4). Case Analysis & Selecting Fluids
One of the most critical points of thinking during the embalming operation is that of
case analysis. This is the time when intentional thought and analytical thinking are vital to obtaining the desired end results.
Every case is individual and different. While there may be many similarities from case to case, finding the particulars and
having a method or process for treatment is essential to making the difference in the total embalming effect.
Knowledge of the time of death can also be beneficial knowledge. The more time that lapses
between death and the embalming operation, the more complicated the case could become. The cause of death can have a noticeable
impact on the process of case analysis. The facts surrounding the death will help determine what specific techniques and types
of fluid should be used in the embalming process.
If the deceased has died as the result of trauma or severe injury, these factors may
also vary the procedures and selection of chemicals. Open wounds and lacerations invite problematic issues that need special
treatment and care.
Medical conditions such as a jaundice condition make accurate selection of fluids a mandate
for thorough tissue preservation and normal appearance and color. If jaundice is present in a mild form the embalmer may not
be able to detect it by general skin color. Observing the whites of the eyes will probably be a more accurate way of detecting
more mild jaundice conditions.
Other known medical conditions of the deceased, especially vascular diseases and related
conditions will give the embalmer better insight as to how to more accurately perform the embalming procedures. Sometimes
the vascular alterations performed in heart bypass surgeries can affect the circulation in the extremities of the body.
Pharmaceuticals (prescription medication) that may have been consumed by the deceased
prior to death may be very influential on how the embalmer approached the case analysis process. Drugs and medications are
a very complex science that can have a myriad of influences on the effects of the embalming chemicals used in what would be
considered to be a “typical” embalming procedure.
Another aspect of case analysis is the possibility of non-prescribed drugs and chemicals
in the body of the deceased. Opiates and other recreational pharmaceuticals can distort and change the expected results of
an embalming operation.
One of the most important things to consider is the moisture content of the body. Bodies
are generally swollen to some extent when there is an excessive amount of moisture in the body. There is a difference between
obesity and high moisture content in the body. Even though it is common to have an elevated moisture content in overweight
or obese bodies, obese cases can be somewhat dehydrated depending on specific conditions in and around the time before the
person’s death took place. Often time the appearance and texture of the tongue, nose and eyes may be an indicator of
dehydration in a larger or obese person.
Bodies that lack moisture content are often emaciated or somewhat skeletal in appearance.
Often the lips, nose and/or eyelids will be exceptionally dry or crusty in appearance. Often times it will be difficult to
close the eyes and mouth because of such conditions. In cases like these it should be the objective of the embalmer to restore
some level of moisture to the tissue of the body for a more natural cosmetic appearance and texture.
This is often accomplished by injecting an arterial fluid solution that is designed to
restore dehydrated tissue by the addition of moisture into the body. The easy way to identify such arterial solutions is that
they look cloudy or even “milky” in their original containers and when mixed into a solution in the embalming
injection machine. This appearance is because of the presence of hydration chemicals often referred to as humectants, in the
solution. Lanolin is often used in the manufacturing of these products.
With bodies that have a higher moisture content more astringent and dehydrating embalming
solutions should be used. These fluids generally appear more translucent or transparent in their original containers and when
mixed into a solution in the embalming injection machine. Often manufacturing companies market these chemicals as moderate
to higher index fluids of formaldehyde solutions.
This is why it is appropriate to have a selection
of chemical solutions available for use in the various embalming operations performed. Each case is unique, despite its similarities
to other cases that an embalmer may have experienced. So a careful analysis of these particulars of any given case will only
serve to better insure the desired results.
5). Raising Vessels
Selecting the correct arterial vessel for injection is important to not only the ease
of embalming the case, but also the thorough penetration of the embalming solution into the entire body for preservation,
disinfection and cosmetic affect wherever possible.
On most normal (non-autopsied) embalming cases most embalmers would select either the
right carotid artery or the right femoral artery as the primary point of injection. The primary reason for the selection of
the right carotid artery is because of its size and ease of location, and its proximity to the center of the body’s
circulatory process – the heart. Other arteries may need to be used to obtain thorough tissue penetration throughout
the entire region of the body.
The selection of the right femoral artery for a first or primary injection point might
be for its size and ease of location. The incision for this artery can also be comfortably hidden underneath clothing and
thus requires less cosmetic attention during the preparation of the remains for viewing and/or memorialization.
In some obese cases where there is very little neck to sufficiently have room to raise
the carotid, and where the thickness of the thigh would cause the femoral to lie deep in the tissue of the leg, some embalmers
opt to raise the auxiliary artery located in the armpit region. Generally this artery still remains more superficial in that
region of the arm and can be raised for injection with approximately the same effort that it would be when used as a second
or third point of injection.
