TECHNIC OF PUNCTURES 83 



Technic of Punctures. Perhaps the most important 

 bacteriological technic with which the nurse has an 

 important duty is the puncturing of cavities such as 

 drawing fluid from a chest or knee, the cerebrospinal 

 fluid from the spinal canal, or the taking of blood from 

 a vein. For all these the skin over the site of operation 

 is cleansed precisely as for a major operation. It is 

 the practice of the author for vein puncture, in making 

 a blood culture, to have the arm at the bend of the 

 elbow inside (sometimes the leg is used) scrubbed with 

 soap and water, using a very soft brush, washed with 

 sterile water, and either painted with 10 per cent, iodin 

 alcohol or a wet dressing of 1 per cent, formaldehyde 

 applied; if the puncture is not done for some time, 

 fresh iodin solution is used when everything is ready. 

 These two methods have been found very successful 

 in destroying the bacteria always present in the deeper 

 layers of the epidermis. They are chiefly small white 

 cocci not unlike the cocci that cause abscesses. They' 

 will be considered later under the name Staphylococcus 

 epidermidis albus. 



There is little to be done by the nurse aside from 

 preparation and general assistance, but she should 

 know what is being done and why. 



Fluids are removed from the pleural cavity or 

 spinal canal and elsewhere, because in these locations 

 bacteria of specific kind or in characteristic conditions 

 are to be found. For instance, in cerebrospinal menin- 

 gitis the causative germs are found within the pus 

 cells of the cerebrospinal fluid, as double, biscuit- 

 shaped cocci, and they have a particular staining reac- 

 tion by which they are recognized (see Chapter VIII.) 



