mike7evans

Eric... Pretty coincidental. I had my wound care certification that I got after I went through PEER Assitance. I didn't have any wound problems but I saw many that did... mostly from meth injections. However, I soon became bored with wounds after I got my certification which, at the time, required 2000 hours of experience and passing a pretty difficult exam. When it came up for renewal, I didn't renew as I never saw it put me ahead in pay nor positions. Take care, Michael

sorry, not an addictions nurse. however, i am an addict...sober x 15 years. i was reading all the posts to your thread. honestly, i expected to find substandard information. i was pleasantly surprised. yes, an addict/alkie (same disease) can and will be manipulative. after all, we/they have obtained their phd in manipulation by avoidance of getting caught. i was a tad different in that i wanted out. my life was deteriorating. i subscribed to the moral model instead of the disease model. i enjoyed the post of the nurse who said whatever number an addict tells you they drank, you can multiply that number by three. hahahaha... true. this is not to say that addicts should be treated with sympathy. they should be treated with empathy/understanding. in my experience in dealing with other addicts, i use good assertiveness techniques. assertiveness is neither being on the offense nor the defense. it is neutral. it involves boundaries very similar to dealing with inmates. a good resource is an old book you can probably pick up online for a buck..."when i say no, i feel guilty." this was the initial resource that led others into writing unlimited numbers of books on, "boundaries." "wow, you smell good." "sir/mam, i am here to get your blood pressure." (just a quick example here) avoidance of any over-familiarity is a must. sadly, the relapse rate of addicts in very high as most do not follow a simple set of rules to staying sober. why am i not in addictions nursing? according to several hearsay reports, relapse rates are higher for an addict working in addiction health care than working in other jobs. i value my sobriety and chose carefully the places i am employed. i qualify for my addictions nursing cert but i don't feel i want a certificate on the wall expressing this. i am sober only by the grace of god and not knowledge. best wishes.

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

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

To DeeCee, What culture do you have this 50% experience in? Thanks Michael

To OneThunder: Yes, I didn't cover dentures. Sorry. There is a prosthesis that CAN be used. However, it is my experience, that IF the dentures are not sent and the prosthesis or cotton is used by the embalmer....then typically, the day of visitation, the family will come in to view and ask, "here are his/her dentures, can you put them in?" Well, the answer is: "we can put them IN THE CASKET." The full truth is, we DO put them at the foot of the casket. However, we cannot place them in the mouth. Embalming has already taken place. Formalin has firmed protein in the cells. The mouth cannot be taken apart unless one is willing to mess up what is already done and take a chance on a really bad looking deceased. (The setting of the mouth is a focal point of the survivors) Now.... I have read the past few posts whereas several have talked about "pulling on the eye lids" and such. The procedure I described to be performed in post mortem nursing care doesn't invovled "pulling on the eye lids." It is a simple, "dry the eyes of moisture with a 4X4 or similar. Apply a small amount of vaseline to the bottom lid, and simply running the fingers over the top lids to bring them down to touch the bottom lids. The tackiness/sticky-ness of the vaseline will hold them together. Just asking for an attempt to get the lids closed before rigor sets in. This shouldn't invovle any "tugging" whatsoever. Plus the lids are delicate and will easily swell when a pressure is put on the system during embalming. Here is an exception to this request: Occasionally, nurses get a dying case that just won't die. Their body actually dies before their system dies. Finally, after they are pronounced, rigor is already happening or has happened and continuing. Therefore, IF there is resistance to the upper lids coming down, then just leave them alone as the embalmer will have to use the eye cap procedure anyway. So, the way I described, actually may take 15 seconds of a nurses time in bringing the upper lids down. Hope this helps. Another thing you are correct on... messing up the hands can cause leakage after embalming. YES, correct. I saw a former post that said something to the effect of, "bullmalarky about delicate tissues... would rather have a mark on the head..." blah blah. Basically, it said to me, "I am such a hard headed nurse and I am not going to take suggestions." Nothing I can do with that. Here is the full blown answer since my former simple answer got poo pooed on. WHEN tissue is damaged, even though it looks minor....then when decomposition sets it (which is nearly immediately and progressive), it is FURTHER damaged by the decomposition probably exponentially. Therefore, a simple skin tear on the hands/arms, turns into destroying the integumentary layer in that area. This allows fluid to escape out once a pressure of formalin is applied upon the system. We usually embalm at/about 3-4 pounds of pressure which I have calculated (years ago) to equal about 180mm/Hg...enough that in the living to cause a nose bleed to some. (I may need to recalculate as I have forgotten exactly). (Embalming machines are not precise instruments) Therefore, a simple bruise or maybe not even a bruise but just some very minor tissue damage turns into swelling once a pressure is placed on the system. With all that said...don't get spooked and scared to give a little Post Mortem care. I have maximized it somewhat so that my point is made. So this is the entire reason I originally said, "simple post mortem care should be done such as clean the present feces, apply a diaper, close the lids with a little vaseline." And yes... as you have pointed out... locate the dentures and secure them with the deceased in whatever fashion. Thanks. Michael