When locating the right carotid artery, the incision should be made along the top curvature
of the clavicle bone. The guide for locating this vessel can be easily found by drawing an imaginary straight line down through
the center of the right eye downward past the right corner of the mouth down the neck and onto the upper chest region.
Once the incision in the vein is made and properly dilated, the right jugular vein will
be the first major vessel to be exposed. The carotid artery will be positioned just slightly deeper than the jugular vein
and slightly more medial to the interior of the thoracic cavity.
When locating the right femoral artery, an imaginary straight line can be drawn down
the leg between the pubic synthesis (the center of the groin region) and the crest of the Ilium (the most superficial extension of
the hip).
Once the incision is made and properly opened, the femoral artery will be the first major
vessel to be exposed. Just beneath the artery the femoral vein can be typically located. Often time in elderly people the
femoral artery may be very hard and brittle. These sclerotic vessels should be handled very carefully so as to not rip them
or sever them with the instruments the embalmer is using to clean the incision or raise the vessels.
Each vessel that is raised for injection or drainage should
have two ligatures placed around them. This is so the vessel walls of the artery that is being injected can be closed down
around the artery tube. It is also so that the artery and the vein can be tied off on either side of the vessel’s incision
before closing the external incision.
6). Injection Processes
Once the proper embalming fluid solution has been determined (See # 4. Case Analysis
and Selecting Fluids), it can be mixed in the embalming machine and made ready for injection. The vein that is going to be
used to receive drainage from should be opened first. Either a drain tube or spring forceps can be inserted into the vein
to keep it dilated. Then the artery may be opened so that a artery tube attached to a hose from the output of the embalming
machine may be inserted into it. The ligature placed around the vessel (See # 5. Raising Vessels) will tie the vessel walls
around the inserted artery tube. Depending on the condition of the vessel it may be necessary to use artery clamps around
the vessel to hold the artery tube securely in place.
Each embalming machine is different when it comes to understanding and controlling the
injection pressure (how much force is used to inject the embalming chemicals into the human remains) and the rate of flow
(how fast the embalming chemicals travel into the body). Typically most embalming machines have a gauge that displays what
the injection pressure is. It can usually be adjusted to a desired level. Most injections can be safely made between 3-5 lbs.
of pressure.
Some embalming machines have an adjustable rate of flow also. Rate of flow can usually
be determined by looking at a sample stream going back into the reservoir tank of the embalming machine. On older embalming
machines it is common to find that the rate of flow control does very little to change it. Many times there is no gauge to
see what rate of flow the machine is actually producing.
Knowing how much embalming fluid solution to inject is an important issue in achieving
the optimum results in an embalming operation. Most embalming standards call for a minimum of one gallon of embalming chemical
solution for every 40-50 lbs. of body weight. The heavier the body, the lower the pound ratio should be. If the moisture content
of the body is higher and a stronger hypotonic solution is being used, it is best to use a higher volume of solution. Sometimes
the quantity of fluid arterially injected will have a dynamic affect on the final results in regards to the firmness in the
body and the skin. This is why many embalmers vary the quantity of embalming fluid that is injected because of their requirements
of producing a firmer body or a more flexible body when the case is completed.
If the body is dehydrated and/or emaciated and a hypertonic solution is being used, it
might be sufficient to go by the principal of one gallon of solution to fifty pounds of body weight, realizing that a little
extra injected solution will usually only compliment the results.
When injecting the body with the embalming chemical solution it is usually a good technique
to stop the injection every gallon and evaluate what progress is being made. This technique is sometimes referred to as an
intermittent type of injection.
Observing three basic indicators in the body as the injection is taking place will help
identify the potential results that may be achieved by the end of the operation. The first indicator is vessel distention.
This distention can be seen as a bulging and/or a darkening of the veins just below the surface of the skin across the surface
of the body. During the course of the injection these vessels may actually change colors to a similar shade or color of the
embalming chemicals that are being injected.
Another related indicator is when the actual skin color changes to be more of the shade
or color of the embalming chemicals that are being injected. The third indicator is the tissue texture. As the tissues of
the body receive the embalming chemical solution through the capillary systems it often causes the firming or stiffening of
the skin and muscle tissues. This can be very noticeable to the touch. There are some cases where the skin and muscles will
not firm with the injection of these chemicals. Therefore tissue firmness is not always an indicator of tissue preservation
or effective embalming.
