Embalming Chapter 15; Treatments after Arterial Injection

CLeaning instruments:

(prior to disinfection) --> Immerse all instruments including trocars in a solution of Bard-Parker disinfectant (8% by volume formaldehyde in 70% ethanol or isopropanol) or in 200 to 300 ppm of an iodophor for 45 minutes or longer.

Things you need for surface embalming

- Chemicals - Cotton - Plastic - Tape or shrink wrap

what are adhesives good for?

- Closing jagged tears in the skin. - to close incisions used to raise vessels.

What during injection can cause distention of the facial tissues, neck or glandular tissues, and eye tissues.

- Excessive amounts of fluid. - Rapid injection. - Too much injection pressure. - Poor drainage. - excessive massage. - too weak of index.

Preventing maggots:

- Keep files out of the prep room. - Examine for fly eggs. - Stuff orifice with cotton. - Different fluids - San veino (hydrocarbon solvent)

Why would you take out an intravenous device before embalming

- Possibly restricted drainage. - Gets in the way (port in jugular) - removal of needles / catheters can cause swelling/ discolorations if removed before emb.

When washing the body after embalming you are looking for what:

- Posterior lesions - Blisters - Ulcers

Examples of internal application of surface packs would be

-Buccal cavity of mouth - Underneath eyelids - Underneath the scalp/ inner trunk ways of an autopsy -Nasal cavity

how must gas trapped in facial tissues be removed? when?

-By channeling ---> open Lips; hypodermic needle/ bistoury knife/ scalpel to channel the face from inside of the mouth. ---> if eyes are affected, exvert lids and incise; use cotton to absorb any leakeage. - AFTER EMB.

Pre embalming distention causes:

-Edema, -tumors, - swelling due to trauma, - distension from gas prodcued by Clostridium p. - distension from allergic reactions. - distension from steriod drugs. - gases in the tissues from subcutaneous emphysema.

Paperwork after embalming includes

-Embalming report -Jewellery and clothing form. - Donation forms

Ways to prevent mold

-Keep bodies dry -Swab with phenol - Re cozmatize

Technique for suturing:

-Keep tight -Pull in thread (not needle) -Take your time -Use different threads

Resetting features after embalming (eyes, mouth)

-Replace wet cotton -Add cotton or posing - compounds to fill

2 methods of closure of incisions:

-Suturing - Super adhesives

After the body has been washed and dried, incisions closed, invasive devices removed, and their punctures sealed, the embalmer should continue the treatment of...

-lesions/ ulcerations - discolorations.

Potential areas of leakage could include:

1.) Any area of trauma to the face or hands where the skin was broken or torn. 2.) Cranial autopsy incisions. 3.) Autopsy sutures. 4.) Surgical sutures. 5.) Sutures at sites where vessels were raised for arterial injection. 6.) Areas where edema is present. 7.) Intravenous punctures. 8.) Punctures used for drawing postmortem blood samples. 9.) Any point where the skin has been broken

Surface embalming of the mouth and lips:

1.) Cotton = placed over the dentures and saturated with cavity fluid. 2.) use a hypodermic needle and syringe to moisten the cotton. 3.) Glue the lips; the preservative works from the inside of the mouth to preserve the tissues. ---> Cosmetic treatment can be immediately implemented using this method of preservation.

Surface emb. of the eyelids:

1.) Cotton can be used for eye closure or a small piece of cotton can be inserted over the top of an eye cap. 2.) Moisten the cotton with a few drops of cavity fluid. 3.) Seal the eyelids with adhesive. --> Cosmetic treatment can begin immediately

Surface emb. of the NOSE:

1.) Cotton saturated with preservative fluid can be inserted into the nostrils. ---> can later be pushed back far enough that it will not be noticeable. 2.) A small gauge hypodermic needle can be used to inject a preservative solution from inside the nostrils into various areas of the nose. ----> (If hypodermic treatment is used, expect some leakage from the injection sites.) ----> Cotton can be placed within the nostrils to absorb the leaking preservative and later removed. 3.) The columna nasi and possibly the tip of the nose can also be reached by injecting from within the mouth.