I am pretty much in line with "JessicRN's" thoughts on this one. It does kinda sound to me like you had a little control thingy going on in that... you did this and that... still, no consequences to this nurse suited you. I guess my question is: IF the BON did get ahold of this but all they did was slap a 25.00 fine on it, would you be satisfied with that? Not beating on you just kinda thinking you might wanna take a look at yourself on this one. Bottom line is.... you do your part and the consequences are up to a higher power...whoever, that higher power is. I do chart very accurately like JessicRN stated as I don't get into any coverups. I then do routing as advised. If they sit on it, then THEY sat on it, not you. You may consider this "justification." However, I have simply learned where my part ends and another begins. Good story on your dilema. thanks. M

Hello Chasing, I agree with RNMI on his/her response. The nurse should tell you as they should know a little more.... BUT, not to say this is always the case as you may be a regular there and the nurse is an agency or whatever. In that case, consult the nursing supervisor. BUT, FYI, the rule of thumb "typically" is: If going to the funeral home, etc... pull all lines. If going for an inquest (a Medical Examiner's investigation to determine if a full autopsy is necessary) then leave it all in. Back when embalming, I doubt I would've known what to do with a foley. Well, I really said nothing more than RNMI. LOL Michael

Correction to something.... I said "distal." I meant "proximal." Too many hours without sleep and then auto battery problems after the temp dipped to at/about 0 degrees F here in Tennessee. Something we are not used to. Thanks, Michael

Hello Skybaby, Hey, did you receive my private message to you with my email address? I never got a reply from you. UNLESS, I thought something was spam and it got deleted. If so, sorry and please resend. Still, with any bandages, I just cannot agree with around the wrist. If you could tear wet toilet paper with it, then don't use it. You have NO upfront idea of the time before embalming (if going to be a traditional funeral) Yes, what Talaxandra stated is MUCH better than the thin ties, still I can't go with it. The reason is... somewhere along the way we get a nurse that is thinking, "I don't have a kerlex(s) and we used to always just use these thin ties...etc.." After working at this place that we had several low functioning nurses, I just learned to attempt to fool proof things. So my opinion remains at: (If you feel like you must bind the arms to prevent arms falling...then perhaps...) Tie from just above the elblow (distal), across the chest to the opposite arm with 3-4" wide Kerlex gauze. As we advance in thoughts/ideas/concepts, more and more funerals are going to a less conversative approach. Therefore, it is more acceptable to display in casket a person in short sleeves when years ago the standard was a suit for a man and long sleeve dress for a woman. Hope this helps. Just worked 3 13hour shifts so I am off to zzzzzz. See you. Michael

i may be the most qualified to respond to this question as i am an rn plus a licensed funeral director and embalmer. all the post mortem care we learned in nursing school... ie: tie the mouth/jaw closed, tie the hands together, etc.... please forget all of this. i will explain: most set up rigor in the hours following and a process of desquamation can begin = "skin slip" or separation of the epidermis from the dermis. therefore, tying the scarf around the head to jaw technique closes the mouth and locks the mouth closed. it is much better for an embalmer to close the mouth than open it if/when rigor sets in. one embalmer in our company once broke a jaw opening it. tying the hands together at the wrist often results in tearing the skin around the wrist. this is extremely difficult to cover with makeup. if a nurse is anal and just has to tie arms, then tie from above the elbow to the other elbow. bowels relax and, most often, the deceased defecates...nothing new there. if cleaned, typically they will continue to defecate. simply clean them 1x and apply a diaper. an overall bath is unnecessary for most cases unless unusually dirty such as confused feces eating elderly patients. an embalmer has a table that he/she will wash the skin in an easy fashion. a porcelain table with running water is necessary after embalming to clean his/her mess -- ie: blood, feces, etc. the only value a total nursing bath on the average patient can be would be if the nurses have taken care of this patient for a long term period and have some emotional vestment. it can help them work through their grief process. now...something no one knows or does. the eye lids also set up rigor. if eyes are left open and rigor happens...i had to use "eye caps" to get closure. it is similar to a very large contact lens with barbs on the outside. then i pull the lids over with forceps or similar and the barbs stick into the posterior of the lids. therefore, simply dry the eyes with a 4x4, apply a light coat of vaseline...and close the lids. bottom lid 1/3 up, top lid 2/3 down. the vaseline has a tacky-ness and the lids stick to one another. in summary: dry, close the lids. clean up waste/secretions and apply a diaper. those are the 2 most important. if the family wishes to visit, then you may close the mouth (f it will stay closed) but then please open it back at least 1/2 way before sending out. thanks, michael