The dilution of the concentrated fluid with water to form the arterial fluid solution. Case analysis or pre-embalming analysis will determine the strength of the dilution. It will also determine the need for pre-injection, co-injection and water conditions, etc. Occurs in the maching.
Normally, it is the further dilution of the already diluted fluid by the fluids in the body. It is the union of the tissue juices and liquids with the arterial fluid solution to further reduce the concentration of the preservative ingredients. It occurs in the body.
Body conditions will vary from extreme dehydration to extreme edema. Variation in the moisture content of the body will determine the variation in primary dilution.
In Secondary Dilution
100 pounds of body weight will yeild 65 pounds of water.
Dehydrated Bodies in Secondary Dilution
100 pounds of body weight will yeild 75 pounds of water.
Normal bodies in Secondary Dilution
100 pounds of body weight will yeild 85 pounds of water.
Edamous Bodies in Secondary Dilution
The movement of arterial fluid solution from the point of injection throughout the arterial, capillary, and venous portions of the blood vascular system.
- Capillaries - 85%
- Veins- 10%
- Arteries- 5%
Capacity of Blood Vessels - Forced by Articulo-Mortis
- The movement of the fluid solution from a high pressure potential to a point of minimum resistance.
- The use of a fluid solution having a high diffusive power and a low viscosity. The lower the viscosity, the better the penetration.
Maximum Fluid Distribution Witout Undesirable Surface Changes is Based Upon Two Factors:
The passage of some elements of the injected arterial fluid solution from an intravascular to an extravascular position.
- Pressure Filtration
- Gravity Filtration
- The mechanical force or pressure provided by the injector.
- The internal molecular force generated by osmotic pressure.
Fluid Diffusion Results From a Combination of two Forces:
The passage through the capillary walls of arterial fluid solution because of positive intravascular pressure exerted by a pump (embalming machine), compressor or gravity against the fluid, forcing the liquid out through the tiny intracellular spaces in the capillary bed; in other words, putting fluid into the body via an embalming machine.
The passage of solvent through a semi-permeable membrane from a dilute to a concentrated solution (fluid). When two solutions of unequal concentration are separated by a semi-permeable membrane, such as a capillary wall, the solvent molecules will move in the greatest number from the area of lower solute concentration to the area of higher solute concentration. (hypo to hyper)
Osmosis (Hindered Diffusion)
Solution having equal tension on both sides of the capillary wall (same osmotic pressure).
- Example: Salt solution and blood (.9 saline solution).
A solution having abnormally high tension or viscosity and an osmotic pressure higher than that in an isotonic solution (too thick for arterial solution).
- Example: Topical Jelly
A solution having abnormally low tension or viscosity and an osmotic pressure lower than an isotonic solution (better for arterial fluids).
Arterial fluids injected at high pressures and rates of flow cause tissue cells to fill rapidly with a hypotonic solution, eventually causing the cells to swell and burst.
- Examples: Puffed necks, lips and eyelds.
Danger of Hypotonic Solutions
The separation of differing substances in solution because of their differing diffusability through semi-permeable membranes. It is the process of separating crystalloids and colloids in solution by the difference in their rates of diffusion through a semi-permeable membrane. Many of the essential agents in an arterial fluid solution are dissolved crystalloids, which must depend upon the pulling power of the water molecules to carry them through the semi-permeable membranes into the tissue cells.
Dialysis (Selective Diffusion)
The intravascular (which eventually becomes extravascular) settling of fluid by gravitational force. It is the eventual downward passage of fluid solution into adjacent tissues under the influence of gravity.
- Fluid dye
- Distension of superficial blood vessels
- Blood drainage
- Clearing of intravascular blood discolorations
Signs of Fluid Distribution
- Dye in the tissues
- Firming of the tissues
- Loss of skin elacticity (beginning firming)
- Drying of the tissues
- Rounding of fingertips, lips, and toes
- Mottling of the tissues (bleaching)
- Fluorescent dye observed using "black light"
Signs of fluid Diffusion
- Amount of fluid to use
- Strength of solution
- Temperature of solution
- Pressure of Injection
- Rate of flow
- Relation to each of the above to disinfection, preservation, removal of discolorations, swelling.
Summary of all factors relative to fluid and its injection.
