embalming 2 week 6

Sam Rodgers

- inventor of trocar in NYC on 8/27/1878

• Patent no: 207551

cavity treatment

• Usually takes place after arterial embalming

• Cavity treatment is a two step process

  • Aspiration and then injection 

    • Many embalmers prefer to wait as long as possible before initial aspiration. Many embalmers may re-aspirate just before dressing the body. 

When arterial embalming isn’t possible

• Such as badly burned or decomposed bodies. Cavity treatment (along with surface treatment and hypodermic treatment) may be the only method of preservation available. 

before arterial embalming one might consider

• Limited treatment of the abdominal cavity to remove gas and drain fluids (edema) 

  • Limited treatment of the thoracic cavity if fluids or subcutaneous emphysema is present

timeline of cavity embalming

1. Arterial embalming 

2. Aspiration of the cavities 

   1. Time of treatment 

      1. Immediately after arterial injection, or

      2. Several hours after arterial injection 

3. Injection of cavity chemicals 

4. Closure of the trocar point of entry 

5. Washing and drying of the body 

6. Possible re-aspiration 

7. Possible re-injection 

suggested order of aspiration

1. Thoracic cavity and its contents

2. Abdominal cavity and its contents

   1. Pelvic cavity and its contents

cavity embalming treatments

• The contents of the hollow viscera and the walls of the visceral organs that might not have received sufficient arterial embalming 

  • Proper cavity treatment will help delay decomposition and prevent gas, odor, and purge 

historically for cavity embalming

• A hand-pump or air pressure machine would have been used for aspiration of fluids

equipment needed for aspiration

• A pointed (and sharp) trocar

• A device to create suction or vacuum 

• Flexible tubing or hose to connect the two 

adult and kid trocars

• An 18’’ long, ⅝’’ bore trocar, with removable tip is recommended

• The tips may be sharpened with a whetstone 

• A 12’’ trocar, with ¼’’ bore

  • This may also be used for hypodermic injection of tissue 

equipment after aspiration

• A gravity device such as a fluid injector (which screws on to a standard fluid bottle) tubing, and trocar

creating a vacuum for hydro-aspirator

• Always installed on a cold water line with sufficient water pressure

  • A vacuum breaker is normally part of the plumbing installation or the hydro-aspirator itself 

creating a vacuum electric aspirator

• An electric motor with an impeller

• The rotation of the impeller creates the suction

• More expensive, and requires maintenance 

• Use is recommended for areas with poor water pressure

  • Can’t back-flush the trocar with water 

point of entry

• Trocar entry is made 2 inches to the left and 2 inches above the umbilicus (navel) 

  • There is nothing special about this location, except it provides a common point of reference

RA of the heart

• A line drawn (or imagined) from the point of entry to the right ear lobe 

  • This will direct you toward the right entry of the heart 

stomach and the cecum

 (linear guides in opposite directions from each other) 

• A line drawn (or imagined) from the left axillary area, through the point of entry, to the lower right quadrant 

  • This line will direct you towards both the stomach (upper left quadrant) and the cecum (lower right quadrant) 

urinary bladder

(linear guide) 

• A line drawn (or imagined) from the point of entry to the pubic symphysis 

  • This line will direct you towards the urinary bladder 

right side of the heart internal guide

• Move the trocar along a line from the left anterior superior iliac spine, and the right ear lobe 

  • After the trocar has passed through the diaphragm, depress the point of the trocar and enter the heart 

internal guides to the stomach

• Direct the trocar point toward the intersection of the 5th intercostal space and the left mid-axillary line and continue until the trocar enters the stomach 

cecum anatomical guide

• Direct the trocar toward a point ¼ the distance from the right anterior-superior iliac spine to the pubic symphysis; 

• Keep the point of the trocar up near the abdominal wall until within 4 inches of the right anterior-superior iliac spine

  • Then dip the point 2 inches and insert it forward into the cecum of the colon 

urinary bladder anatomical guide

• Keep the point of the trocar up near the abdominal wall, directing the trocar to the median line of the pubic bone (pubic symphysis) until the point actually touches the bone

  • Retract the trocar slightly, and insert into the urinary bladder 

partial aspiration

• When the stomach is tightly distended with gas or edema, this pressure should be relieved prior to (or during) arterial injection 

• The presence of fluid or gas creates significant extravascular resistance, which may interfere with proper injection or drainage 

• Method 1 

  • Using a scalpel, make a puncture at the standard point of trocar entry and insert a blunt trocar or drain tube into the hole. This will allow aspiration of most of the gasses or fluid 

• Method 2 

  • Using a scalpel makes a puncture in the left inguinal area of the body. Fluids will gravitate to this lower location and gas may also be removed

time periods for cavity treatment

• Immediately following arterial injection or several hours after arterial injection 

