war dept usa number

I. Centralization of supplies
II. Personnel
III. Dressing carriage
IV. Housekeeping and supplies
V. Trays

I. Centralization of Supplies

Topic Preview

  1. Definition
  2. Location
  3. Scope
  4. Solutions
  5. Purpose
  6. Services
  7. Rubber goods

The centralization of supplies in hospitals is not a new idea. It has always been used, and with much success, but the centralization of surgical supplies and special equipment is the .result of experiments which had their inception about 20 years ago.

Definition: Centralization, as the term is used here, means the concentration of all equipment in one place, under one head, where it may be cared for with the greatest efficiency and used to the best advantage.

The department in which this imortant work is carried out has been given several names, but the most common designation is Central Supply Room. It is then defined as a unit in the hospital which issues sterile supplies and most of the special equipment needed in the care of patients.

Location: This Central Supply Room should, if possible, be centrally located and must be directed by a competent supervisor. These two factors are of vital importance. With the former, time, labor, and money are saved in the service rendered, and without the latter, it would not be possible to carry out its extremely important function.

Scope: The size, scope and capacity of this unit will be determined, in large measure, by the individual requirements of the hospital. It will, therefore, vary widely in hospitals of different sizes. It may be the place where surgical supplies are prepared and distributed, or if the plan of the hospital lends itself to a large department, it may control all surgical supplies from dressings to sterilization of obstetrical and surgical packs and all special equipment, including rubber goods. This takes in the preparation of sterile trays for certain treatments. In some hospitals, the collection and storage of blood has been added to the facilities offered by this room.

Solutions: Solutions for intravenous use may be made in this department. A room for the exclusive making of solutions must be used, as the air must be free from dust and lint. Special equipment is necessary and the person making solutions must be reliable and experienced. The water used must be especially distilled so that it will be free from impurities and minute particles of foreign material, sometimes found in ordinary distilled water. The other ingredients used must be the purest obtainable. The bottles and tubing are washed and rinsed with the greatest care and the tubing inspected regularly. These factors are as important as the making of the solution itself. Standard solutions for intravenous use may be secured in sealed flasks from commercial firms. The tubing requires the same care.

These factors will regulate the number of persons required to give exacting 24-hour service.

Purpose: The purpose of the Central Supply Room is to conserve time and material by reducing the duplication of supplies and effort. Such duplication has heretofore existed when dressings and sterile supplies were taken care of on the wards and floors, or in the dressing rooms in connection with each hospital department. The aim of the hospital in maintaining a Central Supply Room is to render to doctor and patient the best and most efficient service in the interest of each.

Before the inauguration of such service, it was the custom to issue all supplies from the main storerooms to the wards, and replacements were made as needed. Gauze and cotton were at one time included in these supplies, and dressings were secured from the operating room. This may still be the rule in some hospitals where dressing rooms off wards are considered necessary. Catheterization, douche, and bladder trays were set up as well as intravenous and hypodermoclysis trays. The solutions for the intravenous and hypodermoclysis trays came from the operating room.

With the advent of the Central Supply Room, this procedure has changed, and trays and solutions for all these treatments are now provided through this central organization. The transfer from wardsand floors to a single source where perfect technic/is guaranteed is a definite forward step in the care of patients.

Services: The following services are given the various departments: Bladder irrigation, catheterization. coionic irrigation, douches, eye treatments, gastric analysis, gavage, hot and cold compresses, hand immersion containers, poultices, enteroclysis, myringotomy, and mortuary. Trays for such work are equipped, supplied, and supervised in the Central Supply Room in readiness for the nurse from the department in charge of the patient. Each hospital is obliged to work out its method of requisitioning equipment taken from this room. Everything must be signed "out" by the person taking it and reported "in" when it is returned. Trays are checked to make certain that everything has been returned in good condition. Each hospital, also, has its method of charging, and when this applies to the services rendered by this room, charge tickets are written when the equipment is given out.

Other trays used for dressings, aspiration, gastric decompression, intravenous therapy, hypodermoclysis, spinal puncture, cisternal puncture, and tracheotomy are taken care of by the nurse in the Central Supply Room, as is also the fracture cart.

The Central Supply nurse goes to the patient's bedside with specific equipment, assists with the treatment and makes certain that the nurse left in charge understands the subsequent procedure and further application of the recommended treatment.

