Preparation of the Infant- Exam 2- 4

Question 1

It is recommended that the embalmer not use these for the preparation of the infant. Many of these small bodies do not demand as much preservatives as an adolescant or adult, but require a similar strength of arterial solutions. Use regular arterial fluids and strengths only slightly reduced from those of the adult.

Answer 1

Pre-Injection and Weak Arterial Solutions

Question 2

• Cranial
• Throacic
• Abdominal
• Spinal autopsy
• Limbs examined

Answer 2

Complete Autopsy- Infants

Question 3

• Cranial, thoracic or abdominal cavities, spine or limbs.

Answer 3

Partial Autopsy- Infants

Question 4

Removal of only one organ.

Answer 4

Organ Examination Only- Infants

Question 5

• Organ donors- removal or eyes and/or any of the visceral organs or skin that may be used for transplantation.
• Infants whose embalming has been delayed but who have been neither refridgerated nor frozen.
• Infants that require restorative Treatments (these bodies may or may not be autopsied)
• Fetuses

Answer 5

Unautopsied Bodies- Infants

Question 6

• Positioning the infant
• Carefully wash the infant
• Remove any intravenous tubes or any other invasive connections to the arterial or venous system. Also remove tracheotomy tube, adhesive tape, etc. Dry wash and cotton gently applied to blood stains, etc.
• Phenol jelly or topical preservative jelly, low fuming, is preferred for osmotic preservation
• Wrap infant in prep towel and show only the face- infants on their backs at rest.

Answer 6

Special Considerations for Non-Viewable Infants

Question 7

Assume for identification purposes that the non-viewable infant will be seen by one authorized PRD.

• tradition as well as local customs dictates procedures.

Answer 7

Positioning the Body- Non-Viewable Infants

Question 8

• Feature setting
• Body Positioning
• Dressing

Answer 8

Pre-Embalming Considerations

Question 9

Avoid mouth closure methods if possible- in a problem case, a muscular suture will fine suture and small half moon needle can be used.

Answer 9

Feature Setting- Mouth (Viewable Infants)

Question 10

Avoid glue; instead use petrolatum jelly, stay cream, or even massage cream on the lips. Allow lips to part- suckling instinct- a natural feature that should be preserved.

Answer 10

Lip Closure- Infants

Question 11

Baby eye caps especially designed for children or “cut down” trimmed adult sized eye caps; clear are preferred over flesh color. Glue or petrolatum jelly can be used as an adhesive (Be careful of eyelashes).

Answer 11

Eye Closure- Infants

Question 12

Head block cannot be used; instead, use towel or small styrofoam blocks to position baby prior to embalming.

• Arms- optional at sides or across the abdomen
• Head optional- straight or slight tilt to right
• Legs- Immediately after injection, wrap legs with wide strips at knees so they will appear straight in casket.

Answer 12

Body Positioning- Infants

Question 13

Never cut clothing, often parents will dress baby for the last time.

Answer 13

Dressing- Infants

Question 14

• Pack nose and throat with cotton and sealer, small forcep will be necessary.
• Autopsy- clear plastic over-all incisions- prep towel- plastic and baby hat will be necessary. All incisions must be hidden.
• Small band aids can be placed on top of any incisions.
• Always assume that the family will dress the baby.

Answer 14

Be sure all Incisions are Packed, Sutured, and Sealed

Question 15

Embalming considerations- nonautopsied

Because vessels are too small to inject and drain and because of the absence of intestinal bacteria- osmotic preservation with topical preservative jelly or topical including cavity packs and osmotic sprays and plast will temporarily preserve the infant long enough for funeralization- long viewings are discouraged, however.

Answer 15

Stillborn Infants and Those Which Die Soon After Birth

Question 16

Two Methods:

1. Ascending Aorta- No
2. Abdominal Aorta- Yes

Answer 16

Babies up to One Year of Age (Non autopsied)

Question 17

• An incision can be made with a strong surgical shear directly down the midline of the sternum. The sternum is then separated exposing the pericardium around the heart.
• The pericardium around the heart is opened exposing the heart as well as the ascending and arch of the aorta.
• A small curved arterial tube is inserted into the ascending aorta as it arises from the left ventricle of the heart.
• Drainage is established from the right artrium.

Answer 17

Ascending Aorta (NO)- This is never to be done

Question 18

This method will NEVER be used or supported by CCBC Catonsville Mortuary Science Program for 2 reasons:

1. Unnecessary mutilation of the sternum
2. Arterial fluid will enter the head by way of the common carotid arteries too quickly.

Answer 18

Ascending Aorta

Question 19

• A 3 inch incision is made just to the left of the midline (or on the midline) of the abdomen from the xiphoid process of the sternum to the umbilicus.
• Open the greater omentum and remove part of the large and small intestines until the spine is visible.
• Abduct the abdominal aorta just to the left of the spine.
• Insert small arterial tube downward toward the common iliac arteries; avoid going into bifurcation. Inject both legs.
• Inferior vena cava will rapidly expand during injection- pierce vena cava with sharp needle to establish drainage.
• After legs and buttocks are embalmed, reinsert arterial tube upward through same entry point in descending adominal aorta. Emblam the head and torso. Drainage will continue from inferior vena cava.