- Puncture Test
- Tracer Dye
- Fluorescent dye test
Tests for fluid distribution and diffusion
Slightly puncture tissue with a needle, then squeeze to detect fluid at the legs/toes, arms/fingers, and head (behind ear).
Adding any of the commercial active dyes to the arterial fluid solution. This will be detected in the surface tissues. This is the most common method. Always inject from the femoral artery so it enters the head evenly; for highly concentrated dye, two capfuls to a tankful.
- Active dyes are a type of this
Detected only under ultraviolet black light; viso-balm co-injection.
Fluorescent Dye Test
- Diminish secondary dilution
- Remove intravascular discolorations
- Prevent distention
- Permit disinfection and preservation
- Retard postmortem decomposition.
Purpose and Importance of Drainage (List question)
- Closed drainage technique to limit blood exposure- heart tap with a trocar
- Use of procedure with allows control of drainage by vein tubes inserted into veins or into the right atrium by means of flexible tubes.
- Short barrell trocar directly into the right atrium of the heart.
- Long barrell torcar directed into the right atrium of the heart from another point of entry (starting at the anterior, superior iliac spine).
Methods of Heart Tap
It is not so much the volume of solution injected into the body that counts, but the amount that actually remains there. Fluid which merely passes through the vascular system to end up in the drainage can't possibly accomplish anything in the way of preservation.
Arterial Fluid Retention
- Back Pressure
- Closing the drain tube pump
Methods of Fluid Retention
Clamp the corresponding vein after all blood has exited (straight or autopsy case).
Creates backpressure (straight case)
Close the drain tube pump rod to create backpressure
Disinfection and preservation of human remains. The action of embalming chemicals can be summarized as having three over-all effects.
The purposes of Embalming Process
- Inactivate the action of chemical groups on proteins and amino acids.
- Inactivate both autolytic and bacterial enzymes.
- Kill microorganisms
3 Over-all Effects of Embalming Chemicals
Is second only to good distribution of arterial fluid solution in the embalming process.
This is the basic foundation establishing drainage. All methods of establishing drainage involve some variation of this concept.
Consists of injecting fluid solution into the aterial system and allowing it to push the blood ahead of itself into the venous system and out through the drain tube.
Center of embalming circulation.
Arch of the Aorta
Center of venous drainage is the juncture of the superior and inferior vena cava at the:
- Both liquid and clotted
- Arterial fluid solutions
- Interstitial fluid- fluid between the organs and tissues.
- Lymphatic fluid
Drainage consists of any one but usually a combination of these 4 substances (fluids).
At the right atrium of the heart.
Accomplished by inserting a narrow barreled trocar directly into the right atrium of the heart during injection. (Most embalmers today feel this is foolhardy).
- Most of the time the embalmer will puncture the arch of the aorta by accident (6 point injection).
- Clotted drainage will clow the small holes at the end of the trocar; thus the whole purpose is defeated.
- Even if the embalmer is accurate at hits the right atrium and the drainage is clot free, the emblamer still has no way to create backpressure to overcome short circuits. If anything, a successful heart tap encourages short circuits.
Problems with Heart Tap
Utilize either right internal jugular, right femoral or right iliac vein and insert with great care a slick hose or tube until it drops into the right atrium of the heart. The hose or tube must be pushed back and forth to allow it to enter the superior and inferior vena cava.
Flexible rubber or plastic tube or hose
- Increase pressure and pulsating pressure. Increase rate of flow.
- Creating a backpressure by opening and closing drain tubes.
- Massage the body, especially arms and legs; always toward heart; elevation of appendages.
- Instruments- Drain hoses, trocar, drain tube, forceps, vibrating embalming table (outdated).
- Chemicals- Co-injection, pre-injection (usually idential chemically) does not dissolve blood clots but dilates and lubricates the lumen of the vessels and prevents further clotting.
Methods of Stimulating Drainage (List Question)
- Multiple points of injectio and drainage.
- Slow rate of pressure and flow; first to allow arterial fluid to ride over and around clots.
- Cold packs to encourage drainage
- In severe, almost hopeless situations, surface embalming and hypodermic embalming are the only solutions. (surface embalming/jellies and cavity packs, danger of burning tissue). Can use arterial fluid if it does not contain active dye.
Solving Difficult Drainage Problems
Beware of sludge; can accumulate at bifurcations if you start off too fast (high pressure and rate of flow).