Included in the list of equipment available through the Central Supply Room are bed elevators, respirator, resuscitator, oxygen tent or tank with special face or nose attachment, and an electric breast pump, if this item is not under the care of the obstetrical department The glass .parts for the enumerated apparatus are sterilized in the Central Supply Room. Other equipment which may be called for by the nurses in the several departments or delivered, as is routine in each hospital, includes the following articles: Atomizers, crib sides, hypodermic trays, luer syringes and accessory trays, electric heating pads, dressings, inhalators, stupe kettles, tongue depressors, restraints, drainage bottles, rubber goods, and equipment for isolating the individual patient in the ward, together with cans for disinfection of material from typhoid patients.

Rubber Goods: When rubber goods are considered a part of the supplies in the Central Supply Room all replacements are made from there. In this way, every department of the hospital has the advantage of first class equipment and material readily available and always in perfect condition. In the Central Supply Room, all supplies are carefully and regularly checked, needed repairs made, and materials held ready for immediate call or stored for future use. Consequently, single pieces of equipment may be used where previously several were necessary and many important items which were earlier considered too expensive for routine handling may be serviced through this central department.

It is, therefore, easily apparent that the introduction of this so called "Room"-really a large department-constitutes actual progress in the standardization of hospital supplies.

II. The Personnel

The graduate nurse in charge of the Central Supply Room may have had a postgraduate course in operating technic or surgical nursing, or some postgraduate work in one or more Central Supply Rooms, or perhaps she is a nurse with particular aptitude for this work and interested in its every phase. In addition to her training, as a person she must be thoroughly conscientious, tactful, and adaptable in order to cope successfully with the constantly changing program involved in this work. Her students must give particularly intelligent and conscientious service, for here human lives are at stake in their hands, and the most scrupulous attention must be paid to all details.

While there is routine work which must be performed at the same time every day, all the emergency requirements are met with equipment from this department. It is obvious that cooperation must be an essential feature of this service. Upon the nurses in the Central Supply Room rests the responsibility for the efficient working of life-saving equipment.

Nurses from the Central Supply Room are frequently among the first to see patients after admission to the hospital. A special treatment may be necessary or the patient may have to be prepared for immediate operation, in which case the patient receives the attention of the Central Supply Room nurse. Thus her work can and does carry her into the hospital's "front line." This nurse must be able to meet people easily, create a good first impression, and exercise discretion at all times. Sick people are not ordinarily in a very happy frame of mind. They know an effort will be made to restore them to health, but they have entrusted themselves to strangers and look about them for some sign of personal sympathy.

The number of nurses needed to carry on the work of the Central Supply Work varies with the routine of the hospital. According to observation, a hospital of 250 beds with an active surgical service requires one supervisor, five students, and one night nurse. It is importantto have Just enough nurses. Often the department is limited as to space and with too many nurses there is likely to be confusion. Naturally, an insufficient number makes the work difficult. A general staff nurse is vital to this room and the service it affords. She is in the unit when the supervisor is busy on the outside or is teaching or off duty.

A senior student nurse who is particularly interested in this type of work may be able to take charge of the room at night, but, where the service is very active, the responsibilities are frequently too great to be assumed by so young a nurse. A qualified general staff nurse who is conscientious and reliable, and who can handle the many angles of this important department when alone, is the one to assume this responsibility.

In some nursing schools, the enire training of students in the Central Supply Room and its technic is given at one time, with two weeks assigned to each branch of the work and eight weeks allotted for the complete service. In other schools, one month during the junior year and another in the senior year are designated for this work.

The night duty term in Central Supply Room is given after these other weeks have been completed. As the understanding of the intricate night duties grows, a Central Supply Room night nurse should be chosen with care in order that she may render to the patients theservice for which the department was intended.

The use of a maid is optional, but there are many things which she can do well while the nurses are attending to more important tasks. The same is true of an orderly. If the department is large and all supplies are to-be delivered by the department, an orderly is required. Otherwise, it will only be necessary to call an orderly from a department whenever heavy or awkward equipment is to be transferred.

III. Dressing Carriage

Topic Preview

  1. Technic of dressing
  2. Procedure
  3. Fracture carriage

The dressing carriage is so comlete in itself that it could be called an emergency room on wheels. It holds everything the doctor will need in doing a dressing or performing a slight operation.

The size of the hospital and the number of surgeons operating daily will determine the number of dressing carriages needed, and the number of dressings each attends will regulate the amount of equipment or each carriage.

