Case Analysis: Difficult - Obese

300-350 lb.

Concentration 2.5%

Dilution – approx. 10 oz. arterial fluid per gallon of solution (Using 32 index) Use Dilution Calculator for all other index’s. Mix approximately 3-4 oz. of Arterial conditioner and 3-4 oz. of drainage chemical.  RCI Restricted Cervical Injection may be necessary.  Many times with larger bodies, the head and face receive the fluid more thoroughly during injection.  Because the body is much larger than normal and the amount of time needed to properly inject arterially typically results in over injection of the neck and head/face, resulting in over-injection. 

Directions –

  1. Raise both L and R carotid arteries (RCI)
  2. Inject at a rate of about 20 oz. per minute at 20 lbs. of pressure.
  3. Increase pressure if little or no distribution to the legs and feet are evident. 
  4. Rate of flow may need to be increased slightly.  Watch for swelling or firming in the abdomen, for this may be a sign of swelling and cause purge.
  5. Clamp off Drainage and use intermittent drainage.  This will promote thorough distribution and diffusion to the tissues.  If the body is swelling, remove vein clamp and allow free drainage.  (lowering rate of flow may be necessary).  Gravity-option machines may be the optimal choice.
  6. Raise vessels where distribution was not readily detected.
  7. Hypodermically inject all tissues that did not receive thorough distribution.
  8. Lift body to a dressing table atop a cotton sheet. 

NOTE: Body weight may and usually will cause arteries to collapse.  Elevating the pressure may combat this problem.  Elevating the shoulders with a body positioning device will help alleviate pressure imposed on to the body parts by the table top.  For wider bodies, place a 5’ 3” white PVC pipe in the trough of the table.  This will assist with water-flow on the table and help avoid fluid spill-overs.