Procedure to prepare all incisions for closure:

1.) Do not suture until after cavity aspiration; ---> aspiration relieves pressure on the vascular system and helps to prevent leakage. 2.) Be certain all vessels are securely tied. ---> This prevents any further leakage. 3.) If there is edema in the surrounding tissues, force as much liquid out of the incision as possible. 4.) Dry the incision. 5.) Cotton saturated with a cautery solution can be packed into the incision. ---> (can remain within the incision). ---> can be used with incision seal powder to prevent leakage. (6.) Make several sutures before applying the incision seal powder to the incision. ----> In this manner, a "pocket" is created and the powder is retained within the incision and not spread on the surface of the body

Surface embalming can be used to treat:

1.) Intact skin that has not received arterial fluid. 2.) broken skin areas: ---> abrasions, ---> skin-slip, ---> burned tissues, ---> surface lesions.

How is pitting edema fixed

1.) Moved to other areas by mechanical aids: --> gravitation, massage, channeling of the area, and application of pressure (e.g., pneumatic collar, weights, elastic bandage, water collar, digital pressure). 2.) elevation of the head and firm digital pressure. 3.) can use trocar to channel the neck allowing edema to drain from the facial tissues into the thorax (during cav. asp.).

How to tell an area is lacking arterial solution:

1.) No evidence of fluid dye. 2.) Intravascular blood discoloration. 3.) Tissues exhibit no preservation fixation. ---> Fixation is not as intense as expected. 3.) Dyes may be blotchy and not as intense.

Post embalming steps:

1.) Preservative treatments for areas that did not receive arterial solution or did not receive sufficient arterial solution. 2.) Closure of embalming incisions. 3.) Removal (and closure of the opening) of invasive devices (pacemaker, intravenous needles, surgical drains, colostomy apparatus). 4. Washing of the body, turning of the body to dry, and inspect for posterior lesions. 5. Final treatments for ulcerations and discolorations. 6. Corrective treatments for purge and packing of all orifices. 7. Removal of gases or edema from viewable facial areas. 8. Inspection of mouth for purge or moisture; resetting of features if necessary, and insertion of false teeth if these were not available before embalming. 9. Application of adhesives to eyes and mouth. 10. Dressing with plastic garments. 11. Terminal disinfection of instruments and preparation room and personal hygiene. 12. Preparation of documentation, shipping instructions, etc.

Treatment of colostomy bag:

1.) Remove bag. 2.) Pour cavity fluid to sanitize bag and place in the bio-bin. 3.) disinfect area and stoma with cav. fluid or phenol solution. 4.) Pressure on stoma + slight twisting to force bowel back into abdom. cavity. 5.) CLose colostomy (purse string/ "N" suture)

5 steps of embalming:

1.) Select pressure / ROF 2.) Inject solution arterialy 3.) Massage/manipulate body 4.) Control drainage 5.) Treat cavity

4 preembalming steps:

1.) Set features 2.) Position body 3.) Select/raise vessels 4.) Select/ prepare fluid --> also shave, remove medical devices, pack orphices if needed.

Treatment of discolorations post-emb.:

1.) Surface compresses containing phenol solution, an accessory bleaching solution, or cavity fluid. 2.) Treated internally with hypodermic treatment. ---> (less of a delay).

2 SUPPLEMENTAL METHODS OF EMBALMING:

1.) Surface embalming 2.) hypodermic embalming

Treating edema of eyelid (4):

1.) Weighted Surface compress. 2.) cavity fluid on cotton under the eyelids, during and after injection; (3) hypodermic injection of phenol compound or cavity fluid after emb.; (4) heated electric spatula after emb.

Leakage from areas Where the skin has been torn may be corrected by:

1.) a phenol compound surface compress (or cavity fluid compress) 2.) Clean area with a solvent. 3.) Dry with hair dryer. 4.) seal with a super adhesive or surface glue.

Treatments of ulcerations/ lesions post-embalming:

1.) dry tissues/ deodorize ulcerations. 2.) can inject the area around the decubitus ulcer with cavity fluid/ accessory chemicals to combat the gas bacillus that forms tissue gas. ---> use large-diameter hypo needle (6 guage) or infant trocar. 3.) diapers 4.) plastic garments

Cleaning the embalming machine

1.) flush with warm water (and ammonia to remove residue). 2.) leave water in the tank. 3.) wipe down w/ disinfectant.

When anal purge is present after emb.:

1.) force as much purge as possible from the rectum by firmly pressing on the lower abdominal area. 2.) Pack the rectum using cotton saturated with cavity fluid, autopsy gel, or a phenol solution. 3.) Dry packing should be inserted into the anal orifice after the moistened cotton. ---> Leave a portion of the dry cotton so it can be seen to help fully block the anal orifice.

