The direct treatment, other than by arterial injection, of the contents of the body cavities and the lumina of the hollow viscera. (Aspirate and inject highly concentrated cavity fluid)
Direct treatment, other than vascular (arterial) injection, of the contents of the body cavities and the lumina of the hollow viscera; usually accomplished by aspiration and injection of undiluted cavity fluid.
Embalming chemicals which are injected into the cavities of the body following the aspiration in cavity embalming. Cavity fluid can also be used as the chemical in hypodermic and surface embalming.
An embalming instrument which is connected to a bottle of cavity fluid to aid in injecting the cavity fluid, undiluted, into the various cavities of the body.
Apparatus that is connected to the water supply; when the water is turned on, a suction is developed and is used to aspirate the contents of the body's cavities.
A device that uses a motor to create a suction for the purpose of aspiration.
Sharply pointed surgical instrument used in cavity embalming to aspirate the cavities and inject cavity fluid. The trocar may also be used for supplemental hypodermic embalming.
A plastic threaded screw like device for sealing punctures and small round trocar openings.
Preparation room equipment used to insert trocar buttons into trocar punctures created when the trocar is inserted into the body.
Trocar Button Applicator
A line drawn or visualized on the surface of the body or a prominent anatomic structure used to locate internal structures during cavity embalming, from a point of reference two inches to the left of and two inches superior to the umbilicus.
Suture used to close small punctures or holes. A series of small stitches are made through the skin around the circumference of the opening. The ends of the thread are knotted.
Purse String Suture
- Thorough disinfection and perservation- supplementing that which is secured by arterial injection. Even though the viscera recieve arterial fluid, it is not guaranteed that the hollow organs ( in the 9 region plan of the abdomen) plus the heart and lungs will recieve the fluid. It is also good for the removal of foreign matter in the organs and liquid associated wtih ascites.
- acceleration of putrefactive changes may occur
- for insurance against putrefactive changes in tissues within the body cavities which, due to obstructions in circulation and short circuits, may not have been throughly disinfected and preserved during injection.
- Removes blood from the heart and trunk vessels which is not removed during vascular embalming.
The Purpose of Cavity Embalming
- Remove as much of the liquid and semi-solid contents of the viscera as possible and thus reduce the germicidal obligation of the cavity fluid.
- Remove gases and liquids and this relieve pressure against the blood vessels and other organs. Prevent purge.
- Remove blood from the heart and major trunk veins by direct aspiration so the blood is not forced by gravity or gas pressure into the superficial capillaries of the neck, ears, or face to cause a visible stain.
Primary Purposes of Aspiration (List Question)
- Immediate Method
- Deterred Method
The two opposing theories in cavity treatment
Immediately after injection, aspirate the body cavities to prevent gas formation and other putrefactive changes from starting or continuing.
Cavity work done an hour or two after arterial embalming has been completed to allow sufficient time for the arterial injection to take effect (usually done the next morning).
- Only practical method in high volume funeral homes.
- Eliminates the chance of gas build-up in the throacic cavity which may cause feature swelling, particularly in the neck.
- Eliminates the chance of post embalming purge, thereby, you avoid having to redo the features.
Advantages of the Immediate Method
- Will allow sufficient time to get the best results from arterial injection.
- The organs in the viscera will be firm, allowing easy entrance for the trocar.
- Liquids and fluids will have time to settle to the bottom of the cavities, thus making for easier aspiration.
- Usually only one bottle of cavity fluid will be sufficient, rather than the two or three bottles used in the immediate method.
Advantages of the Deterred Method
If drainage and fluid distribution are good and there is no swelling or purge, use the _____ method of cavity treatment (as a general rule concerning aspiration and injection of the cavities).
If drainage is poor and clotted or if there was a necessity for multiple points of injection and drainage, the ______ method is recommended (as a general rule concerning aspiration and injection of the cavities).
Always reaspirate someone else's work.
Trust no one
Invented and patented in 1878 by Samuel Rogers, who also had his own fluid called allekton.
Should be clear, temperature sensitive, rigid plastic.
- Avoid the flexible, dark, gum rubber type; they collaspe and the embalmer has no idea what is being aspirated. OSHA violation.
Used with tubing, glass jugs and jars with gooseneck attachments. these are old fashioned but should be kept on had for emergencies.
Hand pump or the Electric Air Pressure Machine
The most common method of aspiration used today. Attached to a water faucet. It will create suction with the lever turned down or will create a flow of water with the lever turned up.
The Penberthy Hydroaspirator
- Danger of contaminating local water supplies; always check to see if it complies with city ordinances or regulations.
