carotid artery and places a cannula inferiorly toward the trunk of the body as when typically embalming the body. The next step is to take an additional cannula and insert it into the right carotid artery superiorly toward the head, being sure to leave the stopcock open. The next step is to open the left carotid artery and insert a cannula with the stopcock open toward the left side of the head, carefully tying off the inferior portion of the left carotid artery to prohibit any returning fluid. Using the right jugular vein as the drainage point, the embalmer then injects the body through the right carotid artery. The embalmer can also raise the left jugular vein to keep blood from returning to the head, thus preventing a “flushed” look. Throughout the procedure, fluid may reach the tissues of the face through collateral circulation. This is why it is important to leave the cannula stopcocks open, as these will be the drainage sites. Once the body is thoroughly embalmed with the appropriate index solution, the embalmer can move to the head and inject the right side and left side of the head with a slow and steady rate of flow and pressure, which will give satisfactory results. It is highly recommended to use a delayed aspiration, preferably 6 to 12 hours later. This will allow the vascular pressure from the embalming fluid in the vessels to perforate the interstitial tissues for maximum preservation. As mentioned earlier, because of the onset of hypostasis, it is imperative to postpone the early stages of decomposition from opioid use. It is recommended to use 32 ounces of cavity fluid to treat the viscera—one bottle for the thoracic cavity and one bottle for the abdominal cavity. Because the vascular system may be compromised or interrupted by the opioids, the embalmer should use pulse instead of continuous flow so as not to force the fluid into the vessels. After the embalming operation, all PPE should be carefully removed and discarded in the medical waste container. A thorough cleaning of the instruments, floor, and other contaminated areas in the prep room is highly recommended. As opioid powders may have fallen on the floor, staff should not dry sweep with a broom, as this can cause aerosolization. A preferred method is to soak some paper towels with water and then sweep the towels around the room, which will cause any opioid residue to stick to the wet paper rather than become airborne.
Another significant complication is pseudoaneurysm, which causes necrosis on the outside of the artery that results in a contained rupture within the artery wall. While injecting, this arterial wall may rupture and disrupt the enclosed flow of formaldehyde. This may cause swelling and poor distribution to the body. Because opioid vascular deviation occurs through collapsed veins, contaminates, arteriosclerosis, and pseudoaneurysm, it might be necessary to complete a full six-point injection, raising the carotids to the head, the axillaries to the arms, and the femoral arteries to the legs. If the hand does not receive fluid, the embalmer will need to raise the radial artery. Because of the delicate size and premature arteriosclerosis of the radial artery, the embalmer should be gentle to avoid tearing or rupturing the vessel walls. Before beginning the embalming operation, the embalmer might get better results if they preinject with warm water that has a vascular conditioner. This will assist in flushing out the circulatory system, as some opioid products coagulate the blood in the vessels. If the individual is elderly and was taking prescription opioids, this preinjection will help remove the buildup of waste materials in the vascular system. As previously mentioned, kidney damage or other complications can lead to an abundance of nitrogenous waste in the tissues and blood such as ammonia, urea, and uric acid (Mallappallil et al., 2017). These byproducts can dilute and neutralize the effectiveness of the formaldehyde. Because of severe coagulation associated with certain opioids, it is common to distal areas to ensure proper diffusion and adequate preservation. For maximum preservation, it is imperative to formulate a stronger formaldehyde solution with a water conditioner because opioids can have an adverse effect on HCHO (formaldehyde). In cases involving both heroin and kidney disease, it is of extreme importance to use at least three bottles of 30% index with 256 fluid ounces of water for a 140-pound individual. When a death is caused by an overdose, usually there is a postmortem examination. When there is no autopsy, it is recommended to use the restricted cervical technique. This procedure isolates the head from the body and allows the embalmer to control the flow of pressure to the head. To properly use this procedure, the embalmer raises the right
FUNERAL CONTINUING EDUCATION
It all started through study groups with OGR members and the considerable impact opioids has on families and funeral directors. They found that individuals from all walks of life and socioeconomic backgrounds were dying. Funeral directors had all faced the same circumstances. For instance, many people who died were young and left behind small children (Allen, 2017). More significant was the fact that the opioid issues were not being addressed anywhere in the mortuary field. Some people in the field thought these issues were significant enough but did not see them being addressed anywhere, so they set up a webinar to give members a heads-up about how the opioid epidemic might affect them (Allen, 2017). Additionally, an expert panel spoke at the National Funeral Directors Association International Convention and Expo in Boston on October 31, 2017, to address the escalating epidemic. The discussions were about the consequential issues relating to substance abuse deaths and the opioid issues facing the U.S., which are becoming a serious global problem (a pandemic).
It is important to educate all funeral directors and personnel about the dangers and risks of handling the remains of an overdose victim and how the funeral home staff can become more aware of what they are dealing with. From national to state conventions to web-based continuing education courses, it is all about raising awareness. Being proactive in its approach, the International Order of the Golden Rule (OGR), an association for independently owned funeral homes across the United States, has stepped up to the plate. It has created two webinars and published two booklets: Opioid Epidemic: How Funeral Directors Can Respond and Opioid Epidemic: How Communities Can Respond . At first, OGR printed 1,000 copies of the booklets, but because of the remarkable number of requests, there was another mass distribution of 23,000 copies.
EliteLearning.com/Funeral
Book Code: FFL1225
Page 56
Powered by FlippingBook