Post mortem care

mike7evans · Mar 12, 2009

BTW, in this area (midwest) several of our local morticians have requested (at inservices) that (if we think about it) not to pull midlines or PICC's as they are easy routes for embalming. As we meet a lot of the same folks from the funeral homes that do pick-up of the deceased, (and if you do a lot of on-call, you meet a lot of morticians in the middle of the noc!) we try to build relationships. We have several of our local funeral homes that, when the family has no special charity to leave donations to, kindly suggest that our hospice has a foundation to assist those with financial hardships. We have noticed a sharp increase in our donations to our foundation with the forming of these relationships. Also, at our hospice, it is an unwritten understanding that we stay with the deceased until the funeral home has arrived. At three in the morning you do a lot of on call, you also know that there is no hurry on the part of the funeral home to pick up the deceased. Forming these relationships and having the patient ready, clean and presentable not only makes the family content, but it has formed wonderful relationships with our funeral homes--we actually receive referrrals from our morticians wanting us to take care of their loved ones because of our post mortem care of the deceased. Which also goes to show....you are forming relationships with every single thing you do within your company!!!

An embalmer requested NOT to pull a PICC Line since it is access to embalming? LOL. A PICC Line is a venous line. A formalin solution is not put into the veins but rather a major artery...R common carotid typically... or femorals...etc To drain blood from a PICC Line would be way too slow as blood most often is drained from the internal jugular. Are you sure they weren't pulling your leg?

Michael

skybaby RN · Mar 13, 2009

Hey Mike! Always look to you for great info. Regarding NOT pulling lines...I recently spoke to an embalmer (who also teaches) who says that NOT pulling lines can help to maintain the pressure within the circulatory system so that the injection of solution is easier. Once accomplished, the lines can then be pulled. Another scenario in which he recommended NOT pulling lines but rather cap them off (even peripherals) is in the case of the very edematous pt where leakage would not be contained by a dressing. He prefers to pull them after embalming in order to reduce leakage. He said that these lines would not be used for anything else.

What say you?

mike7evans · Mar 13, 2009

Hey Mike! Always look to you for great info. Regarding NOT pulling lines...I recently spoke to an embalmer (who also teaches) who says that NOT pulling lines can help to maintain the pressure within the circulatory system so that the injection of solution is easier. Once accomplished, the lines can then be pulled. Another scenario in which he recommended NOT pulling lines but rather cap them off (even peripherals) is in the case of the very edematous pt where leakage would not be contained by a dressing. He prefers to pull them after embalming in order to reduce leakage. He said that these lines would not be used for anything else.
What say you?

Hello Skybaby/Susan.... glad to see your are still watching this thread.

Well, the embalmer you spoke with has a MUCH better point than the embalmer who stated they used lines for access to the circulatory system, which made no sense at all. Sounds about like the stories we always hear of people sitting up in the casket. LOL.

I haven't embalmed in a few years...only a few cases since I went from Hearsing to Nursing. I never remember a pulled IV line being a big problem. As I always had to know everything about everything...I once calculated out 3 pounds of arterial pressure (which is the standard for embalming) into mm/Hg to find out the equivalent to a blood pressure. Seems that it calculated out to at/about 180mm of Hg arterial.

There are several techniques used in embalming. One was what we called "jack-leg" embalming in which fluid is injected into the arterial system and a major vein (usually the internal jugular) was left often. So fluid would run around the system (if adequate circulation) and come back out. I have seen probably more bodies embalmed like this than in the proper manner.

The technique I used was a pressure system. I would inject perhaps a gallon of fluid arterially while leaving my vein tube closed, in order to create a pressure upon the system. While injecting very very slowly and observing, I could see signs such as protruding veins same as tying off an arm with a tourniquet. I would then turn off my machine and let the pressure set on the system. Then, I would open the vein tube and release the pressure. This method creates a great chance of swelling tissue but does the best job which is why it is done very slowly and with great attention. Takes much longer also.

In the cases where I could see fluid escaping from a former IV site, I would simply cover it with a pressure dressing.

So your guy has better logic than using the lines for access.

Now on the subject of anasarca. IF they had so much fluid on board that I thought pulling a line would cause leakage, then there is a chance they are going to leak anyway if they do a traditional viewing/funeral. In those cases we were always cautious and preventive of this and went ahead and put plastic sleeves under their chosen garments. The have ready made sleeves for all extremities, plastic pants and even plastic coveralls that they can be contained in if leaking profusely. We always had a fear of seeing serous fluid penetrating the clothing.

A major gripe of ours was when we could see puncture signs at the site of the arch of the aorta. The arch is the center of embalmer circulation as the heart serves no purpose. If the arch was majorly damaged by an ME, pressure building was more difficult.

I got a nice email from our Nashville ME's office stating their preferences in pulling lines. I am in corrections so ALL our deaths (aprox 60 a year) are ME cases and they all go there for, at a minimum, an inquest. (Inquest - an informal investigation as to the cause of death. This typically involves reading medical records, physical exam, etc.) Only a small percentage actually have a full post-mortem exam/autopsy. Most of ours are terminal patients with good documention.

Their recommendation is for us to leave the lines in BUT cut and tie the lines. So we do not send an entire bag of IV NS but just some inches of the line so they can see we had a line. They were not that interested in talking about a foley...they said "either way...pull or not pull" is fine with them.

Glad to see your post. Hope you and Mister are doing okay.

Michael

americanTrain · Mar 16, 2009

Someone once told me of a true story where the deceased had been sent to the mortuary; the mortician said, "oh good, a clean one:. Hospice nurses who care, keep up the good work!