- Southwest, drought stricken- against the law.
Many areas outlaw the use of hydroaspirators
It is an improvement over the air pressure machine system but works on the same principle. In the future, may replace the hydroaspirator as an acceptible aspiration method for EPA standards.
The Electric Aspirator
Preparation room equipment which is a complete water system containing a hydroaspirator, water outlet, gooseneck filler for the embalming machine and a snap on hose.
Water Control Unit
Enter trocar through abdominal wall __________ of the umbilicus.
- If the trocar cannot penetrate the abdomen, then it is too dull to use when penetrating the viscera.
- If the hole is made with an instrument other than the trocar, then the trocar will not fit snugly into the hole, causing a decrease in the vacuum and, consequently, in the suction power too.
Two Inches Above and Two Inches to the Left
Throughly puncture and channel all ____, ____, and ____ viscera.
Thoracic, Pelvic, and Abdominal
- Abdominal wall sinks well below the level of the xiphoid process of the sternum.
- All liquids and juices have been removed from the viscera.
- All areas of potential gas build-up have been thoroughly punctured, i.e. colon.
- Be careful not to puncture any surface areas.
- Clear the trocar every three or four strokes.
- Be aware that the hydroaspirator will often clog, causing it to reverse itself.
Objectives to Accomplish During Trocar Aspiration
After aspiration, use a ___ ___ to gravitate sufficient undiluted cavity fluid, under pressure, to all organs in all regions of the cavity. Spread 2-3 bottles over a wide area, keeping the trocar high to allow the fluid to gravitate over the viscera. All three cavities must be treated.
You may use this to inject cavity fluid, but the machine must be rinsed out with two full tanks of clear, cold water. Also clean cavity injector and disinfect trocar.
One bottle of cavity fluid per ___ lbs of body weight. (Minimum 3 bottles)
- Trocar button
- Suture methods
- Leave the hole open and cover with a square of cotton and piece of plastic.
Treatment for trocar punctures
- N-stitch (similar to the purse string, but does not go around the whole circumference of the puncture, crosses over it).
- Purse String Suture
This is considered a poor method because it allows gas to escape and, contrary to a popular misconception, the body will purge which may also cause a stain on the garments.
- Loss of perservative power (seepage of gas)
Leave the hole open and cover with a square of cotton and a piece of plastic
Not an effective cavity treatment method to remove most of the fluids.
- Incision is made between xiphoid process and umbilicus, cavities are opened with a bistoury and free liquids are sponged out, viscera is saturated with cavity fluid. Trachea is opened and packed to prevent purge.
- Used for deceased newborn babies, extensive surgery cases, when your usual equipment is broken or unavilable.
- May require permission from the PRD
Direct Incision Method (Visual Method)
For possible purge material in the nose and throat, aspirate with a curved aspirating tube introduced into the throat through the mouth and both nasal orifices.
Flush the nose and mouth with running water and, if necessary, soap and disinfectant.
Before Embalming- Nasal Tube Aspirator
Re-check nose and mouth for possible fluid purge; if necessary be sure to change the cotton and apply new stay cream and be sure to reaspirate the mouth.
After Embalming- Nasal Aspirator
- When the person dies of brain disease
- Cerebral hemorrhage
- Any condition leading to gas formation within the cranium.
Conditions Necessitating Treatment/Aspiration of the Cranial Cavity
Spinal meningitis, tumor.
When the person dies of brain disease
- Meningcoccal meningitis (usually young adults)
- Crutzfield Jakob Disease (CJD)
Brain Diseases you Should Never Aspirate (due to risk to the embalmer)
Blood exits nose, ears, eyes, etc.
Tap the brain by pulling left ear back, soft spot behind left ear, go in with trocar, tap brain, aspirate, put in cavity fluid (about four ounces)
Auto accident, murder, beating, gunshot wound to head.
Look for protruding eyeballs, a sign of gas build up. This is a positive sign that there has been putrefaction in the brain.
Any condition leading to gas formation within the cranium.
Any short narrow barreled trocar.
Aspirate using a cranial trocar
- Introduce the trocar, coated with petroleum jelly, into the left nostril and then through the cribiform plate of the ethmoid bone. Aspirate the cranial vault thoroughly.
- Inject at least 4-6 ounces of high index cavity fluid into the cranial vault. (use the same trocar because the cavity fluid will disinfect it at the same time). Pack the nostril with sealer and cotton.
- Put head deep in casket pillow this keeps the cavity fluid in the back of the head and fixes the tissues.
Method of Cranial Treatment
- Pressure and flow is too high on the injector
- Obese bodies create low resistance areas in the face and neck
- Clotted drainage in the left and right internal jugular veins.
