Chapter 14 - Cavity Embalming

What equipment is required for cavity injection?

*gravity cavity injector or other injector device connected with tubing to the trocar *disinfectant/preservative chemicals

What is the timeline for aspiration and injection?

Immediately after arterial injection or several hours after arterial injection

Samuel Rodgers

Invented the trocar, in 1878

We aspirate and treat the cavities because:

1. Cavity embalming treats the contents of the hollow viscera 2. The walls of the visceral organs that might not have received sufficient arterial embalming. 3. Proper cavity treatment will help delay decomposition, prevent gas, odor and purge

What equipment is required for aspiration?

A pointed, sharp trocar A device to create suction or a vaccum Flexible tubing or hose to connect the two

proper procedures for injection of cavity chemicals?

After complete aspiration of the thoracic, abdominal, and pelvic regions, cavity fluid is injected (usually by gravity) within the hollow organs and over the viscera. It's important to inject fluid near the anterior surface of the viscera and then allow the fluid to gravitate to lower regions. DON'T dilute cavity fluid, ALWAYS use at full strength.

purge:

The postmortem evacuation of any substance from an external orfice of the body as a result of pressure

Insturment used to aspriate the throat?

a clear plastic tubing

Do we begin treatment above or below the diaphram?

above the diaphram

Advantages to delayed aspiration:

allows sufficient time for arterial fluid to penetrate tissue spaces. Helps pressure the walls of the visceral organs. Most embalmers will delay aspiration for a short period. The length of time it takes to clean the embalming machine and perform terminal disinfection of the body may be long enough. It is best to aspirate prior to suturing incisions made for arterial injection (any surgical drainage opening should be closed before aspiration of the cavities)

Linear trocar guides (surface guides): Right Atrium of the Heart

an imaginery line from the point of entry to the right ear lobe Is lined up with the Right Atrium of the heart.

general remedies of purge:

aspiration and reaspiration of all cavities and of cavity fluid into all areas

Cavity treatment is a 2 step process.....

aspiration of the cavities, followed by the injection of a strong preservative/disinfectant chemical.

obese bodies require additional cavity treatment:

bodies with ascites and hydrothorax require special attention any evidence of abdominal surgery may predispose of purge pack all orfices tightly with cotton re-pack if cotton becomes saturate use AV plugs when necessary stop purge from mouth or nose as a last resort the esophagus may be tied off or severed

What types of bodies are not reaspirated?

cadavers used for science or when a body is embalmed prior to an autopsy.

how do we protect the skin from the contents of purge?

coat the nose, lips, mouth and surrounding areas with massage cream

anatomical trocar guides (internal guides): stomach

direct the trocar point toward the intersection of the 5th intercostal space and the left mid-axillary line, continue until the trocar enters the stomach.

anatomical trocar guides (internal guides): cecum

direct trocar toward a point 1/4 the distancefrom the right anterior-superior iliac spine to the symphysis pubis. Keep the point of the trocar up near abdominal wall until within 4 inches of the right anterior-superior iliac spine; then dip the point 2 inches and insert it foward into the cecum of the colon.

lung purge:

frothy with air bubbles color may be clear, off white or yellow white may be tinged with red blood very little odor may contain arterial solution in addition to fluids from the respiratory tract

Differences between fuming and non-fuming cavity chemicals:

fuming = high index non-fuming = low index (5 or 10), but with other preservatives

Linear trocar guides (surface guides): stomach and cecum

imaginary line from left axillary area, through the point of entry, to the lower right quadrant * this directs you towards both the stomach (upper left quadrant and the cecum lower right qudrant)

Linear trocar guides (surface guides): urinary bladder

imaginary line from the point of entry to the pubic bone (symphysis pubis)

What time are the time periods for cavity treatment?

immediately following arterial injection or sereral hours after arterial injection

when should the throat be aspirated?

just before dressing & casketing

anatomical trocar guides (internal guides): urinary bladder

keep the point of the trocar up near the abdominal wall, directing to the median line of the symphysis pubis until the point actually touches the bone. Retract the trocar slightly and insert into the urinary bladder.