In some large hospitals, dressings are done in a special room off the ward; in others, however, they are done in the wards and in the private rooms. With this complete carriage. the dressings can be done without moving the patient, and the slight operation which may be performed in the patient's room, with the sterile supplies on the carriage, is a saving in time to the surgeon and a saving in money to the patient, as it removes the necessity of taking the patient to the operating room.

Technic of Dressing: By the time the student is permitted to take the carriage out alone, she is thoroughly familiar with everything in it. This is one of the chief reasons why the doctors are so enthusiastic about the Central Supply Room. The nurse who goes out with the equipment from this department knows exactly what to do with it. Previously, it was not always a nurse thoroughly familiar with the carriage and dressings who was asked to assist the doctor.

Now, when the call comes for the carriage, the nurse takes it to the appointed place, and having learned to handle sterile supplies, is ready to assist intelligently. A modern dressing carriage has a place for everything which will be needed and everything in its own place.

The call which the nurse receives may be for one dressing, for six or eight dressings in various parts of the hospital, or for dressings on the ward. The nurse is ready in any case. When the doctor has several dressings to do, he usually plans to do the "clean" ones first.

Procedure: Although the procedure for a dressing is always the same, it may be well to mention it. The patient is screened, made as comfortable as possible, a good light obtained (some carriages have their own lights which may be plugged in any socket), the bed adjusted, gown and covers folded neatly, binder removed or bandage cut, newspaper or paper bag on the foot of the bed, top dressing removed and placed on the paper or in the bag, glove case opened and put in a convenient place for the doctor, then the dressings and instruments which the doctor will need are placed on this towel. When a Mayo stand is used, the towel is placed on it and the dressings and instruments arranged.

When a wound is to be irrigated, a mackintosh is placed under the patient's side, and a kidney basin held in place. Solution basin, asepto syringe, and solution are carefully but quickly procured. The doctor removes the rest of the dressings with the forceps which have been placed on the towel. In taking sterile sponges from jars, the nurse must be careful not to strike the outside of the jar with the forceps; also, when holding forceps, she must remember to keep the point down, otherwise the solution will run up toward the handle, then down over the sterile end, and, be it ever such a small amount, the forceps are contaminated. It is safest to return the forceps to the container.

While the dressing progresses, the nurse must have everything ready as quickly as possible for whatever is to come next-the removal of sutures, cleansing of the wound, removal of drains, or irrigat- ing, etc. Dressings and adhesive are applied or tapes tied and bandage put on.

When the dressing is completed, soiled instruments are dropped in the container especially for them, and the gloves are put in their container. Soiled dressings are wrapped in the newspaper and tied with a string or, if a paper bag is used, the top of the bag is folded over and the package disposed of in the department. In this way it is possible to keep the carriage clean, and the soiled instruments and gloves are easily handled upon the return of the carriage to the Central Supply Room.

The Central Supply Room nurse will not always be able to replace the binder; therefore, the nurse on the ward follows to do this. It is to be hoped that the nurse assigned to each patient can be present for the dressing; otherwise, any nurse on the department may accompany the doctor and nurse with the carriage and record the changes in the dressing from day to day. If a ward nurse does not go with the carriage, the Central Supply Room nurse must make a note of the changes and give this note to the supervisor of the department.

Important points to be rememered by the nurse in order to assist with dressings are:

  1. Be quick to learn the various dressings in order to have things ready for the doctor.
  2. Be systematic in the arrangement of the covers, towels, dressings and instruments, and the articles on the carriage.
  3. Be conscientious in the help given, never using anything when in doubt as to its sterility.
  4. Be alert in seeing that extra dressings are provided as needed; that nothing comes in contact with the sterile dressings or forceps; that instruments used in the dressing are not reinserted into ointment jars, sponge and packing jars.
  5. Be gentle with the patient in this important treatment.

Fracture Carriage: A cart or carriage set up to carry ropes, pulleys, screws, adhesive, ace adherent, bandages, splints, and all other equipment necessary to put on a splint or Buck's extension is a very helpful service from this department. It may be adjusted as time and space permit so that much of the fracture work on any department may be done from this carriage. Painting Balkan frames different colors helps to keep them together and easy to assemble.