When purge is present from the mouth/ nose immediately following arterial injection and cav. treatment:

1.) re-aspirate and re-inject cavity fluid. 2.) Clean out the orifices 3.) tightly pack with plenty of dry cotton (re-pack the throat area if possible).

Minor seepage (e.g., intravenous puncture) maybe corrected by:

1.) wiping away the accumulated liquid. 2.) injecting a phenol compound to cauterize the area. 3.) sealing the puncture with a super adhesive.

What is a rule of thumb for keeping adhesives together

30 count

Hypodermic needles range from ____ to ____ guages and of varying lengths.

6 to 19 gauges ---> larger needles = 6 gauge.

When should you take out intravenous devices?

After arterial embalming if possible.

Subcutaneous emphysema

Air in the subcutaneous tissue that can be caused by Cpr, a traumatic event, or surgical procedure that punctures the lung.

What fluids can you use for hypodermic embalming:

Arterial fluid or cavity fluid

Double curved autopsy needle is used when

Autopsy Long bone donation Surgical incisions Incisions from raising vessels

Considered the most secure and commonly used; can be airtight/leak proof. ---> Used for injection site incisions, autopsy, long surgical, and long-bone donor incisions. 1.) Pass a suture needle and thread from beneath the incision up through the integument. 2.) Cross the needle from side to side with each stitch. (3) tie the suture closed every 5" for long bone/ autopsies to avoid thread break.

Baseball Stitch

When should you close/ remove a colostomy?

Before or after arterial injection.

Direction of suturing: Popliteal A.

Begin the suture at the inferior (or distal) portion of the incision and suture superiorly.

Direction of suturing: Ant. and Post. Tibial A.

Begin the sutures distally and suture superiorly.

Benefit of using cavity fluid for hypodermic embalming:

Bleaching characteristics due to phenol.

Temporary and replaced later by more permanent sutures; used to align tissues into position.

Bridge Suture (Temporary Interrupted Suture)

Generally used to close long incisions; Frequently it is used by the autopsy technician to close the long incisions from the autopsy. ---> This suture prevents leakage of fluids from the body cavities during transfer from the hospital to the funeral home. 1.) Anchor the suture thread. 2.) Pass the needle through both sides of the incision, starting on the outside of the tissue on one side of the incision and passing directly through and out the tissues of the opposite side of the incision. 3.) Pass the thread over the top of the incision and begin the next stitch 1⁄2 to 1 inch beyond the previous stitch.

Continuous (Whip) Suture.

Difference between pace makers and defibrillator

Dfibs need to be taken out but turned off first

Suture is made with two needles threaded with opposite ends of the same thread. ---> Because this suture is permanently fixed at each end, it has greater holding ability than the single intradermal suture. 1.) Pass each needle through the dermis at opposite margins so that both stitches are parallel, similar to the lacing on a shoe. 2.) After drawing the margins tight, knot the two ends together within the incision. 3.) To end the suture, insert both threads onto one needle and insert it under the skin from the end of the incision to a point 1⁄2 inch away.

Double Intradermal Suture.

A suture needle used to close autopsy incisions, long bone-donor incisions, and incisions to raise vessels.

Double curved autopsy needle

When using adhesives what should you do?

Dry incisions Use glue on entire incisions Hold incisions together until sealed Double check incisions

When will skeletal edema be treated and how

During embalming period High index

Skeletal edema

Edema in body appendages, trunk, and head

Pitting edema

Excess moisture in tissue spaces

Direction of suturing: COMMON CAROTID A.

For parallel incision: ---> suture from the inferior portion of the incision superiorly. For supraclavicular incision: ---> Suture from the medial portion of the incision laterally.

Where should you hypodermically inject the hands and palms?

From the palmar surface of the hand or between the fingers.

Unseen areas surface embalming:

Gels, powders, hypo+ stocking or other plastic garments

Advantages or single intradermal sutture

Hidden and good for exposed spots

This method is used to treat small localized body areas or large areas, such as the trunk walls of the autopsied body or a limb that did not receive sufficient arterial fluid and cannot be injected arterially and is thus injected externally.

Hypodermic emb.

What is the most effective supplemental treatment option:

Hypodermic embalming

Where should you hypodermically inject to treat the elbow if it contains edema?

If the elbow area contains edema, the trocar can also be entered from the upper pectoral region to reach the distended area.

Procedure for hypodermic embalming leg

Infant trocar Medially above or below knee (thigh / calf)

What is the simplest treatment to an area that lacks arterial solution

Inject the area with slightly stronger arterial solution arterially.