5 types of purge:

lung purge stomach purge brain purge anal purge false purge (fluid purge)

stomach purge:

may be liquid or semi solid usually resembles coffee grounds has an odor and is acidic may contain stomach contents, blood, or arterial solution

Anatomical trocar guides (internal guides): Right Atrium of Heart

move trocar along a line from left anterior-superior iliac spine and the right ear lobe. After te trocar has passed through diaphram, depress the point of the trocar and enter the heart.

general causes of purge:

pathological conditions of the stomach, intestines, lungs, trachea or esophagus visceral expansion due to high rate of flow or excessive machine pressure. gas in the abdominal cavity due to digestion or decomposition. aneurisms along any part of the aorta. invasive surgical procedures

when might purge take place?

prior to embalming during to embalming after embalming

procedure for purge with good drainage:

proper distribution is not taking place, sectional embalming is indicated

Indication procedure for cranial aspiration:

putrefaction of the brain is indicated by bulging eye balls, with purge from the ears & nose. the text suggests use of only the right nostril. a small trocar is used to puncture the cribiform plate of the ethmoid bone. at this point the trocar enters the anterior portion of the cranial cavity. It is NOT possible to aspirate the posterior portion of the cranial cavity. cavity fluid (only a few ounces) is injected with a hypodermic syringe and long needle. tightly pack nostrils with cotton to prevent leakage.

When might the use of an electric aspirator be required?

recommended for areas with poor water pressure to create a vacuum

general treatments for purge:

relieve abdominal pressure and distention from gas remove edema from the abdomen aspiration...aspriation...aspiration tightly packing orfices before dressin and casketing

Cavity fluid for the average 150 lb. body?

text recommends: 3 bottles of cavity fluid; 1 bottle (16 oz.) for each region: thoracic, abdominal and pelvic. many embalmers use 1 bottle of cavity fluid above the diaphram & 1 bottle below diaphram A poor practice is to restrict the cavity fluid to 1 bottle; 1/2 above diaphram and 1/2 below diaphram

why does purge develop?

there must be a substance present to purge, must be pressure in (or out) an organ

When do Embalmers prefer to reaspirate?

they prefer to wait as long as possible before initial aspiration, then reaspirate just before dressing.

Cavity treatment for partial autopsy and organ donations:

treat walls of the autopsied body with hyperdermic injection and autopsy gel or powder. fill the cavity with absorbent material and saturate with cavity fluid. treat the unautopsied areas with normal aspiration and cavity treatment

At what levels (depths) should cavity fluid be injected?

trocar should never be at a deep level injection, it should be into and over the viscera

anal purge:

very dark and resembles pitch or tar liquid or semi-solid odorous (skatole, indole, mercaptan) allow to continue to purge encourage purge with firm pressure to the lower adbomen don't pack till after cavity treatment content may contain fecal matter, arterial solution and blood

When might one aspirate before embalming?

when abdomen is distended from gas or edema

fluid purge or false purge:

with cavity fluid any blood will be brown in color purge of arterial fluid will be same color of arterial fluid used purge or arterial fluid may be an indication of a ruptured major artery

What is required to make a hydroaspirator work properly?

1. installation on cold water line with sufficent water pressure. 2. a vacuum breaker is normally part of the plumbing installation to prevent backflow into the water line 3. a piece of plastic or glass tubing. 4. a hydroaspirator itself.

3 ways to close the trocar entry point:

1. trocar button, easily removed for re-aspriation 2) sutures - "purse string" or "N stitch" sutures should be tied in a bow, to allow for reopening to aspirate. 3) if body has distention from gas then entry may be left open and covered with bandage - (not recommended for bodies that are to be shipped)

2 methods for removing gas or edema from the abdomen:

1. using a scalpel make a puncture at the standard point of trocar entry and insert a blunt trocar or drain tube into the hole. This will allow aspiration of most of the glasses or fluid. 2. using a scalpel make a puncture in the left inguinal area of the body. Fluid will gravitate to this lower location and gas may also be removed.

Where is the point of trocar entry

2 inches to the left and 2 inches above the umbilicus (navel). There is nothing special about this location, except it provides a common point of reference.

Advantages to immediate aspiration:

Prevents the production of gas that may cause purge. Removes microbes that may accelarate decomposition. Removes blood from heart, liver. and fluid from lungs. Removes semi-solid contents of the hollow viscera that may contribute to bacterial translocation. Allows immediate channeling of the neck that may reduce swelling of the facial tissues.

brain purge:

creamy white and semi-solid caused by swelling or putrefaction of the brain, or head trauma may contain brain tissue, arterial solution & blood

indications for reaspiration:

obese bodies drowing victums when there is purge bodies that have ascites if decomposition is present all bodies that ship in all bodies that ship out it there is presence of gas or distention blood injection, peritonitis, septicimia, pnemonia any distention or swelling of the neck or facial tissues (or back of the hands)