<It is a pinching feeling and has been known to turn the areola and
nipple a dark purple even with less pressure than is required to evert
the
nipple.>

Cathy Liles has made a good point in the use of Nipple pullers, no matter
the type. This caution also applies to some types of shells with small
openings. Care must be taken to observe the tissue circulation closely.

Cyanosis of the nipple means too much unrelieved vacuum has been applied
for too long. This is a sign of obstruction of the circulation in the
nipple skin and possibly much deeper.

The trapped blood changes color as it gives up its oxygen, and the
occlusion has kept fresh blood from entering the capillaries. If no
tenderness is noted then, it will almost certainly be noted within 24
hours.

It is less traumatic to the tissues to apply less vacuum for a shorter
time and progress slowly as the mother's comfort the following day
dictates.

I also agree with her that it can be very enlightening for an LC to try
some of the paraphernalia on herself. Things are not always as simple as
they might seem!

Jean
*********************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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