Personal protective equipment Some opioids such as fentanyl can be absorbed through the skin. It is strongly encouraged to maintain high standards of personal protection. Currently, OSHA does not have an airborne permissible exposure limit as it relates to opioids. Besides the OSHA document 1910.132 (D), which recommends general personal protective equipment (PPE), nothing more has been written for compliance directives to inform persons what additional precautions must be taken (OSHA, 2019). So what does this mean? It means embalmers have the responsibility to protect themselves. As far as PPE, it is advisable to follow everything learned about universal precautions in mortuary school, a philosophy that is sometimes lacking in the prep room. The PPE equipment is a face shield or goggles, a full-length gown, booties, bouffant, gloves, and an N95 face mask, which protects the wearer from inhaling airborne opioids. A regular surgical face mask provides a barrier from splashes of bodily fluids but is not designed to filter out airborne particles. The N95 mask has a charcoal capsule at the front where it actually filters hazardous substances. Embalming the opioid case Opioids cause physiological changes within the body. As an example, heroin can cause premature arteriosclerosis, especially in young adults. This hardening of the vessel walls creates a significant disruption in the arterial system and restricts the flow of formaldehyde to the distal parts of the tissues. Blood vessels in the heroin user may also become clogged with contaminants. The additional substances added to heroin may not completely dissolve and become lodged in the vessels of the kidneys, lungs, and even the brain. Also, heroin breaks down muscles and tissues, so it is advisable to formulate a mixture that will produce the best preservation (Renzoni, 2019). Because proteins are prematurely broken down before death, rapid autolysis (cellular destruction) can occur at the time of death. With the tissues already compromised from autolysis, decomposition could set in rather quickly. Thus, the embalmer is already at a disadvantage before the embalming operation begins. It would be wise to inject with a low and slow pressure and rate of flow, as repeated intravenous injections of heroin or crushed opioid pills can lead to cumulative damage to the veins and cause them to collapse. The flow of formaldehyde will go only where there is the least amount of resistance. Using too high of a pressure or rate of flow will cause either distention or inadequate embalming in the dependent or distal parts of the body. 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, it is recommended to be gentle so as to not tear or rupture the vessels walls.
It is recommended to use nitrile gloves, which are a medical- grade synthetic rubber that provides superior puncture resistance (WESCO, 2019). Latex gloves are a natural rubber and not as efficient. It has been found that nitrile gloves, which are 3 times more puncture resistance than latex, are the most effective in this particular environment. For added protection, the thicker 8-mil glove with the higher cuff length for an additional barrier is recommended. Also, opioid powders will be more visible to the embalmer by incorporating a darker colored glove such as black rather than using a lighter color (WESCO, 2019). Whichever type of gloves an embalmer uses, it is important to remember that though gloves are a necessary precaution, their defective rate and polymer permeability will diminish after continuous use (WESCO, 2019). Over time, natural oils, body temperature, and heavy acidic perspiration buildup can degrade the efficiency of the gloves. Throughout the handling of remains, embalmers should continually check for any leaks, holes, or advanced wear. When in doubt, throw them out. Before beginning the embalming operation, the embalmer might get better results if she preinjects with warm water with 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 complications can lead to an abundance of nitrogenous waste in the tissues and blood such as ammonia, urea, and uric acid (Mallappallil, Sabu, Friedman, & Salifu, 2017). These byproduct materials can dilute and neutralize the effectiveness of the formaldehyde. Because of severe coagulation associated with certain opioids, it is common to hypo 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 both cases of heroin and kidney disease, it is of extreme importance to use at least three bottles of 30% index with 208 fluid ounces of water for a 140-pound individual. When a death is caused by an overdose, usually there is a postmortem examination. In the case where 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 carotid artery and places a cannula inferiorly toward the trunk of the body as normally when 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
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Book Code: FNJ0524
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