Slow rate of Pressure and Flow
- Alternate method
- Intermittent method
- Concurrent or Continuous method
- Discontinuous injection method
Methods of Drainage in Relation to Injection
The arterial fluid is injected into the arterial system wtih the drain tube pump rod kept tightly closed until the superficial veins being to discend. The injection is then halted and the drain tube pump is opened and pumped until drainage stops. The process is repeated over and over until the body is embalmed.
- Will build up a uniform backpressure
- Wil get more uniform fluid distribution
- Will overcome short circuits in vascular system
- Will get maximum amount of drainage
- Will equalize the arterial pressure and venous resistance and allows for the removal of obstructions from the smaller vessels that are not removed in other techniques.
- Will ensure the removal of gravitated blood from the dorsal portions of the body; this is blood which is not removed by the concurrent or continuous technique.
Advantages of the Alternate Method
- Most likely to lead to distension and swelling.
- Very time-consuming method
- More theoretical than practical
Disadvantages of the Alternate Method
Continuous drainage and injection; the embalmer usually uses drainage forceps instead if a drain tube.
Concurrent (Continuous) Drainage Method
- Fastest way to embalm
- Least likely to lead to distension
- Simplest method to learn
Advantages of the Continuous Method
- Renders the least uniform backpressure
- Method having poorest fluid distribution and saturation.
- Method does not overcome short circuits in the vascular system- body only partially preserved.
- Indicates the embalmer lacks skill with the drain tube.
- Unnecessary waste of arterial solution
- Serious dehydration may occur during rapid injection with open drainage.
Disadvantages of the Concurrent (Continuous) Method
Continuous injection and intermittent drainage. Consists of stopping drainage at intervals by closing the drain tube pump rod while maintaining continuous injection; most logical method of embalming and will give the best results utilizing two points of drainage.
- Assists in blood removal by creating backpressure at key intervals during injection.
- Requires less time than the alternate method while still maintaining better arterial fluid distribution, good backpressure and consistent drainage.
- Considered by most embalmers to be the best method when utilizing modern high rate of flow motorized embalming apparatus.
Advantages of the Intermittent Method
- Still the possibility that short-circuit paths may be established during the interval when the drain tube is open.
- The interval during which the drain tube is closed by also be insufficient to equalize the pressure and resistance.
Disadvantages of the Intermittent Method
A repeated arterial injection.
The injection of smaller amounts of arterial fluid solution at intervals rather than the injection of a larger volume of arterial solution at one time.
This method will get the most beneficial results, it is good for burial at sea and edema.
Discontinuous Injection Method
Pulsating pressure is preferred instead of continuous pressure. The brief intervals between pulsations ensure a better absorption with less danger of distension than is characteristic of continuous pressure. The rest period is usually from one to four hours involving one quart to one gallon volumes; third and fourth injections may also be utilized.
Rest Period- During Discontinuous Injection
- Signs of decomposition
- Infectious contagious cases
- Holding bodies for long period of time
- Anatomical embalming to make cadavers
- Refridgerated bodies
- Trauma cases- Accident, murder, etc.
Conditions When the Discontinuous Injection Method Should be Utilized
The prevention of highly objectionable degrees of feature distension. Prevent swelling and distortion of features.
Advantage of Discontinuous Injection Method
It is too time consuming for commercial funeral home embalming.
Disadvantage of Discontinuous Injection Method
- One point injection and drainage
- The split injection and drainage method
- One point of injection with two points of drainage
- The restricted cervical method
- The multi-point or sectional injection
The 5 Operative Prodedures- whether the embalmer uses the alternate, continuous or discontinuous techniquesm one of these will be used
Injection and drainage at and from a single point; very few cases fall into this category. These are ideal cases beacause there are:
- No lingering diseases
- No clotting
- No major pathological changes
- A perfect vascular system with no obstructions
- Embalmed shortly after death
- No presence of antemortem drugs
One Point Injection and Drainage
- The right common carotid artery and right internal jugular vein
- The right femoral artery and the right femoral vein
- The right axillary artery and right axillary vein
- The right brachial artery and right basilic vein
Points most often used in single point injection and drainage
Primary one point injection and drainage site.
