Embalming 2 Chapter 18: Preparation of Organ and Tissue Donors

What are the 2 methods for the preparation of long bone donors:

Method 1: --> the incisions are opened. Method 2: ---> if the sutures are tight, they are not opened. ---> use when femur, tibia, and fibula have been removed. ---> "free flow method"

*4 PROCUREMENT INCISIONS (INTERNAL ACCESS)*

(1) A midline incision that runs from the base of the neck to a point superior to the umbilicus for: ---> heart, lung, or a heart + lung procurement. (2) A midline incision that runs from the base of the sternum to the pubic bone for: --> liver, kidney, pancreas, and/or small bowel recovery. (3) A "T" incision that transverses the abdomen along the inferior margin of the ribcage, and a midline incision from the base of the sternum to the pubic bone for: ---> liver, kidney, pancreas, and/or small bowel recovery. (4) A midline incision that runs from the base of the neck to the pubic bone if a full recovery was done.

*HOW TO CONTROL SWELLING OF THE EYELIDS* (caused by eye enucleation)

(1) Use restricted cervical injection to control arterial solution to the head. (2) Avoid preinjection procedures. (3) DO NOT use weak arterial solution (recommended slightly stronger than average). (4) Avoid excessive manipulation of the eyelids prior to embalming. (5) Let embalming solution drain from the eye during arterial injection. *(6) Avoid rapid rates of flow and high injection pressure during arterial injection.*

For long bone donors, what does the strength of arterial solution accomplish?

(1) if a smaller volume of solution is distributed to the tissues and the muscles, the higher concentration of preservative will, to a certain extent, offset the lack of volume; (2) there is some possterm-27ibility that arterial solution which pools in the tissue spaces will penetrate the tissues and provide some preservation.

*RESTORING EYE AFTER ENUCLEATION*

(1)BEFORE ARTERIAL INJECTION apply massage cream around the eye (2) Remove packing from eye. (3) Autopsy gel on cotton loosely fill orbital cavity. (4) Fill the eye with cotton to recreate normal appearance of the closed eye. (5)Embalm the body. ---> if swelling begins, strengthen solution so minimal amount can be injected. ---> If swelling is excessive, stop injecting and hypo instead. (6) AFTER ARTERIAL INJECTION, remove the autopsy gel saturated cotton and dry the orbit. (7) Place incision seal powder or mortuary putty in the base of the orbit. (8) Pack the orbital cavity with cotton, kapok, or mortuary putty. (9) Exercise the eyelids and insert eyecaps over the filler. (10) Glue the eyelids closed.

*2 Options for the Arterial Injection of an Organ Donor*

(1)EXTERNAL ACCESS: ---> embalming is accomplished by raising vessels at ONE of the commonly used injection and drainage sites. (2)INTERNAL ACCESS: ---> the embalmer opens the procurement incisions and injects the body utilizing arterial structures that remain intact

*The Partial Thickness Method employs an instrument called ?*

- Dermatome ---> it is used to peel or shave very thin layers of the skin.

Donor skin is removed by 2 different methods:

- Partial thickness. - Full thickness.

*The Full Thickness Method or Free-hand Method*

- Removes skin and connective tissue structures down to the muscle layer of the skin. ---> This method removes the vascular layer of the skin. !!!! ------> (Generally, less leakage will be seen during the embalming when the free hand method is used.)

*proximal humerus and scapula removal en bloc*

- Vascular system should be intact. -body =prone position which can cause swelling, discoloration and disfigurement from pressure. -incision is made along superior margin of the scapula, laterally across the shoulder and down posterior portion of upper arm

Skin can be removed from the?

- back - buttocks - lower legs. - chest

*TISSUE*

-A collection of similar cells and the intercellular substances surrounding them.

*ORGAN*

-Any part of the body exercising a specific function such as respiration, secretion, and digestion.

proximal humerus donation includes what?

-Only humeral head and the upper portion of the humerus, ---> scapula is also taken.

*What is the Uniform Anatomical gift act?*

-Permission to donate organs, any person 18 years or older, donation card,

*what are some complications with vertebral donation?*

-Punctures in the skin of the back. --->(inspect for leakage). - Loss of rigidity in back. --->(overcome with limbz system or prosthetic's). vertebral donation rarely takes place without other organs/tissue being harvested: ---> Locating transected vascular structures. ---> leakage is always a possibility. ---> reconstruction of the backbone may be necessary if the tissue bank does not complete it

*ORGAN DONATION*

-The procurement and transplantation of any body part that fulfills such a specific function. ---> kidney, heart, liver.

*TISSUE DONATION*

-The procurement and transplantation of tissues which include the skin, eyes tissue, ligaments, and bones.

*MANDIBLE DONORS*

-Usually not used if there is a viewing. - not a common practice.

*When must tissue recovery be completed?*

-Within 24 hours if refrigerated and 15 hrs when there is no refrigeration.

*incision for long bone donor*

-anterior surface of each leg from the hip to the mid-foot.

