Case Analysis: Difficult, Tissue Gas, Localized, Abdomen


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 traveling up the neck and into the 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 close off drainage.  


Inject each artery of the 6-point individually and separately from each other.  This will reduce the risk of mobilizing the bacterial spore to other areas of the body. (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.  Injecting up the head first, will decrease the chances of transferring the bacteria to the head in the event you would normally inject other arteries first.  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 as well as the RJV).

After embalming, under cutting with a new scalpel blade up the neckline and into the subcutaneous tissue of the face may be a necessary step in preventing further spreading of the bacteria.  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 night.  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.