SAIF Golden Charter

Evolving medical technology and challenges

In the past, pacemakers, later joined by defibrillators, inserted into the upper chest were the only items required to be removed from the deceased before cremation.

Nowadays, medical technology has become more complicated and varied. Not only do embalmers have pacemakers and defibrillators to deal with, but we now have a wide variety of of stimulators, internal pumps and fixion nails to locate and remove. These implants are placed in various parts of the body and can be very well hidden. All of them must be located and removed before cremation.

GT Embalming Service Limited has accumulated much experience regarding these implants and we have set out below a short resume of each device:

Reveal device

This is a cardiac monitor, sometimes called an implantable loop recorder, and is positioned around the clavicle bones and sometimes between the ribs. The device is used to record heart rate and rhythm.

Neurostimulator

This device looks the same as a pacemaker but is placed in the small of the back or sometimes the buttock area. It delivers mild electrical signals to the epidural space near the spine through one or more thin wires and is used in the treatment of chronic back pain. As the normal position of the deceased at embalming is on their back, this device will obvious ly be hidden.

Sacral nerve stimulator

This device looks the same as a pacemaker but is placed in the small of the back or sometimes the buttock area. It helps to improve bladder function by sending electrical signals to the nerves that control the bladder or bowel. As the normal position of the deceased at embalming is on their back, this device will obviously be hidden.

Gastric stimulator

This device looks the same as a pacemaker but is placed in the abdomen. It sends mild electrical signals to the nerves and smooth muscles of the lower stomach helping to decrease nausea and vomiting. Gastric stimulation is also used as a way of treating obesity. It sends electrical signals to the brain triggering feelings of fullness. If a bariatric case is in your care they could have this device implanted, and it would mean that location could be very difficult.

Splenic nerve stimulator

This device is used in spleen stimulation. It regulates the homeostatic balance within the body to fight infection. It is attached directly to the splenic nerve and uses a pacemaker type device to activate stimulation.

Intrathecal baclofen pump

This device is used in the treatment of severe spasticity. A liquid form of Baclofen is delivered directly into the spinal fluid by a pump located in the abdomen and connected to a thin flexible catheter. It is about the size of a compact disc and about two inches thick so it would be easy enough to locate. It is also now available for children and about the size of a 50p piece.

Intramedullary fixation nail

This device is a rod that is fitted into long bones where fracture has occurred and there are several types.

• Solid rods: The same as rods in the past such as hip replacements that are left in place and safe to cremate.
• Saline or gas filled rods: These are rods that are filled with a saline solution or a gas to expand the hollow rod within the marrow and grip the bone from within.

An investigation must be made as soon as possible with the family of the deceased to see if they have knowledge of the implant and the medical history which will show what type of rod is in place.

This takes time, and if a satisfactory answer can’t be found then a procedure called venting (releasing the pressure) must be completed either by a hospital or an embalmer experienced in the venting process. Once venting has taken place the rod is then safe and can be treated as a normal solid rod.

So far, most of the previous devices are found by sight with a thorough examination on the front and back of the deceased looking for scars and tell-tale lumps on the body. Now the devices are getting smaller so the signs will be much less obvious. This will prove to be a challenge for the embalmer.

Ventricular assist system

This device is designed to assist a weakened heart. It pumps blood throughout the body by removing blood from the left side of the heart and pumping blood to the aorta. It is about the size of a golf ball and is placed under the ribcage. Removal of this device is quite an invasive procedure.

Bion nerve stimulator

This device is a rechargeable battery-powered electrode similar in size to a matchstick. When implanted near the occipital nerve in the back of the neck, it alleviates pain by generating pulses that the nerve receives. The bion can be turned on or off via an external wireless remote control. Previous versions of the bion have been used in pain management for osteoarthritis and the treatment of dislocated joints in stroke victims. Due to its size and location it will be extremely challenging to locate and remove.

Micra pacemaker

This device is also called the micra transcatheter pacing system which, unlike most pacemakers that are implanted into the chest with leads running to the heart, is implanted directly into the heart. It is placed in the heart via the femoral vein in the leg which means that there is no chest incision, scar or bump as with conventional pacemakers. The Micra pacemaker is 93% smaller than conventional pacemakers and is about the size of a large vitamin capsule.

Completely self-contained within the heart, it eliminates potential medical complications arising from a chest incision and from wires running from a conventional pacemaker into the heart.

The device is quite a concern for funeral directors as it is totally undetectable but must be removed before cremation as the unit has a 10-year lifespan.

The family of the deceased must inform the funeral director of the existence of the device. The procedure to remove the Micra pacemaker is extremely invasive and to date, GT Embalming Service Limited has removed one of these devices.

Prostate implants

For cases that have received radioactive implants:

• The seeds are radioactive and are left in permanently. The radioactivity decays over time so there are no restrictions at all if the funeral is more than three years after the implant.
• If the funeral is less than three years after the implant, some restrictions may be necessary. The radiation energy emitted by the seeds is very low and is absorbed readily in tissue. Therefore, there is no hazard unless you are performing any procedure in the region of the lower abdomen. Regular preparation of the deceased is not hazardous.
• We recommend that embalming should not be performed within the first 12 months of the implant. However, if the family is strongly in favour then the funeral director should make enquiries with the implant hospital as to precautions needed for the embalming to take place.
• Burial is permitted at any time and cremation is permitted without restriction three years after the implant, Normal disposal of ashes is also permitted after three years or later. If cremation is requested less than three years after the implant then again the implant hospital must be approached regarding the procedure and storage or disposal of ashes.

In conclusion, as far as any new devices are concerned GT Embalming will research any relevant information necessary and establish the correct procedure to remove them, if required. However, this new and ongoing technology presents a challenge and there is a learning curve for all of us.