*With restoration what is a key component?*

-communication between funeral home and harvest team

*4 basic tissues*

-connective, muscle, epithelium, nerve

*What are the 4 basic tissues?*

-epithelium, connective, muscle, nerve

*What are some considerations with rib donation?*

-every other rib is donated. -disruption to intercostal arteries. - increases leakage.

*What are some complication with Mandible donors?*

-facial artery is disrupted, -obvious reconstruction issues, -distinct facial features are totally removed, -swelling and leaking, accidental cuts on face

*long bone donor includes what?*

-femur, tibia, fibula, and hemipelvis

*Eye Enucleation*

-harvest of entire eyeball

*What organs are being removed for donation?*

-heart, -lungs, - liver, - kidney, - pancreas - small bowel

*What are some general considerations with a donor case?*

-heparin problems. -trauma, -delayed embalming, -hypo not unusual, -surface packs, -plastics,

*proximal humerus removal*

-incision is lateral along anterior/superior surface of shoulder. -no vascular interruptions.

what to expect with posterior incision approach (Vertebral body donor)

-incision runs from scapula to level of sacrum. -vascular system shouldn't be compromised if done properly. - possibility of leakage. - reconstruct the body to provide rigidity of the spine/ removed tissues. -apply phenol packs prior embalming. -tight sutures help prevent leakage.

what to expect with anterior incision approach (Vertebral body donor)

-incision runs from xiphoid process to pubic bone. -massive vascular interruption. ----> aorta will be cut in both the thoracic and abdominal cavities, and renal vein(s) will be cut. - Procurement specialists ligate cut vessels. ----> Can inject thru the ends of transected vessels; watch for solution lost in the abdom./thoracic cavities. -selection embalming as needed

*how to embalm abdomen and legs when thoracic organs have been removed*

-inject down the aorta -clamp off aorta and inject up and down right or left femoral artery

*how to embalm thorax, head, and arms when abdominal organs have been removed*

-inject up the aorta -restricted cervical -right or left axillary

*Scleral rim excision*

-only cornea is removed

*What is the Temporal bone prep?*

-pack area where plug was removed. -cauterize area prior to suturing. -pack external ear canal. -if brain is present inject a couple of ounces of cavity chemical is a good idea to prevent gas.

*Where is the incision located when there is a posterior incision for vertebral body recovery?*

-scapula to sacrum

*What are some commonly transplanted tissue types?*

-skin, bone, blood, cornea, ligaments, cartilage

*what are some eye enucleation problems?*

-swelling or distention in and around the orbital cavity. -ecchymosis -small lacerations

*What does a skin donor donate specifically?*

-thin layer of skin taken via dermatome

*Heparin*

-this drug is commonly used prior to the removal of a donated organ to keep blood from clotting

*Why are the Temporal bones removed?*

-to capture the ossicles of the ear.

*what are some complications with embalming donor bodies?*

-vascular interruptions -use of heparin -delayed embalming -procurement itself

*gigli's saw*

-wire surgical saw used in bone procurement

*Where is the incision located when there is an anterior incision for vertebral body recovery?*

-xiphoid process to the pubic bone

*Keys to successful autopsy and organ donor embalming*

1. knowing anatomical structures and relationships. 2. anticipating which vessels have been cut.

3 main problems associated with skin donors:

1.) Body was Prone for removal, this may create a blood discoloration of the facial tissues. 2.) Drying of the affected areas from which skin has been taken. 3.) Control of the: ----> 1. seepage or leakage from the area where skin has been taken ----> 2. leakage from the borders surrounding the areas where skin was removed.

Steps for discoloration of facial tissues in skin donors:

1.) Elevation shoulders and head. 2.) Disinfect the facial tissues, eyes, nasal, and oral cavities. ---> Wash/ dry the face/hair. ---> Apply massage cream. 3.) Pack the throat and set the features. 4.) Use restricted cervical. ---> For the unautopsied body, inject the head draining from the R. internal jugular vein (possibly draining from both jugular veins). 5.) Use higher strength fluid; inject slowly. ---> massage tissues.

Method 3 prep of the legs (long bone donor): "Saturated packing"

1.) OPEN ALL SUTURES. 2.) Legs are packed with an absorbent material and resutured. ---> begin at foot. 3.) saturate the packing with cavity fluid. ---> creates internal compress. 4.) Inject Larger muscles of thigh with infant trocar. 5.) Can apply gel to skin with plastic garments.

Embalming by opening the procurrment incisions for proximal humerus/ scapula donors: (before/after arterial injection)

1.) Open incision to examine if vessels are cut/broken. 2.) If no disruption is found in either the axillary or brachial arteries: ---> Looks for cuts/breaks in the anterior + posterior humeral circumflex A.'s, or in the profunda brachii A. 3.) If axillary or brachial A is cut/broken: ---> Ligate the proximal and distal end of the artery. --------> ligation of proximal end = controls leakage during emb. of rest of body. --------> ligation of distal end= anatom. marker for later injection site. 4.) If either axillary or basiclic A are cut/broken: ---> clamp proximal and distal ends. 5.) Can allow drainage from cut/broken veins as arterial injection takes place.