IV. Housekeeping and Supplies

Topic Preview

  1. Routine
  2. Supplies:
    1. Linen
    2. Glass
    3. Instruments
    4. Suture needles
    5. Suture material
    6. Stainless steel and enamel ware
    7. Drugs

Hospital housekeeping is an imortant subject, and all its details should be kept in mind while working in the Central Supply Room. A clean unit, ample supplies, equipment well cared for and in working order will produce the results expected of this group.

Routine: The housekeeping itself should be perfect; the ceiling and walls of the department kept clean as well as the floor. Cupboards, cabinets, and drawers should be cleaned at least once a week; shelves may require daily dusting as supplies are rearranged on them. It is important to remember that if the doors of these cupboards are closed as soon as articles have been removed or replaced, less dust and lint will accumulate on the shelves. Store and splint rooms require going over at least once a week, with a regular time established for taking account of stock. Extra paper and boxes should be disposed of at once. Sterilizers and other metal equipment need weekly polishing-the autoclave a daily scrubbing with soap and water.

Glass syringes, intravenous trays and other much used supplies may require a daily checkup. With so much of the equipment in constant use, and the checking of material out and in, it is possible to know almost daily what is in the department. However, stock taking is important.

All equipment must be ready and in perfect working order at any hour of the day or night. It should always be kept in the same place.

Supplies: The good housekeeper will have plenty of supplies. In this department these will include: Gauze, linen, muslin covers, instruments, glassware, stainless steel and enamel utensils, sutures, suture material, and a certain number of drugs. Here are factors to consider:

Gauze: When ready-made dressings are used in the hospital, there is less handling of material, therefore, less lint so that dressings may be wrapped in the main workroom. When bolts of gauze are cut and folded into dressings, it is well to have a separate gauze room, be it ever so small. Sponges are prepared for use in several ways; small packages wrapped in paper, while larger ones may be wrapped in muslin. Where large quantities of sponges are in use, either on the carriage or in the departments, they are placed in cans and sterilized. In this case, the sterile sponges are removed with sterile forceps. Sponges wrapped with paper may be sealed with Scotch tape; those wrapped with muslin are pinned.

Linen: Large pieces of linen are not needed in this department, but the small pieces used must be in perfect condition before they are wrapped. These include: Gowns, towels, drapes, laparotomy and peritoneal sheets, and muslin covers. They all must be inspected for tears, worn places, and lost strings. The covers for intravenous and hypodermoclysis sets, catheter and douche trays, glass syringes, etc., are made of double muslin, and will wear well if fastened with pins. The corners of the covers should be inspected carefully, and if strings are used, they must be in good condition. All muslin-wrapped packages must have in one corner, plainly visible, the initials of the person wrapping the package, and the date it was wrapped.

Glass: Rinsing after a thorough washing is important in the care of glass. The ease with which it may be broken must be borne in mind. Atomizers used for tannic acid spray are washed with soap and water, especial attention being given the top, as the hole may be clogged. A stylet will open it easily.

Instruments: These utensils are expensive. The initial cost is great, and so is the upkeep; but, with proper handling, these instruments will render the wear they were made to give. Instruments used in the Central Supply Room may be classified as "clean" and "dirty." Those used on known '"clean" cases may be soaked in cold water for a few minutes, then scrubbed with a cleansing powder and lukewarm water. "Dirty" instruments should be soaked for 15 minutes in a five percent lysol solution before scrubbing. Teeth and crevices should receive particular attention; clamped instruments should be opened and separated, then cleaned, dried, and immediately reclamped. A light application of mineral oil may be applied when the instruments are dry. Care must be exercised in the cleaning of scalpels, particularly those used on "dirty" cases. The cutting edge of all sharp instruments should be protected before being put away.

Suture Needles: These needles may not be requested every day, but they must be ready when they are needed. They may be washed as instruments are, but never with them. All points should be inspected before the needles are hut away. When prepared for suture kits or hemorrhage trays, they are stuck in a piece of gauze bandage. When wrapped alone, a piece of cardboard is placed under this gauze to protect the needle and to prevent the point from coming through the cover.

Suture Material: Sutures of all varieties should always be ready for use. They include catgut in all sizes, silk, linen, silkworm, horsehair, and clips.

Stainless Steel and Enamelware: Many important utensils are made of these materials. They are expensive and must be handled carefully. If they are returned from departments in bad condition, the cause should be investigated.