Answer 19

Abdominal Aorta (YES)

Question 20

Will involve a small intricate baseball stitch. Apply glue over suture and a new band-aid.

Answer 20

Suturing for Both Methods (1 yr age)

Question 21

Use infant trocar 8-12 inches in length 1/4 inch in diameter. Either the immediate or deterred cavity treatment method can be used based on the condition of the body.

• Recommend re-aspiration before dressing leaving cavities dry. Do not add additional cavity fluid unless decomposition is present. No more than 8 ounches of cavity fluid, undiluted, 4 above- 4 below diaphragm.

Answer 21

Aspiration after Injection of the Infant

Question 22

The apiration and cavity injection can be done through 3 inch incision already utilized previously.

Answer 22

Advantage of Abdominal Aorta Method

Question 23

A Trocar button will have to be utilized using this method.

Answer 23

Disadvantage of the Ascending Aorta Method

Question 24

• Any acceptable mouth closure method.
• Any acceptable lip closure method
• Eye caps for eye closure- baby caps or trimmed adult caps.
• Injection and drainage site- right femoral artery and vein
• Cavity treatment- immediate or deterred method reaspiration prior to dressin; inject undiluted cavity fluid- total 16 ounces: 8 ounces above and 8 ounces below diaphragm.

Answer 24

Children from One to Five Years of Age

Question 25

Should be liquid transparent with alcohol base- opaue paste cosmetic in combination with drying powder should only be used to hide discoloration and in conjunction with restorative wax for restorations. Careful shaving of find downy hair, common to babies, alled lanugo must be done prior to injection and prior to cosmetic applicaton (to prevent desiccation and so the cosmetic will not matte).

Answer 25

Cosmetics

Question 26

• Complete autopsy
• Partial autopsy
• Special or local autopsy
• Organ donor autopsy

Answer 26

4 Types of Autopsies Performed on Infants

Question 27

Cranial and trunk cavities are opened and enclosed viscera removed.

Answer 27

Complete autopsy

Question 28

Only one cavity is opened (cranial, throacic, abdominal or spine).

Answer 28

Partial Autopsy

Question 29

Only one organ is removed or a special examination is made of the rout of blood vessels or nerves.

Answer 29

Special or Local Autopsy

Question 30

Eyes may be removed, for the eye is quite large in the infant and the cornea of great value. The heart, lungs, liver, kidneys, or skin may be removed as in the adult, and these donations can be treated as partial autopsies.

Answer 30

Organ Donor Autopsy

Question 31

• Carefully shave fine down hair (laungo) on face; be careful of dessication marks. Always check with family.
• Wash baby inside and out. Open all cavities. Treat viscera if left by pathologist in a separate container. Use zip-lock bag; coat all viscera with topical jelly. Place jellied viscera with hardening compound inside zip-lock bag; close bag.
• Apply massage cream over body surface, especially face and arms for skin protection against discoloration.
• Mix mild fluid- using a humectant base arterial 15-22 index 6-8 ounces in one gallon of water. Attach small abby arterial tube to hose- run through- set low pressure and low flow.

Answer 31

Autopsied - Embalming Considerations

Question 32

Only in difficult cases.

Answer 32

Hypodermic Injection

Question 33

• Use large volume syringe
• Mix mild fluid in pan or bowl- 15 to 22 index humectant based, 6-8 ounces in gallon of water. Reverse needle (#18) by detatching and inserting to point into plastic hub. Attach plastic hub to syringe.
• Open small arteries- right and left common carotid (head), right and left subclavian or axillaries (arms), external iliacs for legs
• Do each artery (6) seprately by carefully inserting non-pointed end of needle. Fill syringe with arterial fluid and inject.
• Treat sidewalls after 6 major arteries are injected. (hardening compound) Return viscera- fill cavities with cotton. Suture incisions, pack foramen magnum

Answer 33

Hypodermic Injection

Question 34

• Cleaning and disinfection procedure
• Close and seal all incisions with glue.

Answer 34

Post Embalming Considerations

Question 35

Carefully wash autopsied or nonautopsied baby. Aspirate nose and mouth. Pack nostrils and throat with cotton. Check eye, mouth and lip closure; check fingernails.

Answer 35

Cleaning and Disinfecting Procedure

Question 36

Apply prep towel strips to glue- use plastic diaper in combination with saran wrap as a protection against leakage.

Answer 36

Close and seal all incisions with glue.

Question 37

1. Left and right external iliacs
2. Left and right subclavians
3. Left and right carotids

(In this order)

Answer 37

6 Major Arteries to Use in an Autopsied Case