Embalming A to Z: Purge
It is the embalmer's worst nightmare, the ticking time bomb which can explode at any time, under any conditions. Nothing can spread panic in a funeral home like having a family member come to the office and announce that "Something is running out of Mom's nose" or "There's stuff coming out of Dad's mouth."
Throughout my career, when I have been confronted with a family member announcing that "Something is running," I have seen calm, confident, competent embalmers hit the floor running to correct the problem. I have washed white shirts, washed casket pillows, taken remains out of the casket for reaspiration and, on a few occasions, replaced the mattress. Once I had to replace the entire casket.
Purge: The bane of the preparation room. Purge: The tormentor of every embalmer on the face of the earth. Purge: The subject about which the public knows nothing, but has a definite psychological reaction to when confronted with it.
Purge can occur at any point in the body where an orifice exists—mouth, nose, ears, urethra, rectum or an artificial orifice such as a wound. Purge can be due to a number of factors, including hemorrhage, gas pressure or both, or excessive embalming pressure with unregulated rate of flow.
Purge from the mouth and nose usually originates in either the stomach or lungs, or both. The color of the purge will usually identify its origin. For instance, stomach purge usually is yellow to brown and can be semi-solid. Lung purge will usually be red to rust brown in color with a foamy texture. Ear purge is usually hemorrhagic in nature, or caused by putrefaction, both of which create intercranial pressure. Purge from the rectum and/or urethra is often due to gas in the hypogastric region. Nasty stuff!
After this unattractive and somewhat offensive but realistic description of the nature of purge, and before we examine the treatment for it, I need to quickly add that sometimes purge is a necessary and good aspect of embalming. But certainly not when it appears after the remains are placed in the casket.
I well remember one evening embalming deceased human remains which started to purge. I immediately turned off the injector and went to fetch my employer. When my boss arrived, he told me to start the injection again, and so I did. The purge continued in a variety of places, but there was no swelling or distension. My boss told me to continue injecting, clean everything up and then aspirate the remains.
Everything turned out wonderful and the family was well pleased. My boss' approach was to let the body respond naturally to the injection and allow the discharge from the case to take its natural course. Sometimes purge during embalming can be desirable.
Stomach purge. All purge eventually will be conquered by aspiration and reaspiration. However, in the instance of stomach purge, 6 to 8 ounces of cavity fluid can be poured down the esophagus while the arterial injection continues. The action of the cavity fluid can solidify the stomach contents.
Also, a liberal amount of cotton soaked in cavity fluid and inserted down the throat in addition to the cavity fluid poured into the stomach can retard stomach purge. It is very important that if you pack the throat with cotton soaked in cavity fluid you also liberally apply massage cream to another portion of cotton and place this on top of the cotton/cavity fluid pack. This will ensure that the deceased's lips will not dehydrate from the astringent action of the HCHO fumes.
It is risky to aspirate the stomach with a sharp pointed trocar while the arterial injection is taking place. The pointed trocar can damage the mesenteric vessels even though the aorta and vena cava are not damaged.
Lung purge. When the cause and/or mode of death have resulted from disease or injury to the lungs or bronchial tree, the purge is usually going to be hemorrhagic in nature.
Six to 8 ounces of undiluted cavity fluid can be poured down the trachea, and a cavity pack can be placed into a throat soaked in cavity fluid. The reaction of the cavity chemical when in contact with blood is rapid coagulation. Hence, when lung purge occurs the cavity fluid not only will coagulate the blood, but also will help in the preservation of the lung tissues.
Ear purge. A purge from the ears is usually hemorrhagic and is usually of short duration, since generally it will stop once the intercranial pressure has been relieved. Brain aspiration is an effective way to relieve this type of pressure. The use of a trocar button will prevent leakage.
Gas purge. Urethral or rectal purges are easily taken care of in the preparation room. This is not pleasant work, but it needs to be done nonetheless. Packing and ligature ties are the most effective way, but the chemical companies have recently invented devices to be used in these instances which are much more sophisticated that the old-fashioned method of packing. However, a novice embalmer who does not or will not pack these private areas has not truly been baptized in the real world of embalming procedures.