Embalming - Drainage & Blood Removal

ONE TO FOUR HOURS

For normal cases, what is the recommended time to delay the initial aspiration and cavity injection?

INJECTION PROCEDURES

From the standard entry point, develop a pattern of dispersing the limited volume of fluid into the entire ventral cavity - Sweep from right to left at different levels

25 PERCENT

How much blood is drained from the body by trocar aspiration?

50 PERCENT

How much of the blood is drained from the body by venous drainage?

25 PERCENT

How much of the blood volume remains in the body after aspiration?

IT SHOULD BE ALLOWED AND EVEN ENCOURAGED TO CONTINUE

How should pre-embalming or con-current embalming purge be treated?

CONFIRMED INFECTIOUS DISEASE CASES

Immediate aspiration of the ventral cavity following the completion of the arterial injection phase of the embalming followed by immediate injection of a volume of cavity fluid is recommended for.......

STANDARD ASPIRATION PROCEDURES

1. Aspirate the sections in an organized pattern, penetrating and withdrawing the trocar from side to side 2. Aspirate the ventral cavity in portions of posterior (bottom), middle, and anterior (top) 3. Allow trocar to remain in areas for sufficient time to withdraw material 4. To reduce swelling in the neck, direct the point of the trocar into the lateral tissues of the neck only - avoid penetrating trachea and larynx from below

CASES PREDISPOSED TO ADDITIONAL VENTRAL CAVITY TREATMENT

1. Blood infections 2. Ascites (edema) 3. Respiratory infection 4. Visceral cancers 5. Obesity 6. History of purge 7. Shipout case 8. Advanced decomposition

PROPER EQUIPMENT FOR INJECTION PHASE

1. Different trocar 2. Cavity injector or embalming machine 3. Sufficient length of tubing of sufficient diameter 4. Cavity fluid

EFFECTS OF UNTREATED PURGE

1. Distorted facial contour - swollen cheeks and upper and lower integumentary lips 2. Dehydrated nostrils and mucous membranes of the integumentary lips 3. Staining of skin, clothing, and casket interior

STEPS FOR THE ILIAC TUBE

1. Insert iliac tube into femoral vein 2. Guide tube upward into the external iliac vein 3. Guide tube around the curve to converge with the inferior vena cava vein 4. Place tip of the tube as close to the right atrium as possible

STEPS FOR THE HEART TAP

1. Insert trocar into standard position - 2" above and 2" to the left of the umbilicus 2. Align point of the trocar parallel to a line extending from the LEFT HIP toward the LOBE OF THE RIGHT EAR 3. Penetrate the right atrium of the heart 4. Add some aspiration pressure

CASES PREDISPOSED TO CRANIAL CAVITY TREATMENT

1. Meningitis 2. Cerebral hemorrhage 3. Syphilis 4. Advanced decomposition

DRAINAGE AIDS

1. Pre-injection chemicals 2. Directional massage 3. Elevation of limbs 4. Intermittent drainage 5. Alternative drainage sites 6. Pulsator device on machine 7. Adjustment of pressure & flow

EQUIPMENT FOR CRANIAL CAVITY TREMEATMENT

1. Small bore trocar 2. Tubing and cavity injector or machine 3. Cavity fluid

CLOSING TROCAR PUNCTURE WOUND

1. Standard trocar button 2. Purse-string suture pattern 3. N-Z stitch suture pattern 4. Leave open but cover with cotton and plastic secured in place, allowing gases to escape, minimizing chance of distention of the abdominal wall and possible anal or pharyngeal purge

PURPOSES OF DRAINAGE

1. To reduce the secondary dilution of the arterial fluid preservatives and disinfectants 2. To remove or reduce the intravascular blood discolorations already present 3. To reduce or prevent the possibility of deep and superficial tissue distention 4. To reduce or prevent the development of post-embalming decomposition

PURPOSES OF CAVITY TREATMENT

1. To supplement the disinfection/preservation of the walls of the hollow body organs previously treated by arterial injection 2. To remove or treat the contents of the hollow body organs of the ventral cavity which did not receive treatment via arterial injection 3. To remove or neutralize the active body and microbial enzymes not treated by arterial injection 4. To remove or prevent the occurrence of odor and purge of the contents of the hollow body organs

5 PERCENT

Just prior to the death of the person, how much blood volume is in the arteries?