EMb. consideration for proximal humerus/ scapula donors:

1.) Opening the incision site will not always show cut/broken vessels. 2.) monitor site for leakage/distension. 3.) Blood leakage from site during injection may be from axillary V, basillic, or another tributary V. ---> try to ligate vessels to prevent postmortem leakage. 4.) Arterial solution leakage = vessel providing circulation to arm/hand is disrupted. ---> inject arm/hand separately from rest of body. 5.) If the axillary artery or the brachial A is cut/broken: ---> Proximal end = clamped. ---> distal end can be used as secondary injection site for arm/hand. 6.) Determine if supplemental emb. is needed. 7.) LIGATE ALL CUT/BROKEN VESSELS. 8.) if leakage is controlled, dry site. 9.) pack incision with saturated cotton (phenol) ---> can remain in place/ be removed . 10.) suture/ incision sealing powder. 11.) external liquid sealer/cotton for leakage control.

Treatment of PARTIAL thickness donors:

1.) Spray skinless areas with disinfectant and pat dry. 2.) Elevate body on bridges. 3.) May be excessive leakage from skinless areas. ----> can try to air dry for awhile. 4.) Turn the body on its side. ---> Dry and inspect the raw areas. 5.) Paint with a cautery agent/ preservative gel. 6.) Cover the painted areas with absorbent material. 7.) Plastic garments +hardening compound for absorbency.

How to restore eye with cornea removal

1.) The body can be injected with any technique and solution strength. 2.) THE EYES CAn BE SET AFTER ARTERIAL INJECTION. 3.) remove packing, aspirate eye to prevent leakage. 4.) restricted cervical if trauma present. ---> use normal strength if not. 5.) DURING EMB. pack eye with saturated cotton. 6.) AFTER, fill orbit with mortuary putty/ incision sealer. 7.) eyecap. 8.) superglue.

Treatment of Full thickness + long bone donation cases:

1.) Vascular system layer of tissue= removed so there is less leakage from surface. ---> try to dry tissues out. ---> elevate with body bridges. 2.) First, embalm the body. 3.) Prepare the boneless limbs. ---> Tightly suture the extremities from which the bones have been removed. 4.) Finally, prepare the areas of the body from which the skin has been removed.

Method 2 prep of legs (long bone donor): ---> "FREE FLOW METHOD"

1.) leave incisions sutured. 2.) Raise R.+ L. external iliac arteries. ---> or R.+ L. femorals. 3.) Insert drain tubes directed down the legs. ---> solution should be high index/waterless. ---> Inject legs with at least 1/2 gallon each. 4.) Stop injection and allow for saturation of tissues while arms, head, and trunk are injected. 5.) Use scalpel to place a puncture in lower leg and insert drain tube/trocar to force as much solution out of the leg. ---> the packing from the procurment team will act as internal compresses. 6.) surface glue all incisions.

External access for emb. organ donors:

1.) raise arteries and veins at one of the commonly used injection and drainage sites. ---> (probably will turn into a multipoint bcuz of vascular damage). 2.) Monitor for distribution. 3). Monitor for for indicators that the ligatures on vessels affected by the procurement are preventing leakage. (4) If procurement ligatures = absent/fail: ---> anticipate excess leakage from procurement incions/ distension cause dby accumulation of liquids in cavities. ---> if leakage/distension = severe, open incision.

Method 1 prep for legs (long bone donors)

1.) support incised tissue with head blocks: ---> to create channel for the drainage of blood and fluids. 2.) Remove all sutures: ---> do not remove prosthetic devices. 3.) locate ligatures place or ligate vessels. ---> LIGATE L. AND R. FEMORAL ARTERIES. 4.) use restricted cervical to emb. trunk, hops, head, neck, and upper extrem. ---> (do not let fluid flow into legs during injection of upper body). 5.) INJECT THIGHS/LEGS USING L. + R. FEMORALS. 6.) INJECT LEG/ FOOT USING L.+ R. POPLITEAL/ TIBIAL ARTERIES. 7.) Hypodermic injection as needed. 8.) after arterial emb., dry tissue with cotton. 9.) Coat tissues with drying/preservative compound. 10.) Suture. ---> add more drying/ preservative compounds wile suturing. 11.) bathe. 12.) Apply cotton/liquid sealer to sutures for leakage barrier. 13.) Plastic garments. NOte: ---> if no internal structures are found from mid-thigh to mid-ankle, use cavity packs/ gels prior to arterial emb.

3 access points (incisions) for vertebral harvest:

1.) thru the already existing incision following organ recovery or autopsy. 2.) ANTERIOR incision (no autopsy or organ recovery performed). 3.) POSTERIOR incision. ---> (used mostly when no previous postmortem invasive procedures occurred, but can be used after autopsy/ organ recovery).

Embalming without opening the procurrment incisions for proximal humerus/ scapula donors:

1.) vessels should be intact. 2.) Employ standard emb. ---> Use a cervical or femoral injection/drain site. 3.) Monitor procurement site for distension/leakage. ---> if distension occurs, determine if procurement site needs to be opened.

one of the tissues most commonly transplanted is

cornea donation/ enucleation

Embalming organ donors is similar to?

embalming an autopsy case

for organ donations use what type of index

high index due to the time delay.