Preparatory and after treatment in operative cases . ping the arteryover the cuff. The hemostats are removed from the vessel edge, andthe artery may then be put in place. Owing to the elasticity of the arterial wall it usually shrinks con-siderably when the pressure from within is removed, as it is at thefree end. To obviate this it may be necessary to dilate the end verygently by inserting the closed jaws of a mosquito hemostat covered18 244 SHOCK AND SECONDARY HEMORRHAGE with vaselin, and opening them for a short distance. The three hemo-stats are then applied to the edges just as with the v
Preparatory and after treatment in operative cases . ping the arteryover the cuff. The hemostats are removed from the vessel edge, andthe artery may then be put in place. Owing to the elasticity of the arterial wall it usually shrinks con-siderably when the pressure from within is removed, as it is at thefree end. To obviate this it may be necessary to dilate the end verygently by inserting the closed jaws of a mosquito hemostat covered18 244 SHOCK AND SECONDARY HEMORRHAGE with vaselin, and opening them for a short distance. The three hemo-stats are then applied to the edges just as with the vein, and the arteryis gently drawn over the cuffed vein on the cannula and tied in placewith another fine linen suture applied in the remaining groove. Themosquito hemostats are removed, and finally the large hemostat whichhas been snapped on the handle of the cannula during all this timeis removed. The process is then completed. After the transfusionthe cannula is removed, both artery and vein are ligated, and thewounds are sutured (see Fig. 201.). Fig. 201.—Diagrams of Stages of End-to-end Anastomosis of Two Blood-vesselsby the Cannula Method (as modified by Cvile and Hitchings). A, Pulling thevein through the cannula. Very fine pointed forceps may be substituted for thesingle suture. B, Cuffing back the vein over the cannula with three mosquitohemostats. C, The vein cuffed and tied in place in the groove next to the handle ofthe cannula. The artery is ready to be drawn over the vein. D, The anastomosiscompleted, and the cannula hemostat removed. The artery is tied in the remain-ing groove. The short handle of the cannula is so light in weight that it does notcause torsion of the vessels. (Crile.) TREATMENT OF SHOCK 245 In making a cannula anastomosis experience will show what sizecannula is suitable for the given vessels. As large a size should beused as possible without injuring the intima of the artery by stretchingit too much. Usually there will be no difficulty in obta
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