85 PERCENT

Just prior to the death of the person, how much blood volume is in the capillary beds?

10 PERCENT

Just prior to the death of the person, how much blood volume is in the veins?

PROPER ASPIRATION EQUIPMENT

1. Trocar of SUFFICIENT LENGTH to aspirate entire ventral cavity from one entry point, equipped with a SHARP/NEW POINT, and of SUFFICIENT DIAMETER to allow passage of semi-solid material without clogging 2. Clear plastic tubing of SUFFICIENT LENGTH AND INTERNAL DIAMETER which will not collapse under pressure from a vacuum 3. Hydro or electric aspirator which can generate SUFFICIENT VACUUM to aspirate semi-liquid material

VENOUS CAPILLARY BEDS AND VEINS OF THE BODY

After death, the majority of the blood volume is located in the......

EMACIATED CASES

All of these cases would most likely require re-aspiration and/or re-injection of cavity fluid except: - Respiration infections - Edematous cases - Advanced decomposition - Emaciated cases

ATTACH A HOSE TO THE DRAIN TUBE

Method to limit the exposure to blood and embalming solution

CAVITY TREATMENT

The direct treatment (other than by arterial injection) of the contents of the hollow body organs and the lumen (lining) of the hollow body organs

PURGE

The post-mortem evacuation of any substance from any orifice due to internal or external pressure

DRAINAGE

The withdrawal of blood, blood clots and/or embalming solution from the body during the vascular injection phase of the embalming process

FROTHY WHITE

Type of purge: Air bubbles in clear liquid - lung purge

FALSE PURGE

Type of purge: Clear or reddish fluid - from short circuit - arterial fluid

COFFEE-GROUND

Type of purge: Clear, brown liquid with dark particles - sour odor - stomach purge

BLOODY PURGE

Type of purge: Dark or bright red fluid - from short circuit disrupted arterial system

CREAM WHITE

Type of purge: Opaque liquid - brain purge - no odor

In articulo mortis

What Latin phrase means "in the vessels of the dead"?

FECES, GASES, INTESTINAL ENZYMES, AND BACTERIA

What are the targets of aspirating the cecum?

BLOOD AND BACTERIA

What are the targets of aspirating the heart?

DIGESTED FOODS, LIQUIDS, GASES, HYDROCHLORIC ACID, AND BACTERIA

What are the targets of aspirating the stomach?

URINE AND BACTERIA

What are the targets of aspirating the urinary bladder?

ASPIRATION AND INJECTION PHASES

What are the two phases of cavity treatment?

LARYNX AND ESOPHAGUS

What area of the body should the embalmer avoid during the routine aspiration of the body?

NASAL ASPIRATOR

What device is used to evacuate material in the upper respiratory tract and is inserted into the nose or mouth?

MIXTURE OF BLOOD AND ARTERIAL FLUID

What does the secondary drainage volume consist of?

THE POST-EMBALMING PENETRATION OF THE ARTERIAL FLUIDS

What event will not occur if the embalmer decides to aspirate the ventral cavity immediately after the completion of the arterial injection?

HEART TAP

What is a method utilized to drain blood directly from the right atrium of the heart?

POINT OF TROCAR MAY PASS THROUGH THE HEART

What is a potential problem with the heart tap drainage procedure?

TIP OF TUBE MAY RUPTURE INFERIOR VENA CAVA

What is a potential problem with the iliac tube drainage procedure?

CAVITY FLUID INJECTION

What is designed to compliment the disinfection and preservation of the walls of the visceral organs achieved by arterial injection?

DIAPHRAGM

What is the anatomical guide used to divide the ventral cavity into superior and inferior portions when performing standard cavity aspiration/injection?

