Case Analysis: Difficult, Tissue Gas, Generalized, Severe

Generalized Tissue Gas Decomposition 

Concentration no less than 3.0%

Remember – Tissue Gas caused by Clostridium perfringens is the fastest “known” generation-duplicating organism in the universe and require immediate treatment. 



These cases can be quite difficult and can create wreak havoc to the embalmer, if not properly equipped.  Proper chemical choice is vital to the destruction of the bacteria. If proper steps are not taken a body can decompose to the point of unrecognizable within a matter of a few hours. Time is of the essence.  


Dilution – approx. 11.5 -12 oz. per gallon solution (Using a 33 index) Use Dilution Calculator for all other index’s 

Directions – 

  1. Pour 11-12 oz of 33-index arterial into embalming machine tank, I prefer Frigid Fluid Co’s. 36 Plus (33 index) because it contains STOP a chemical proven to kill the C. perfringens that causes tissue gas. Frigid Fluid Co. also has STOP concentrate that can be mixed with other arterial fluids.
  2. Add a recommended amount of Tissue Gas chemical to the solution if you do not have the aforementioned Frigid Fluid Co. products. Next,
  3. Add 5-8 oz. of drainage chemical and
  4. 4 oz edema chemical (for tissue fixation). Next,
  5. Add .5-1 oz Dye (add as needed).

    1. Aspirate immediately after arterial injection (do not use a delayed aspiration method).
    2. Inject a minimum of 32 oz. of Frigid Fluid Co’s. Premium Cavity fluid (also contains STOP and should be the cavity fluid of choice).
    3. Re-aspirate after 30 minutes and repeat step 6(b.) repeat as needed.


Repeat steps 1-5 as needed.  Use professional judgment, but approximately 1 gal for every 50 lb. of body weight should be considered.  


Authorization to perform embalming procedures above and beyond “NORMAL EMBLMAING” is strongly recommended and may be required in some situations.


Recommended procedures:

Perform a 6-point vessel raise. I suggest using a bra-strap incision for both L & R Carotid arteries so that the embalmer can easily locate the Subclavian artery, which leads into the Axillary artery of the arms.  Both Carotid and Axillary arteries can be injected from one incision site.

Semi-lunar incision on severe cases helps eliminate tissue gas from further traveling up into the neck and face.

Tie off or clamp all arteries and next, open vessels (the “tie-off” should be proximal to the abdomen and the open incision should be distal from the “tie-off”). This will allow arterial gas to escape but also disallow the possible spread of gas from the abdomen to further spread into the extremities during injection. 

Open all veins adjacent to the raised arteries.  Do not restrict drainage.  


Inject each artery of the 6-point individually and separately from each other.  This will help control swelling. (Disinfect the arterial tube after each injection site and before inserting it into the next artery).

Restricted Cervical Injection (RCI) – First injection should be up into the face and head via Common Carotid Arteries. Inject the carotid arteries separate. First inject the Left then the Right carotid, in that order.  Do not use a “Y-injector”.  Full control over each side independently is not only vital for flow control but will also help to expel trapped gas from within the arteries (as the embalmer injects up the left carotid artery, gas will be forced out of the open incision in the RCC artery and Right Jugular vein).

Inject both Axillary arteries (order is not critically important). Tie-off all arteries and veins leading back towards the body and head at this point to eliminate potential mobilization of the bacteria to other parts of the body that have been already embalmed.  Drainage should take place at the injection area.

If the tissue gas is severe in the arms, several external punctures with a disinfected needle may be used to release the gas from the tissue.  Before using this technique the needle should be submerged into Premium Cavity fluid.  After the puncture technique gentle massaging of the tissue will encourage the gas to escape.  More punctures may be necessary.  For extreme gas build-up an incision may be made on the forearm just superior to the wrist and between the ulna and radial bones or the bicep near the deltoid.  Lightly massage the gas towards the incision allowing the gas to escape the body.  Further treat the area with Cavity fluid using a syringe and needle if necessary.


Next, inject down the External Iliac or Femoral arteries.  Take drainage from the Femoral vein.  As with the arms, incisions may need to be made, allowing trapped tissue gas to escape. Then tie off all arteries for the exception of the RCC.  Next, inject down the Right Common Carotid (RCC) artery as normal, to adequately embalm the trunk of the body.  After arterial injection, under cutting with a new scalpel blade up the neckline and into the subcutaneous tissue of the face may be a necessary step in allowing the trapped gas to escape.  Hypodermically inject undiluted Premium Cavity fluid in tissue surrounding the neck such as the Deltoids, Trapezii and Pectoralis muscles. Cotton soaked with Premium Cavity or STOP may need to be placed inside the incisions overnight. Examine body before leaving for the evening.  Instruct night staff (if available) to inspect the body every hour and make a note of it on the case report.


Buy some time. 24-hours should be sufficient time to detect further spread of the gas-causing bacteria.  Visitation should not be scheduled for at least 48 hours after embalming.