As soon as the fluid ceases to flow, the tubeis closed with the finger and thumb, or the end is kept carefully 22 TAPPING, ASPIRATION, ETC. in the fluid in the basin, and the patient turned round again on. Fig. 1.—Wells Tapping Fi^. 2.—Keiths Tapping Trocar and Cannula. Trocar and Cannula. (Full size.) (Fill] size.) Fig. 3.—Wells Cannula forAscites.(One-half size.) to the back. As the cannula is withdrawn, the surroundingskin is pinched up between the finger and thumb; and, should TAPPING. 23 there be any bleeding from the opening, a little time will begiven for it to cease before a piece of sticking-plaster, twoinches square, is put on. Should the bleeding not tend tostop, the wall may be transfixed with a needle and pressuremade by twisting a thread round it. A broad flannel bandagemay be put on to make the patient comfortable, and if theabdomen be very fiat, the hollow is filled up with wadding.The after treatment consists in keeping the patient on the back,so that the puncture opening will be at the highest level; andfluid which may remain behind has thus no tendency to escape.Perspiration must

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