Lab Manual - Origins and guides of arteries and veins Flashcards
- Accessibility
- Proximity of the aorta
- Diametric Size of the Vessel
- Effect on posing the body
- Location of the exposed area
- Practicability of establishing good drainage from corresponding veins
Consideration and Precautions for each artery and vein are based upon these things.
- Superficial or deep
- Relationship of the artery and vein to surrounding structures
- Presence or absence of branches of vessels which may be disturbed or blocked by its use.
- All incisions in arterial injection should be limited to no more than 3”.
Accessibility
- Injection site as close to arch of the aorta as possible (center of embalming circulation).
- Center of venous drainage is the right atrium of the heart
Proximity to the aorta
The lumen of a vessel, artery, and vein will decrease in diametric size as they distance themselves from the aorta and vena cava.
Diametric size of the vessel
Some injection sites may adversely affect the positioning of the body.
- Cachexia - Femoral may be inaccessible
- Desiccation marks - Right common carotid by instruments
Effect on posing the body
After suturing an injection site, sutures may be visible.
Location of the exposed areas
Because of certain anatomical structures, bones, tendons, muscles, cartilage, etc., good drainage is often difficult to establish and maintain.
- The external iliac vein as it becomes the femoral vein when it passes through he ilium bone.
Practicability of establishing good drainage from corresponding veins
Begins at the level of the sternoclavicular articulation and terminates at the level of the superior border of the thyroid cartilage.
Right common carotid Artery
Begins at the level of the second costal cartilage and termites at the superior border of the thyroid cartilage.
Left common carotid artery
An incision is made along the posterior border of the inferior 1/3 of the sternocleidomastoid muscle. The incision is thus parallel to the muscle and vessel itself.
- An incision on the surface of the skin to raise the common carotid arteries. It is made along the posterior border of the inferior 1/3 of the sternocleidomastoid muscle.
- Note: There is no logical reason to use this incision in embalming. The problems generated by this incision outweigh the benefits.
Parallel incision
This method of incision involves the utilization of both common carotid and both internal jugular veins.
- Recommended for difficult cases
- Method of injection wherein both common carotid arteries are raised.
- Inject the right, clamp the left
- Half moon incision used historically, most embalmers prefer two separate three inch supraclavicular incisions.
Restricted Cervical method (Incision)
- Direct distribution to the face
- Close to center of venous drainage
- Close to center of embalming circulation
- Face possibly can be embalmed using the restricted cervical method with a mild solution, while remaining portion of body can be injected with a stronger solution- fluid will enter the head from vertebral arteries.
- Has no branches except its terminal branches
Considerations of the common carotid arteries
- Incision may be visible after dressing
- Tubes may leave mark on face
- Face may be over-injected on the left side when utilizing the right common carotid as an injection site and visa versa.
Precautions of the common carotid arteries
Originate at the bifurcation of the left and right common carotid arteries at the superior border of the thyroid cartilage.
- The bifurcation will occur front to back not side to side.
Internal and External Carotid Arteries
Anterior branch: Primary blood supply to the face.
External Carotid Artery
Posterior Branch: Primary blood supply to the brain.
Internal Carotid Artery
The internal Jugular vein will lie later and superficial to the common carotid artery. Therefore, the common carotid artery will lie medial and deep to the internal jugular vein.
Accompanying vein to the carotid artery
Branch of the external carotid artery that supplies blood to the cheeks and lips.
The external Facial Artery (Maxillary Artery)
Along the inferior border of the mandible just anterior to the angle of the mandible.
Anatomical Guide: External Facial Artery
Along the anatomical guide, not more than one inch in length, directly over the mandibular notch.
Place of incision: External Facial Artery
The left and right of these have different origins.
- Only raised in autopsy cases
Origin of the Subclavian Artery
- Arises from the right brachiocephalic artery
- Begins at the sternoclavicular articulation
- Terminates at the lateral border of the first rib
Anatomical limits: Right Subclavian Artery
- Arises directly from the arch of the aorta as the third branch.
- Begins at the level of the second costal cartilage
- Terminates at the lateral border of the first rib.
Left Subclavian Artery
Which is longer, the left or right subclavian artery?