An Important consideration is to determine whether the drainage from the vein should
be permitted to be continuous flowing or if it should occasionally be restricted so as to build up some pressure in the arterial
system to try and open up potentially closed or relaxed areas. It is always the safest procedure to leave the drainage open
at all times. However, a skilled embalmer that has ample experience in recognizing potential vascular issues can use intermittent
restrictions to enhance circulation and drainage quality. Understanding that the vascular system in the human body is one
continuous loop can help in the determination of where problematic issues concerning fluid circulation in any particular case
may be. Once and if those areas are located or determined such technique may be applied.
Many embalmers massage various parts of the
body (specifically the arms, hands, legs and feet) so as to encourage circulation in areas that may not appear to be reached
in the initial moments of the arterial fluid injection. If the body is going to undergo massage, it should be moderately gentle,
and the motion of the massage should always move toward the center of the circulatory process. The is generally the heart,
especially when using the carotid artery for a primary injection and drainage point. It is generally never advisable to massage
the face and neck.
7). Post Injection Procedure
Once the injection is complete and the artery tube and drainage instruments have been
removed from the applicable vessels. The artery and the vein can be tied off on either side of the incision that was made
in the vessel. They should then be gently pressed back down into the open area of the general incision. Typically it is necessary
to swab out the open area of the general incision with disposable towel or a piece of cotton. The application of a powdered
sealant can be poured into the incision cavity to help prevent any potential leaks in the general incision once it has been
sutured.
The suturing of the incised area is an important procedure. The type of needle that is
used and the type of ligature is generally a consideration to the preference of the embalmer. The important issue is to make
sure each stitch that is made is initiated to the closest edge of the general incision and is drawn tight to form a tight
closure of both sides of the open incision. The embalmer should also make certain that both ends of the incision are sutured
properly so as prevent possible leaks.
After the incision is closed and the excess ligature has been removed, it may be beneficial
to apply some of the same powdered sealant used in the incision opening to the external surface of the closed incision. Remove
any excess sealant powder and allow the area to thoroughly dry.
Then a spray adhesive or liquid sealant can be applied to the incision. A swatch of cotton
or compressed cotton towel may be placed directly on top of the incision as a final treatment.
The embalmer’s main objective in closing
the incision properly is create a clean dry area that is not subject to leaking and if necessary, can be easily cosmetized.
8). Aspiration and Cavity Treatment
After the arterial injection of the embalming chemical solution is completed and the
incision has been properly closed, it is time to treat the abdominal and thoracic regions of the body. The abdominal region
is that area of the human body directly below the lungs extending to the top of the legs. The thoracic regions is the area
of the human body starting from the neck extending down to the bottom of the lungs.
Selecting the correct length of a trocar is important. A trocar that has a barrel length
extending from the navel to the lower neck region when laid on top of the body, should be adequate to sufficiently serve in
the aspiration process.
The reason for aspirating the abdominal and thoracic regions of the body is to remove
any excess fluids or gases (especially those produced by the human body itself) that may accelerate the natural decomposition
process in the post mortem human remains. This is done by attaching a hand held trocar to a suction producing device. Most
funeral homes utilize a hydro aspirator device which uses water pressure to create suction, flushing the extracted bodily
fluids and gas down the sanitary sewer system or into a designated holding tank.
The trocar should be inserted into the abdominal region generally an inch or two to the
left side of the navel on the body. (This would be to the right of the navel as one looks at the abdominal region of the body).
A good aspiration technique is to regularly push in and pull out from the point of insertion creating a fan shaped pattern
with the trocar throughout the interior of both the abdominal and the thoracic region of the body. This pattern should be
repeated at various depths throughout the abdominal and thoracic regions.
After the body has been thoroughly aspirated the embalmer should use the trocar, attaching
it to a bottle of cavity fluid with a hose and use the force of gravity to inject the fluid in the cavity fluid bottle into
both the abdominal and thoracic regions. The same technique that was used in the original aspiration process can be used to
gravity inject the cavity fluid. In many cases of normal or larger adult bodies, it may be advisable to inject two complete
bottles of cavity fluid – one into the abdominal area and one into the thoracic area.
Once the aspiration process and the injection of the cavity fluid is
complete the point of trocar insertion should be closed. It is always advisable to place some incision sealant powder as was
used in section # 7 into the point of trocar incision Since this is typically
a round opening a plastic device called a trocar screw or trocar button may be secured into the opening, effectively closing
the opening. When a trocar button or screw is not available a simple series of small stitches, using a needle and some ligature
will also do the same job effectively.