Drugs: The drugs used here are not as numerous as those in the wards or on private floors, but an ample supply of the ones required must be on hand. Ointments are sterilized for various uses. Boric acid, zinc oxide, and vaseline, for example, are sterilized in small jars, which are filled about three-fourths full. While boric acid and zinc oxide are cooling, they should be stirred with a sterile tongue blade.

V. Trays Available in the Central Supply Room

Intravenous Tray
1 intravenous set (muslin wrapped)
1 flask solution
1 flaskholder
1 splint (padded)
1 mackintosh covered with towel
1 accessory tray containing:

1 bottle alcohol, 70 per cent
1 bottle isotonic iodine
1 jar sponges or cotton balls
1 tourniquet
1 file
1 2-cc. syringe and needle
1 No. 19 needle, 1 1/2 in. or 2 in.
1 1-cc. amp. 2 per cent novocaine
1 2-in. bandage
1 roll 1/2-in. adhesive

Gloves optional
Standard may be sent out with tray.

Intraperitoneal Tray
1 50-cc. syringe with adapter
1 20-cc. syringe
1 No. 20 short bevel needle
1 No. 22 short bevel needle
2 applicators
1 small piece of best cotton
Solution at proper temperature
When tray goes out, send accessory trag with sterile gown and gloves; Tr. metaphen and collodion.

Hypodermoclysis Tray
1 hypodermoclysis set (muslin wrapped)
1 flask solution
1 flaskholder
1 accessory tray
Gloves optional
Standard, if required.

Accessory Tray
Alcohol, 70 per cent, sprinkler top bottle
Isotonic iodine, 3-oz. bottle
Jar for sponges or cotton balls

Wangensteen Tray
I duodenal drainage tube - Levine, Rehfuss or Wangensteen
Sod. bicarb.
1 16-oz. graduate
1 large kidney basin
1 medicine glass
1 teaspoon
1 large basin (for ice)
1 rubber apron
1 mackintosh covered with towel
1 2-oz. Luer syringe (with tubing and connector)
Drainage apparatus (Wangensteen)

Lumbar Puncture Tray
1 2-cc. syringe
1 No. 24 and 1 No. 22 needle
3 spinal needles: No. 20 32 in.. No. 20-3 in., No. 18--3 1/2 in.
1 spinal manometer with adapter
2 specimen tubes marked I and 2
1 laparotomy sheet '
4 applicators
1 small piece best cotton
When tray goes out send: Accessory tray, collodion, I amp. novocaine 2 per cent, adhesive 1/2 in., sterile gown, and gloves.

Tonsil Hemorrhage Tray
6 curved Kelly hemostats
2 straight Kelly hemostats
2 Allis forceps
1 plain forceps
1 toothed forceps
1 straight scissors
1 pillar retractor
1 needle holder
2 curved needles
8 tonsil sponges
12 3x3 gauze sponges
1 2-in. bandage
1 sol. cup
Metal tongue blade, sutures and sterile water added when tray goes out, also head lamp or mirror and can of tonsil sponges.

Venous Section Tray
1 scalpel. No. 10 blade
4 mosquito hemostats
1 probe
1 grooved director
1 toothed forceps
1 plain forceps
1 scissora
2 cannulae-1 glass
1 aneurysm needle
2 straight skin needles
1 lap sheet
5 applicators
1 2-cc. syringe and needle
12 3x3 gauze sponges
1 2-in. bandage
Add sterile water to sol. cup and suture material to tray. Also send accessory tray, 1 amp. novocaine 2 per cent, sterile gown, and gloves.

Scrub Tray
4 solution cups
12 cotton balls
4 dressing towels
2 111's
1 2-in. bandage
Solution added to tray when ordered.

Shave Tray
1 sprinkler top alcohol, 70 per cent
1 tube shaving cream
1 towel
1 safety razor with extra blade
1 straight razor with extra blade
1 solution basin
12 cotton balls
4 applicators
8 3x3 gauze sponges
1 small rubber sheeting
Solutions added to tray before it leaves room. No bichloride used on bone cases.

Suture Tray
1 lap. sheet
4 applicators
1 scalpel No. 10 blade
3 mosquito hemostats
4 straight hemostats
1 curved Kelly hemostat
1 straight scissors
1 needle holder
1 toothed forceps
1 solution cup
2 Allis forceps
2-cc. syringe
1 No. 24 and I No. 22 needle
6 curved cutting edge needles
2 straight skin needles
12 3x3 gauze sponges
1 111
1 2-in. bandage
Add water to sol. cup, take accessory tray, 1 amp. novocaine 2 per cent, adhesive, gown, and gloves.