CAVITY TREATMENT

What is the direct treatment of the contents of the body cavities and the hollow body organs (other than by arterial injection)?

ONE BOTTLE ABOVE AND ONE BOTTLE BELOW DIAPHRAGM

What is the minimum recommended volume of cavity fluid to use during the injection phase?

BLOOD

What is the primary component of the initial drainage volume?

ALLOWS MAXIMUM TIME FOR POST-EMBALMING PENETRATION

What is the reason/rationale for delaying cavity treatment?

THE LEFT NOSTRIL

What is the recommended entry point for cranial aspiration procedures?

START ON TOP AND WORK TOWARD BOTTOM

What is the recommended method for aspirating the three depth levels of the ventral cavity?

ENCOURAGE AND PROTECT WITH MASSAGE CREAM

What is the recommended treatment of concurrent embalming purge?

STOP BY REASPIRATION AND REINJECTION TO TREAT THE CAUSE, NOT JUST SYMPTOMS - PACK ORIFICES, PROTECT WITH MASSAGE CREAM

What is the recommended treatment of post-embalming purge?

ENCOURAGE AND PROTECT WITH MASSAGE CREAM

What is the recommended treatment of pre-embalming purge?

THROUGH LEFT NOSTRIL PIERCING THROUGH THE CRIBRIFORM PLATE OF THE ETHMOID BONE

What is the standard entry point of the trocar for the cranial cavity?

TWO INCHES ABOVE AND TO THE LEFT OF THE UMBILICUS

What is the standard entry point of the trocar for the ventral cavity?

STOMACH

What organ is targeted using the following trocar guide? - 1. From the standard entry point, direct the point of the trocar toward the intersection of the FIFTH INTERCOSTAL SPACE AND THE LEFT MID-AXILLARY LINE 2. Push the trocar forward until the point pierces the hollow organ

CECUM

What organ is targeted using the following trocar guide? - 1. From the standard entry point, direct the point of the trocar toward a location ONE FOURTH OF THE DISTANCE FROM THE RIGHT ANTERIOR SUPERIOR ILIAC SPINE TO THE PUBIC SYMPHASIS 2. Keep point near abdominal wall until it is about four inches from the hip, then pint the tip of the trocar downward by raising the handle and push forward until the point pierces the hollow organ

HEART

What organ is targeted using the following trocar guide? - 1. From the standard entry point, direct the point of the trocar toward an IMAGINARY LINE FROM THE LEFT ANTERIOR SUPERIOR ILIAC SPINE TO THE LOBE OF THE RIGHT EAR 2. Keep the point of the trocar high along the abdominal wall until it pierces the diaphragm, then point the tip of the trocar downward by lifting the handle and push forward into the hollow organ

URINARY BLADDER

What organ is targeted using the following trocar guide? - 1. From the standard entry point, direct the point of the trocar toward the INTERSECTION OF THE MEDIAN PLANE AND THE PUBIC SYMPHASIS 2. Keep the point of the trocar close to the abdominal wall until It comes in contact with the bone, then withdraw the point slightly and direct the point downward by lifting the handle and push forward into the hollow organ

HEART

What organ may be accessed by directing the point of the trocar along a line drawn from the left anterior-superior iliac spine to the lobe of the right ear of the cadaver?

INTERNAL JUGULAR VEIN

What paired vessels ABOVE the diaphragm are utilized as drainage points?

FEMORAL VEIN

What paired vessels BELOW the diaphragm are utilized as drainage points?

PURSE STRING SUTURE

What suture pattern may be used to close a trocar puncture in place of the trocar button?

ARTERIAL FLUID SOLUTION

What the last drainage volume primarily consist of?

MENINGITIS CASES

Which of these cases may necessitate cranial aspiration?

POST-EMBALMING PURGE

Purge that happens after the arterial injection phase of embalming

CONCURRENT EMBALMING PURGE

Purge that happens during the arterial injection phase of embalming

PRE-EMBALMING PURGE

Purge that occurs prior to the arterial injection phase of embalming