Right carotid artery and right internal jugular vein
Best for contagious infectious diseases for one point injection and drainage sites because it minimizes exposure for the embalmer.
Right femoral artery and right femoral vein
Because fo the many recent problems faced by modern embalmers, this procedure is rapidly becoming the most popular. All cases involving complications short of decomposition, including most hospital and nursing home cases, fall into this category. It is injection and drainage from separate points.
The Split Injection and Drainage Method
- The left common carotid artery and the right internal jugular vein
- The left axillary artery and the right axillary vein
- The left brachial artery and right basilic vein
- The right femoral artery and the right internal jugular vein
- Any artery above the heart and any vein below the heart
- Any artery below the heart and any vein above the heart
Points most often used for split injection and drainage
May cause a puffed up neck
Any artery above the heart and any vein below the heart
Any artery below the heart and any vein above the heart.
The vast majority of embalmers consider this method to be the most logical and most successful in solving contemporary embalming problems.
One Point Injection and Two Points of Drainage
- Establish a single point of injection that will lead to the arch of the aorta. Any major artery will do.
- Establish two points of drainage, one above the heart at the right internal jugular vein (which leads to the superior vena cava) and one below the heart at the femoral vein or common iliac vein (which leads to the inferior vena cava)
- Utilizing the right femoral artery and right femoral vein and right internal jugular vein is the best method for treatment of a lenghty postmortem interval.
Procedure- One point of Injection and two Points of Drainage
Utilizing two separate supraclavicular incisions, raise both common carotid arteries and both injernal jugular veins.
Restricted Cervical Method
- Inject the left common carotid artery downward and drain from both internal jugular veins. Clamp off the right common carotid artery with a hemostat and nick it above the clamp to allow clots to drain.
- Inject the torso first, utilizing the left common carotid artery downward into the center of embalming circulation at the arch of the aorta.
- After the torso and the appendages are injected and thoroughly embalmed, inject the head (left common carotid upward first, and the right common carotid artery upward next).
Procedure- Restricted Cervical Method
- Severe edema in the body
- All obese bodies (300lbs of excess body fat)
- All cases where maximum preservation is desired, such as ship-outs and storage cases
- All cases where the embalmer anticipates swelling of the neck and facial features.
- Cancer and radiation therapy with rapid weight loss (especially renal cancer- excess urea)
Cases that Warrant the Restricted Cervical Method
The torso and appendages can be injected with a rather strong solution for maximum embalming effect while the head, particuarly the face, can be injected with a mild, less dehydrating solution.
- Also can utilize instant tissue fixation of the cardinal signs of decomposition are present (particularly in the head).
The greatest advantage of the restricted cervical method.
If the cardinal signs of decomposition are present, particularly in the head, then this can be used followed by aspiration and injection of cavity fluid into the brain will be necessary through the cribiform plate of the ethmoid bone.
Instant Tissue Fixation (Head Freeze)
- The head can be adequately embalmed through the vertebral arteries with no swelling or distortion of the facial features, thus eliminating the need to inject both common carotids upward.
- Most embalmers will still inject both right and left common carotids upward for safety.
Notes: Restricted Cervical Method
The six point injection. Any case involving the necessity to utilize two or more complete injection sites. Every artery raised will require that its corresponding vein also be raised for drainage.
The Multi-point or Sectional Injection
On any multi-point or sectional injection, it is recommended that the embalmer inject both directions on every artery raised. In this way, the ____ ___ ____ areas will recieve the fluid solution.
Thoracic and Abdominal
- All cases where decomposition is obvious, including skin slip and greenish abdomens.
- All cases where there is a rupture of major proportion in a trunk vessel, such as in a ruptured aortic aneurysm.
- All cases where the embalmer experiences severe blockages in the vascular system, such as ASCVD and other degenerative arterial conditions.
Casues that Constitute the Necessity for Multi-point Sectional Injection
- Legs: Right and left external iliacs
- Arms: Right and left subclavian (to inject vertebrals in back of head)
- Head: Right and left common carotids
- Always create backpressure by clamping off corresponding veins when drainage becomes clear fluid.
Sequence for Injecting an Autopsy: Multi-point (sectional) Injection
For a multipoint injection of an autopsied case, if there are no subclavians, inject into ______ in opposite direction and clamp off subclavians; the fluid will be forced to go into the vertebrals.