Left
Gives off 4 Branches:
- Left and right Vertebral
- Left and right internal mammary
- Left and right costocervical
- Left and right thyrocervical
Branches of the Subclavian Arteries
It is imperative that the left and right subclavian arteries be injected on these cases so that these eight arteries carry arterial fluid to the shoulders and back of the head. Of the eight arteries, the left and right vertebral are of primary importance.
Autopsy Cases
Originates from the left and right subclavian arteries and terminates by forming the basilar artery in the foramen magnum.
Left and right Vertebral Arteries
Along the inferior border of the lateral one-third of the clavicle bone, exposing the vessel near its point of termination.
Place of incision: Subclavian Artery
A continuation of the subclavian artery and terminates by becoming the brachial artery.
Axillary Artery - Origin
The arm pit.
Base of the Axillary Space
Established by drawing a line along the fold of skin which envelopes the lateral border of the pectoralis major muscle.
Anterior border of the Axillary Space
Established by drawing a line along the fold of skin which envelopes the lateral border of the latissimus dorsi muscle.
Posterior Boundary of the Axillary Space
Established by drawing a line which connects the two points where the pectorals major and the latissimus dorsi muscles blend into the chest wall.
Medial Boundary of the Axillary Space
Established by drawing a line which connects the two points where the pectoralis major and latissimus dorsi muscles blend into the arm.
Lateral Boundary of the Axillary Space
A vertical line drawn from the center of the medial border of the base of the axillary space.
Mid- Axillary Line
Through the center of the base of the axillary space and parallel to the long axis of the upper extremity when abducted.
Linear guide: Axillary space
Posterior to the medial border of the coracobrachialis muscle.
Anatomical guide: Axillary space
- Begins at the lateral border of the first rib
- Terminates at the inferior border of the tendon of the teres major muscle.
Anatomical Limits: Axillary Space
Along the anterior margin of the hairline of the axilla. (arm pit)
Place of incision: Axillary Space
- Close to the face
- Close to the center of circulation
- Close to the enter of venous drainage
- Vessels are relatively superficial
Considerations of the Base of the Axillary Space
- Danger of over injecting face, particularly if there is any obstruction present in the other trunk arteries of the body.
- Anomalies of both artery and vein are common
- If the arm is not treated properly, it does not appear natural when the body is placed in the casket.
- Numerous branches
Precaution of the Base of the Axillary Space
Axillary Vein
Accompanying vein for the axillary artery
Medial and superficial to the axillary artery: therefore the axillary artery will lie lateral and deep to the axillary vein.
Relative location of the Axillary Vein
- A continuation of the axillary artery
- Terminates at the elbow where it bifurcates to become and ulnar and radial arteries.
Brachial Artery: Origin
From the center of the base of the axillary space to the center of the forearm just below the end of the elbow.
Linear Guide: Brachial Artery
Lies posterior to the medial border of the belly of the biceps brachii muscle.
Anatomical Guide: Brachial Artery
Begins at the inferior border of the tendon of the teres major muscle and terminates at a point just inferior to the antecubital fossa (elbow)
Anatomical Limits: Brachial Artery
In front of the elbow/ in the end of the elbow.
Antecubital
Along the linear guide.
Place of incision: Brachial Artery
- Close to the face
- Close to the center of circulation
- Close to the enter of venous drainage
- Vessels are relatively superficial
Considerations of the Brachial Artery (same as axillary)
- Danger of over injecting face, particularly if there is any obstruction present in the other trunk arteries of the body.
- Anomalies of both artery and vein are common
- If the arm is not treated properly, it does not appear natural when the body is placed in the casket.
- Numerous branches
Precautions of the Brachial Artery (same as axillary)
Basilic Vein.
Accompanying vein of the Brachial Artery
Medial and superficial to the brachial artery: therefore the brachial artery will lie lateral and deep to this.
Relative Location of the Basilic Vein
Originates at the bifurcation of the brachial artery.
Radial Artery: Origin
On the surface of the forearm from center of the antecubital fossa to center of base of the second digit.
Linear Guide : Radial Artery
Just lateral to the tendon of flexor carpi radialis muscle.
Anatomical Guide: Radial Artery
Linear guide at the wrist. Make incision two inches above the wrist.