Blood Culture Tray
Alcohol, 70 per cent
Tr. iodine
Jar of cotton balls
Alcohol lamp and matches
10-cc. syringe
1 No. 22 and 1 No, 4 needle
Also scrub tray
Removing 2 towels, Ill's and I sol. cup
Adding 3 sterile applicators and the solutions.

Male Catheterization Tray
2 solution cups
1 large kidney basin
1 16-oz. graduate
1 catheter introducer
1 catheter container with Nos. 16-18-20 catheters
1 towel
4 3x3 gauze sponges
1 111
1 gauze sponge for K.Y.
Solutions and K.Y. added when tray is ordered, also gloves.

Male Bladder Irrigation Tray
To regular catheterization tray add asepto syringe. Use graduate on tray for solution, which is added when tray is ordered, also K.Y. and gloves. Check temperature of solution.

Female Catheterization Tray
2 sol. cups with 4 cotton balls in each
2 large and 2 small cotton balls on tray
1 large cotton ball between them
1 perineal sheet
1 8-oz. graduate
1 med. sized kidney basin
1 catheter container with 2 No. 12-14 catheters
Nos. 8-10 catheters on child's tray
K.Y. on cotton ball and sol. in cups when tray is ordered. Add gloves.
Sterile bottle when sterile specimen is to be obtained.

Female Irrigation Tray
Large white enamel tray-2 quart irrigation can
Y connector
2 sol. cups, 4 large cotton balls in each
3 large and 2 small cotton balls
1 large kidney basin
1 hemostat
2 No. 16 catheters
1 medicine glass
Solution added when tray is ordered, also gloves. Asepto syringe or funnel may be used instead of can.

Coionic Irrigation Tray
I gal. irrigating can
I gal. pitcher
1 kidney basin
2 clamps
5 rectal tubes: No. 22-No. 32
Y connector

Douche Tray
2-qt. irrigating can with rubber nozzle
1 sol. cup with 4 cotton balls
4 cotton balls
1 small kidney basin
Perineal repair:
Nos. 16-18 catheters
6 3x3 gauze squares
1 V.P.
2 small cotton balls
Solution proper temperature is added when tray is ordered. Gloves.

Eye Tray
1 sterile eye flush jar with solution
Jar with cotton balls
1 kidney basin
Mackintosh covered with towel

Enteroclysis Tray
2-qt. irrigating can with tubing
1 Murphy drip
1 clamp
1 glass connector
1 catheter No. 18

Ear Tray
1 ear syringe
1 medicine glass
1 medicine dropper

Gastric Analysis Tray
1 mackintosh covered with towel
1 med. sized kidney basin
1 med. sized basin
1 Rehfuss tube
1 medicine glass
1 bottle glycerine
1 2-oz. syringe
1 specimen rack
1 small roll adhesive
1 safety pin, 1 clamp

Venous Pressure Tray
1 manometer with adapter
1 10-cc. syringe, Nos. 19-20-21 needle
2 applicators
Lap. sheet
Accessory tray, gown, gloves
1 amp. novocaine, 2 per cent

Vaginal Examination Tray
1 sol. cup with 4 cotton balls
1 perineal sheet
2 applicators
3 cotton balls on tray
1 med. sized kidney basin
2 glass slides in container
1 uterine forceps
Solution, K.Y., and gloves are added. Speculum if necessary.

Flaxseed Poultice Tray
Olive oil
Sod. bicarb.
Double boiler .
Spatula and wooden spoon
1 enamel graduate, 16 oz.
Sol. cup with 4 large cotton balls
Wax paper
Small tray with dressing towel

Mustard Plaster Tray
Mustard, flour, olive oil in proper containers
Measuring spoons
Wooden spoon
Basin (small)
1 sol. cup with 6 cotton balls
Wax paper
Hot water bottle
Small enamel tray with dressing towel

Nasal Packing Tray
2 nasal specula
1 metal applicator
1 nasal forceps
1 No. 12 catheter and 1 piece black silk
1 scissors
1 medicine glass
6 3x3 gauze sponges
1 piece good cotton
1 hemostat
1 medicine dropper
1 1in. bandage
When going out, add bottle Adrenalin chloride and 1 bottle 1/2-in. packing

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