Operative surgery . The veins selected for the procedure are the in-ternal saphenous at the ankle,the median basilic, or mediancephalic at the bend of theelbow, and the external jugu-lar vein. The instruments re-quired for the purpose is theordinary thumb lancet, or acurved or straight sharp-pointedbistoury. The first, however,possesses the greatest numberof traditional virtues. If theregion of the elbow be selected,the median cephalic vein is pre-ferred, on account of its greaterdistance from the brachial ar-tery and the posterior relationto cutaneous nerves. The armshould be constricted by a
Operative surgery . The veins selected for the procedure are the in-ternal saphenous at the ankle,the median basilic, or mediancephalic at the bend of theelbow, and the external jugu-lar vein. The instruments re-quired for the purpose is theordinary thumb lancet, or acurved or straight sharp-pointedbistoury. The first, however,possesses the greatest numberof traditional virtues. If theregion of the elbow be selected,the median cephalic vein is pre-ferred, on account of its greaterdistance from the brachial ar-tery and the posterior relationto cutaneous nerves. The armshould be constricted by a band-age drawn sufficiently tight toobstruct venous return withoutinterfering with arterial circu-lation ; this will cause the veinsto appear prominently distend-ed, unless the patient be veryfleshy, in which case the sense of touch must be relied on to indicate theexact situation of the vessel. The vein should be well defined by the finger,and held in position by the thumb or finger placed just below the point of. Fig. 252.—Opening the vein with scalpel. OPERATIONS ON VEINS, CAPILLARIES, ETC. 219 incision. After thorough cleansing, the incision is made oliliquely to thetransverse diameter of the vein, and of sufficient dejotli to freely open thevessel without severing it (Fig. 252). The flow of blood may be increasedby causing the patient to grasp firmly a stick or broom handle; it may beimpeded by the interposition of the subcutaneous fat, which should bepushed aside. The amount of blood taken will be regulated by the strengthof the patient, whether he be standing or lying, and by the demands for de-pletion. If standing or sitting, the effects will be sooner felt than if in arecumbent posture. Usually, however, from half a pint to a pint will flow is arrested by removing the bandage above and applying the fingerto the bleeding point, after which a small aseptic compress is placed overthe incision, and confined in position by adhesive plaster so arranged as nott
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