Place of incision: Radial Artery
Venae comitantes - two small veins that lie on either side of the radial artery - thumb side.
Accompanying Vein: Radial Artery
- Originates at the bifurcation of the brachial artery.
- It is larger than the radial artery.
Ulnar Artery : Origin
On the surface of the forearm from the center of the antecubital fossa to a point between fourth and fifth digits.
Linear Guide: Ulnar Artery
Lies lateral to the tendon of the flexor carpi ulnaris muscle (lies between tendons of flexor carpi ulnaris and flexor digitorum superficialis).
Anatomical Guide: Ulnar Artery
Linear guide at the wrist. Make incision two inches above the wrist.
Place of incision: Ulnar Artery
Venae comitantes- two mall veins that lie on either side of the ulnar artery- little finger side.
Accompanying Vein: Ulnar Artery
Formed in the palm of the hand just inferior to the fingers by the juncture as well as the branches of the radial and ulnar arteries.
(Referring to the correct anatomical position, this is superior to the fingers).
Volar Arch
- Common Carotid Arteries
- Internal and external carotid arteries
- The external Facial Artery (Maxillary Artery)
- Subclavian arteries
- Left and right Vertebral Arteries
- Axillary Artery
- Brachial Artery
- Radial Artery
- Ulnar Artery
- Volar Arch
Arteries of the head, neck, shoulders, and arms
- Brachiocephalic Artery
- Aorta:
- Ascending aorta
- Arch of the aorta
- Descending aorta
Arteries of the trunk related to the aorta: Primary trunk veins- the superior and inferior vena cava
First Branch off of the aortic Arch.
- Approximately two to three inches in length; right side only.
Brachiocephalic Artery (Innominate Artery) : Origin
Right brachiocephalic vein.
- Will lie lateral and superficial tot he right brachiocephalic artery: The right brachiocephalic artery will lie medial and deep to the right brachiocephalic vein.
Accompanying Vein: Brachiocephalic Artery (Innominate Artery)
The left ventricle of the heart.
Aorta: Origin
Divided into three parts:
- Ascending
- Arch
- Descending
- Descending throacic
- Descending abdominal
Aorta
Arises from the left ventricle of the heart.
Ascending Aorta
Continues from the ascending aorta and is the center of embalming circulation.
Arch of the Aorta
This is excluded from embalming circulation because at death the tricuspid valve between the right atrium and the right ventricle as well as the bicuspid (mitral) valve between the left atrium ad left ventricle shut down.
The Heart
Left side of the spine, above the diaphragm (phrenic muscle).
Descending Throacic Aorta
Left side of the spine, below the diaphragm (phrenic muscle).
Descending Abdominal Aorta
Divides the descending thoracic aorta from the descending abdominal aorta.
Diaphragm (Phrenic Muscle)
All major trunk arteries arise (originate) from here.
The Descending Aorta
- Superior Vena Cava
- Inferior Vena Cava
Accompanying Vein: Aorta
From above, empties into the right atrium of the heart.
Superior Vena Cava
From below, empties into the right atrium of the heart.
Inferior Vena Cava
- Main drainage vein of the body.
- Lies to the right of the spine.
- All veins have valves except for these.
- All veins will eventually drain into these.
- Right atrium of the heart is formed by the juncture of these.
- Right atrium of the heart is the center of venus drainage during embalming.
The Inferior and Superior Vena Cava
- Common Iliac Artery
- External Iliac Artery
- Internal Iliac Artery
- Femoral Artery
- Perfunda Femoris Artery
- Popliteal Artery
- Anterior Tibial Artery
- Posterior Tibial Artery
- Dorsalis Pedis Artery
- Plantars arch
Arteries below the descending abdominal aorta
Originates at the descending abdominal aorta: bifurcation right and left.
Common Iliac Artery : Origin
Common Iliac Vein
- Lies directly inferior to the common iliac artery; therefore, the common iliac artery lies directly superior to the common iliac vein.
Accompanying Vein: Common Iliac Artery
The vascular system twists here, reversing the relationship arteries have to veins.
Base of the spine (Bifurcation of the descending aorta)
Is an extension of the common iliac artery.