  • A good argument can be made for either method

  • If there are not two trocars available, then after aspiration, clean and disinfect the trocar on the inside (back-fluid) and outside) 

advantages to immediate aspiration

• Prevents the production of gas that may cause purge 

• Removal of microbes that may accelerate decomposition 

• Removes blood from the heart, liver, and fluid from the lungs 

• Removes semi-solid contents of the hollow viscera that may contribute to bacterial translocation 

  • Allows immediate channeling of the neck that may reduce swelling of the facial tissues 

advantages to delayed aspiration

(8-12 hours) 

• The delay will allow sufficient time for arterial fluid to penetrate tissue spaces

• The delay will help preserve the walls of the visceral organs 

  • Most embalmers will delay aspiration for a short period. The length of time it takes to clean the embalming machine and perform terminal disinfection of the body is maybe long enough 

clinical for aspiration

• It’s best to aspirate prior to suturing incisions made for arterial injection. Any surgical drainage openings should be closed before aspiration of the cavities 

cavity treatment

 (for partial autopsies and organ donations) 

• Treat the walls of the autopsied body with hypodermic injection and autopsy gel or powder

• Fill the cavity with absorbent material, and saturate with cavity fluid

  • Treat the un-autopsied areas with normal aspiration and cavity treatment c

cranial aspiration

• Putrefaction of the brain is indicated by bulging eyeballs, and purge from the ears or nose 

• The text suggests use of only the right nostril. A small bore trocar is used to puncture the cribriform plate of the ethmoid bone 

• At this point the trocar enters the anterior portion of the cranial cavity. It’s not possible to aspirate the posterior portion of the cranial cavity 

  • Cavity fluid (only a few ounces) is injected with a hypodermic syringe and a long needle. Tightly pack the nostril with cotton to prevent leakage. 

injection of cavity chemicals

• After complete aspiration of the thoracic, abdominal, and pelvic regions, cavity fluid is injected (usually by gravity) within the hollow organs and over the viscera 

• It’s important to inject fluid near the anterior surface of the viscera and then allow the fluid to gravitate to lower regions 

  • Don’t attempt to dilute cavity fluid, always use cavity fluid full strength 

cavity fluid is available from most supplies in 2 types

• Fuming = high index (30 or more) 

  • non fuming = low index (5 or 10) but with other preservatives 

for the average 150 LB body

• The text recommends 3 bottles of cavity fluid, one full bottle (16 ounces) for each region 

  • Thoracic -abdominal -pelvic

  • Many embalmers use one bottle of cavity fluid above the diaphragm and one bottle below the diaphragm 

  • Although a poor practice, there are many establishments who restrict the use of cavity fluid to just one bottle, half above the diaphragm and half below the diaphragm  

    • Use of a commercial trocar button is common practice. Trocar buttons are easily removed for re-aspiration 

closure of the trocar entry

• Use of sutures is quite common

• The ‘purse-string’ or the ‘N; stitch are both recommended

• Sutures should be tied with a bow-knot to allow opening for re-aspiration 

  • If distention from gas is a problem the entry may be left open and covered with a bandage (not recommended for bodies that are shipped) 

when to reaspirate

• Obese bodies

• Drowning victims

• When there is purge

• Bodies that have ascites

• If decomposition is present 

• All bodies that ship in 

  • All bodies that ship out 

do you seal the casket when shipping by air

• Everything you have probably heard is a myth, everything you have probably heard is a myth. 

• If a casket is at sea level, let’s say the air pressure inside the casket and outside the casket is equal to 1. 

• If a casket is at 30,000 feet,

  • What is the air pressure outside the casket?

    • Less than 1

  • What is the pressure inside the casket?

    • It’s still 1 

    • The worst that will happen is that you might pop the gaskets at 30,000 feet 

when to reaspirate

• If there is presence of gas or distention in the stomach 

• Blood infections, peritonitis, septicemia, pneumonia 

  • Any distention or swelling of the neck or facial tissues (or back of the hands) 

final comments

• Always aspirate the throat through the nose with a nasal tube aspirator 

• It’s considered good practice that many establishments re-aspirate just before dressing and casketing 

• Always observe the aspirated contents, use clear plastic tubing. 

• When aspirating the thorax pay particular attention to fluid in the lungs

• During aspiration, the horizontal movements with the trocar should ‘fan out’ like the spokes of a wheel 

• During aspiration vertical movements with the trocar should be at 3 different levels

  • Superficial 

  • Medium

  • Deep 

• When injecting cavity fluid, the trocar should never be at a deep level. Injection should be into and over the viscera 

  • To avoid bacterial translocation always aspirate above the diaphragm first. Follow the same rule for injection. 

fluids from stomach, lungs, and brain

stomach	nose/mouth	Liquids, semisolids, dark brown ‘coffee ground’ appearance, odor, acid pH
lungs	nose/mouth	Frothy, any blood present is red in color, little odor
brain	nose/ear/eyelids	Gases can move into tissues of the eye, fractures can cause blood to purge from the ears, creamy white semisolid brain matter may exit through a fracture or the nasal passage