Due to a number of private requests from podcast listeners and community members along with a general easing of the restrictions on embalming COVID-19 cases, we thought it would be helpful to offer some advice to enhance your embalming approach.
A year on through the COVID-19 Pandemic; Episode 5: The One That Went ‘Viral’ remains as relevant as when it was recorded and released.
Via experience gained through the pandemic to date, Presenter Andy has established a go-to method which he feels is an effective approach to COVID-19 cases. Here are some points to consider of key importance and also the things that he would do differently;
Pre-Embalming Considerations
- Wherever possible COVID-19 cases should be scheduled to be cared for consecutively as the last cases of the day.
- Establish who can/cannot be in the embalming theatre and a suitable notice be placed on theatre door.
- Ensure you have an operational down-draft system.
- Ensure you have access to and are using PPE in line with the BIE guidelines, minimum standard respiratory protection of FFP3 mask, ideally a personal respirator.
- Cover the deceased’s naso/oro orifices with a 3 ply surgical face mask or other suitable covering before manoeuvring the deceased.
- Any personal belongings removed from the deceased will require attention. Any material (fabric) items to be treated with a sterilisation mist and placed into an appropriate sealed plastic bag. Any non-material possessions soaked in disinfectant for the required contact time.
- Chemical preparation as determined by the individual needs of the case but a minimum of 3% final concentration of a formaldehyde based arterial should be employed. The addition of an accessory disinfectant chemical can be added to the arterial at a ratio of 100ml per 1000ml solution (Episode 1: Embalming Equation & Episode 9: Jekyll & Formaldehyde).
- When preparing the disinfectant bath, double the recommended dilution strength.
- Important to thoroughly disinfect the deceased with a suitable contact disinfectant (without aerosolisation).
- Using an antifungal disinfectant considered attention paid to facial features, beginning with eyes and ears before removing the face covering in stages as naso/oro orifices are treated.
- Provisionally set features, utilise temporary mouth closure (shoelace bow).
- Incision site; double cervical incision to access right common carotid artery, right internal jugular vein and the left common carotid artery (the left common carotid need not be incised as per Restricted Cervical Incision unless warranted as the purpose is not to isolate the head, rather ensure maximum distribution). Alternatively a central incision may be utilised to access these vessels from one site along with direct access to the trachea.
The Embalming Process
- It is advisable to introduce approximately two litres of arterial solution into a closed system, utilising the delayed drainage technique (via the right internal jugular vein) to allow for adequate perfusion of the lung tissue (Episode 3: Vein Drainage).
- To minimise aerosol generating procedure (AGP) the use of cardiac massage should be avoided.
- As an alternative to using cardiac massage, increasing pressure of injection with controlled rate of flow along with intermittent drainage can be as effective (Episode 2: Pressure & Rate of Flow).
- Thorough and considered aspiration ensuring maximum penetration of the respiratory tract.
- Before effecting preparation and closure of the cervical incision site(s), the trachea should be located, carefully incised to ensure complete separation into a superior and inferior portion. An absorbent packing material soaked in disinfectant should be introduced into both portions of the trachea.
- Cervical incision site(s) should be closed using a suitable intradermal or inversion wormian suture.
- Ensure use of a traditional formaldehyde based cavity fluid, minimum of one litre throughout thoracic, abdo-pelvic cavities.
Post Embalming
- Due to the nature of the virus and enforced distancing, a deceased’s usual personal grooming routine may not be discernible to the embalmer. Therefore clear instruction from the client/family should be obtained.
- All instruments should be disinfected for the required contact time.
- The embalming theatre should be cleaned thoroughly and a liberal application of sterilisation mist to conclude.
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