External Iliac Artery
Along the medial border of psoas major muscle.
Anatomical Guide: External Iliac Artery
The external Iliac Vein
- Lies medial and deep to the external iliac artery, therefore, the external iliac artery will lie lateral and superficial to the external iliac vein.
Accompanying Vein: External Iliac Artery
Originates from the common iliac artery.
Internal Iliac Artery (hypogastric artery) : Origin
- Branches off approximately half way down psoas major muscle toward the pubic viscera.
- Carries blood to organs in the pubic cavity.
- This artery is usually severed in autopsied cases.
Anatomical Guide: Internal Iliac Artery (Hypogastric Artery)
Continuation of the external iliac artery
Femoral Artery : Origin
On the surface of the thigh from the center of the inguinal ligament to the center point on the medial condyle of the femur bone.
Linear Guide: Femoral Artery
Rounded articular process of a bone.
Condyle
Base of the anterior triangle.
- Also the superior border
Inguinal Ligament
Lateral Border of the femoral triangle.
Medial border of the Sartorius muscle
Medial Border of the femoral triangle.
Lateral border of the Adductor longus muscle
A dense sheet of fascia which attaches firmly to the inguinal ligament and encircles the thigh. This roof must be incised to expose the boundaries and contents of the femoral triangle.
Fasia Lata
Through the center of the femoral (scarpa’s) triangle bounded laterally by the sartorius muscle and medially by the adductor longs muscle.
Anatomical Guide: Femoral Artery
- Begins at the point posterior to the center of the inguinal ligament
- Terminates at the opening in the adductor magnus muscle.
Anatomical Limits: Femoral Artery
Along any portion of the superior two-thirds of the linear guide.
Place of incision: Femoral Artery
- Large in size (diametric)
- Lower portion of the body can be embalmed without concern of distention of face.
- Even fluid distribution to both sides of the face when injecting upward.
Considerations of the Femoral Artery
- I point injection with active dye
- Using humectants
When to use the Femoral Artery
- Vessels are deep-seated in obese cases
- Drainage is sometimes difficult to establish and maintain.
Precautions of the Femoral Artery
Femoral Vein
Accompanying Vein: Femoral Artery
Medial at the inguinal ligament processing to immediately posterior at the apex of the femoral triangle. (Scarpa’s Triangle)
- The femoral vein will lie medial and deep to the femoral artery, therefore, the femoral artery will lie lateral and superficial to the femoral vein.
Relative location of the femoral vein
Will bifurcate from the anterior aspect of the femoral artery within scarpa’s triangle and descend downward along the lateral aspect of the thigh and terminate at the knee.
Profunda Femoris Artery
An extension of the femoral artery.
Popliteal Artery
Though the center of the popliteal space parallel to the long axis of the lower extremity.
Linear guide: Popliteal Artery
- Begins at the opening of the adductor magnus muscle.
- Terminates at the inferior border of popliteus muscle.
Anatomical Limits: Popliteal Artery
Parallel incision on the posterior medial aspect of the thigh just superior to the popliteal space.
Place of incision: Popliteal Artery
Originates at the bifurcation at the popliteal artery.
Anterior Tibial Artery
From the lateral border of the patella to the anterior surface of the ankle joint.
Linear guide: Anterior Tibial Artery
Originates at the bifurcation at the popliteal artery.
Posterior Tibial Artery
Branches off the posterior tibial artery.
Peroneal Artery
From the center of the popliteal space to a point midway between the medial malleolus and the calcaneus bone.
Linear guide: Posterior Tibial Artery
Midway between the medial malleolus and the calcaneus tendon. (achilles tendon).
Place of Incision: Posterior Tibial Artery
An extension (or continuation) of the tibial artery.
Dorsalis Pedis Artery
From the center of the anterior surface of the ankle joint to a point between the first and second digits (toes).
Linear Guide: Dorsalis Pedis Artery
Along the superior one-third of the linear guide- superficial.
Place of incision: Dorsalis Pedis Artery
Formed at the base of the digits (toes) anteriorly by the dorsalis pedis artery and posteriorly by the posterior tibial artery.
Plantars Arch
Apex of the femoral triangle.
Adductor Magnus muscle
