The Fixion Expandable Nail has proved to be a revolutionary concept in the treatment of long bone fractures. However, its explosive capacity when subject to heat is understood to be greater than that of a pacemaker, making it essential that Fixions are identified and vented prior to cremation, yet there are no guidelines as to where the responsibility for this lies. NAFD President and Health & Safety representative Sue Saville represented the funeral sector at a meeting at the Ministry of Justice to discuss the existing range of implants requiring removal prior to cremation, including pacemakers, ICDs and implanted drug pumps. Implants that require venting (Fixions) and radioactive implants, which preclude cremation under any circumstances, were also reviewed by the stakeholders, who included the cremation authorities, the British Medical Association, the British Orthopaedic Association and Fixion manufacturer Biomet UK. Identifying and recording implants
Although it is only battery powered devices which present the problem, it appears that many GPs, clinicians, mortuary staff and surgeons do not know the differences between implants – even innocuous replacement hip and knee joints – so errors can creep in when they are filling out medical forms for cremation. To avoid confusion it was agreed that implants should be routinely recorded in a patient’s notes and that this information should be prominently flagged when patients relocate. Details are not always readily available – for example when a patient dies of natural, unrelated causes following admission to hospital or shortly after signing on with a new GP – but the consensus was that “Not Known” is unacceptable as an answer and that it is the responsibility of the doctor completing the form to obtain the information.
Sometimes it will simply not be possible to find out about implants, for example when dealing with the homeless or overseas visitors, so a 100% success rate is not a realistic goal,” says Sue Saville. “However, we all accepted that patients and their families are the best source of accurate information and we must, therefore, explain why it is so important for them to discuss implants with hospital staff on admission, to raise the subject when signing on with a new GP and to tell funeral directors when making arrangements for a cremation.”
One of the suggestions for tackling this issue – for further debate – was to develop a booklet to go on prominent display in GP surgeries, hospitals and registry offices. It would also be made available to funeral directors, while copies would automatically be handed to patients prior to their admission to hospital and when they change their doctor.
Responsibility for venting
Funeral directors are not expected to vent Fixions, unless they wish to do so, but it was agreed they should take responsibility for arranging for the devices to be vented by the appropriate agencies if the death has not taken place in a hospital. Biomet UK – the sole manufacturer of Fixions in the UK – will support all stakeholders by providing them with a list of the hospitals it supplies, which will be distributed via the Ministry of Justice. Each hospital on this list has the tools to vent Fixion Nails and will be obliged to do so wherever necessary, although there could be a cost implication if an implant is vented by anyone other than the hospital which fitted it.
The manufacturer is also planning a series of ‘teaching sessions’ at all the hospitals which use Fixions so that mortuary staff can learn how to vent them. The problem will go away
The potential for explosion during cremation concerns approximately 2,000 UK Fixion Nails, although it is not known how many of the recipients still survive. The good news is that the problem will eventually cease to exist, because in the next couple of years Fixions are expected to progress to the point where venting takes place immediately after they have been inflated and prior to the wound being closed. Until then, the National Association of Funeral Directors will keep the profession up to date regarding developments and aim to provide further guidance on the issue.