- Thoracic and abdominal gas. i.e. tissue gas and subcutaneous emphysema.
Conditions Necessitating Treatment for a Swollen Neck
- Restricted Cervical Method
- Air or water collar
- Turkish towel/water packs
Treatments for Swollen Neck
After injection, excise muscle with a scalpel or reduce muscle with an electric spatula. Before suturing, pack the trachea.
Restricted Cervical Method- Afterwards
May leave marks on the neck.
Air or water collars
- Blood infections
- Advanced decomposition
- Ascites (Abdominal edema- peritoneal)
- Pulmonary Infections- pneumonia
- Infectious diseases of abdominal organs and tissues.
- Obese bodies
- Whenever gas formation causes distension or post-embalming purge.
- Prior to shipping
Conditions Necessitating Re-aspiration
- Immediate Method
- Reaspirate a few hours after embalming
- Reaspirate just before dressing and casketing
- Additional Cavity fluid should be injected; if viscera is solid and has no odor, no more cavity fluid is needed.
Treatment for Re-aspiration
- Semi-solids (blood clots, fascia, etc.)
Materials to be Aspirated
The postmortem evacuation of any substance, from any external orifice of the body, due to pressure.
- Normally occurs in the mouth and nose, but could be from any orifice.
- Intestinal flora (E.coli)
- Certain pathological conditions (diseases) i.e. liver disease, lung cancer.
- General decomposition
- Environmental conditions, i.e. heat (hot environment encourages purge).
- Large stomach
Predisposing Conditions Leading to Purge
- Stomach purge- liquid, coffee ground color, sour odor.
- Lung Purge- Frothy white, foamy, usually no odor
- Brain Purge- Creamy white, no odor or color
- Rectal- Feces escaping from the rectum
- Vascular- color and consistency similar to arterial fluid solution.
- Not a true purge
- Not a true purge
Types and Characteristics of Purge
Color and consistency of arterial fluid solution but not a true purge- actually arterial fluid solution that has escaped the blood vascular system and is exiting the mouth and nose.
False Purge (Fluid purge, short circuit purge)
This can be done by exerting pressure on the throacic cavity. Chances of future purge can, and should, be eliminated in the prep room, even at the inconvenience of reposing the features. After embalming, pack the trachea.
Always Encourage Purge if it Occurs Before or During Embalming
A flow of clear arterial fluid solution begins to exit the mouth and nose.
- Could be in the respiratory tract or the gastrointestinal canal.
Positive Sign of a Major Short Circuit or Rupture in the Vascular System
- Pulmonary tuberculosis
- Degenerative disease of the vascular system i.e. aneurysm, ASCVD
- Severe gastrointestinal ulcer (gastro, duodenal ulcer)
- Traumatic injury to the respiratory tract (bullet or knife wound)
- Heart murmer
Causes of Clear Fluid Purge
- Puffed and swollen face and neck
- Generally little or no distribution of fluid to the extermities
- Severe distension of the abdomen
- No drainage
- Clear arterial fluid exiting from mouth and nose
- Recent abdominal or thoracic operation
Signs of a Clear Fluid Purge
- Turn off machine, stop injection immediately; continuing will cause severe swelling and will result in a waste of fluid.
- Begin a six-point injection, opening the corresponding veins for drainage and inject in both directions.
The Only Solution to a Short Circuid Purge
An indication of failure to properly aspirate and treat the viscera; often it is that the embalmer did not aspirate the body enough or the overuse of cavity fluid.
- It is the liberated gas that counts, the fluid is only a vector or vehicle transporting formaldehyde.
- Cream the area over which the purge matter flows to minimize burning of the lips, cheeks and neck.
- Reduce gas pressures in the abdomen by the careful insertion of a trocar.
Purge Prior to Embalming
Determine that the escaping substance if purge matter (stomach,lung) and not arterial embalming solution which may be escaping from damaged lung or stomach tissues.
- If purge, release pressure with torcar (aspiration)
- If arterial fluid, perfom regional (sectional) injection- six-point injection- 12 directions.
Purge During Embalming
Reaspirate and reinject concentrated cavity embalming fluid until purge is controlled.
Purge Following Arterial and Cavity Embalming
- Nasal tube aspiration of the throat
- Aspiration and injection of brain through the cribiform plate of the ethmoid bone when distended eyes indicate intracranial decomposition.
- Check features
Other Treatments for Purge
Open, flush, and aspirate both the esophagus adn trachea; then pack with cotton, topical jelly and sealer powder.
Prior to Suturing the Supraclavicular Incision