Where should you hypodermically inject to treat the trunk walls and buttocks? --> what do u use?

Insert a trocar into the center of the lateral trunk walls.

Where should you hypodermically inject to treat the leg? --> what do u use?

Insert the infant trocar on the medial side of the leg just inferior or superior to the knee. ----> From this point, both the thigh and lower leg can be reached.

Hypodermic embalming of facial area uses

Insulin needles

Suture that creates a tight, leak proof closure. ---> disadvantage = unsightly ridge appears on the surface of the incision. 1.) Begin at one end of the incision and direct the needle through the tissue so that it passes through both sides of the incision from the outside. 2.) lock the stitch by looping the needle through the thread. 3.) When completing the loop, pull the thread tight. 4.) Repeat this process until the incision is closed. ---> (The needle insertion should be made consistently from the same side of the incision).

Interlocking (Lock) Suture.

suture is used to gather in and turn under excess tissues ---> pattern of this suture is the same as that of the single intradermal suture, except that the stitches are made parallel to the incision edges and do not pierce the margins of the incision. - The stitches do not enter the incision except to start the suture. - Not visible and may be waxed as needed. - Suture used for closing a carotid incision or closing the scalp on the cranial autopsy

Inversion (Worm) Suture.

Is cotton or linen thread stronger?

Linen ---> recommended for autopsies, bone donors, and vessels incision sutures.

When would you use interlocking suturing

Long bone donations

Bad thing about syngel

May turn skin blue

What are some types of medical devices removed after embalming

Pace maker Iv needles Surgical drains Colostomy apparatus

What is a way to cheek if there is no preservation fixation

Pinch test

If transferring to a recieving FH the body how should hands be positioned (if instructions were not given)

Placed on abdomen

Use of 3/8 inch circle needle

Restorative and vessel rasing incisions

Made with one needle and a single thread; used on exposed areas of the body and is directed through the subcutaneous tissue only. 1.) insert the needle deep into the tissues at one end of the incision. 2.) Make a knot in the thread a short distance from the end and pull the knot to the position of the needle puncture in the integument. 3.) Direct needle through the dermal tissues only, develop a back-and-forth pattern from one side of the incision to the other.

Single Intradermal/ subcutansous (Hidden) Suture.

How much gas will arterial injection remove

Small portion of gas

Crepitation

Spongy feel of gas in the tissues caused by subcutaneous emphysema.

If swelling/ distension occurs during injection what should you do

Stop injection immediately and Evaluate situation

When would continuous (whip) stitch be used

Surgical closer Autopsy closure Long incisions

Direction of suturing: Radial and Ulnar A.

Suture from the distal portion of the incision medially.

Direction of suturing: Femoral A.

Suture from the inferior portion of the incision superiorly.

Direction of suturing: Axillary A.

Suture from the medial area of the incision laterally (with the arm abducted).

Direction of suturing: Brachial A.

Suture from the medial portion of the incision laterally with the arm abducted).

comprises the disinfection practices carried out after the embalming process to protect the environment and includes personal hygiene for the embalmer as well as disinfection of the instruments, equipment, and preparation room.

Terminal disinfection

Where should you hypodermically inject to treat the arm/forearm. --> what do u use?

The infant trocar can be used inserted inro the area of the cubital fossa of the arm to reach the arm and forearm.

Interlocking suturing is identified as

Tight leak proof Unsightly ridge

Disivatages of the baseball sutture

Tissues adjacent to sutture are pulled into a ridge

How do you close a hypodermic embalming insert in a nonviewable spot:

Trocar button

Gluing features:

Use adhesive to seal mouth and eye: ---> make sure surface is dry/ clean with a solvent. - lips: ---> keep glue behind the weather line. - eyes: ---> keep glue away from lashes apply to eye cap or inside like of closure

Direction of suturing: Autopsies (Trunk standard Y incision)

Use bridge sutures to align the skin into position. Begin the trunk suturing at the pubic symphysis and suture superiorly.

Where should you hypodermically inject to treat the ears?

behind the ears

Where should you hypodermically inject for facial areas?

from inside the mouth to avoid leakage. --> In the autopsied body, large portions of the face can be reached through scalp incisions.

Where should you hypodermically inject to treat the nose?

from the inside of the mouth

Surface emb. can be applied both ______ and ______.

internally and externally

The chemicals used for surface emb. come in what forms:

liquids, gels, and powders.

Rubber-based adhesives do not work well on?

moist/ oily surfaces.