CVC/AL consent

[BobLoblaw78]

I have always consented central and arterial lines with general anesthetic and discussed preop and put it under the type of anesthesia. Is it time to add another block with standard explanation and risks for the procedure to our form? How many people consent patients for vascular access on a predetermined, typed form? I have always likened it to inserting an ETT... it falls under the anesthetic. But I can see how a change would be better protection and would appreciate knowing what others do. Thanks.

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[vector2]

It's part of our consent form. I only discuss it with the patient if additional lines are planned.

 

[nimbus]

We discuss and explain the plan in preop. We don’t get separate written consent for lines. Same for nerve blocks.

 

[abolt18]

Our consent form has a separate section that you can check and the patient can initial for several things: MAC, GA, regional anesthesia, art line, and central line/PAC.

 

[GassYous]

Our consent form has a separate section that you can check and the patient can initial for several things: MAC, GA, regional anesthesia, art line, and central line/PAC.

Sounds like a waste of time

 

[abolt18]

Sounds like a waste of time

100%. I hate it. When they implemented a paper consent a few years ago, legal straight up said "we know that having a physical consent signed does not reduce the risk of lawsuits occurring or being successful, but 'just in case' we are adding this..."

 

[GassYous]

100%. I hate it. When they implemented a paper consent a few years ago, legal straight up said "we know that having a physical consent signed does not reduce the risk of lawsuits occurring or being successful, but 'just in case' we are adding this..."

in residency we used to do all the inpatient preops. Took hours to print out the papers, talk to the patient, get them to sign, find the nurse to "witness". The cool nurses would just sign and the crappy ones would be like "uh I didn't witness the consent so I can't sign." Look lady your patient is literally only here so they can have surgery so please sign the meaningless paper so I can move on with my night as its midnight and I'm trying to get to bed

 

[2Fast2Des]

in residency we used to do all the inpatient preops. Took hours to print out the papers, talk to the patient, get them to sign, find the nurse to "witness". The cool nurses would just sign and the crappy ones would be like "uh I didn't witness the consent so I can't sign." Look lady your patient is literally only here so they can have surgery so please sign the meaningless paper so I can move on with my night as its midnight and I'm trying to get to bed

Still don't know why that kind of thing existed. Why can't the consent be done on the day of surgery, how much time does it take? Thankfully in residency we never obtained a consent, I think it was baked into the surgical consent or just not even a thing. Even the inpt pre-ops, is that really necessary? We all look up our patients anyway, and there was never a cancelled case no matter how sick the pt was. I see it as a waste of time and just scut monkey tasks

 

[Beeftenderloin]

Our consents make no mention of vascular access/monitors. Our pre-op template in epic has a section for planned additional lines/monitors. If I plan to place an art line, central line, etc. I check the box in epic and usually just tell the patient what they’re going to wake up with.

 

[deleted875186]

Our consents make no mention of vascular access/monitors. Our pre-op template in epic has a section for planned additional lines/monitors. If I plan to place an art line, central line, etc. I check the box in epic and usually just tell the patient what they’re going to wake up with.

I do the same. Lines are part of the “general anesthesia” consent, just like the ETT, or just like blood products. We have separate consent for MAC, separate for regional.

 

[UscGhost]

They say yes with their eyes...

 

[Ashers]

Still don't know why that kind of thing existed. Why can't the consent be done on the day of surgery, how much time does it take? Thankfully in residency we never obtained a consent, I think it was baked into the surgical consent or just not even a thing. Even the inpt pre-ops, is that really necessary? We all look up our patients anyway, and there was never a cancelled case no matter how sick the pt was. I see it as a waste of time and just scut monkey tasks

On the flip side of this, as an attending, I had a surgeon upset when I didn't do the exact type of anesthesia she "consented" the patient for because her surgical consent included anesthesia consent. I told her I make the anesthesia decisions and consent the patients, and I decide that. She wasn't happy.

Working at several places, we also have a similar thing to abolt18 with a place to say for different anesthesia types artline, CVL, etc.

 

[BobLoblaw78]

On the flip side of this, as an attending, I had a surgeon upset when I didn't do the exact type of anesthesia she "consented" the patient for because her surgical consent included anesthesia consent. I told her I make the anesthesia decisions and consent the patients, and I decide that. She wasn't happy.

Working at several places, we also have a similar thing to abolt18 with a place to say for different anesthesia types artline, CVL, etc.

I like to enlighten them in a fun way. I will "jokingly" reply that they consented them for the wrong kind of anesthesia (and/or the wrong type of surgery depending on how well I know the surgeon). It makes them aware that there is more than just their schedule and opinion. I had a surgeon ask me this morning if he had any endoscopy cases (it was in a manner that it was obvious he thought I should know his full day and where he should go). I told him I honestly didn't know his schedule or cases. Even funnier, I was discussing a PEG tube patient the same surgeon. I had not met the patient but he had a juge base of tongue mass on imaging involving tongue and submandibular. He reassured me with, "He can open his mouth really wide....he is like a Mallampati 4!" (He was right about opening- I could see 2/3 of the guy's epiglottis on mouth opening).

Thanks for the feedback on consents. I haven't fallen behind on our consent like I was worried had happened. And it sounds like it will present more of a liability issue if my consent has the procedure listed but we don't actually consent for it (say they end up needing an unanticipated CVC line). I think I will add additional vascular lines in the general consent verbiage. We already have the different types of anesthetics listed out w/ explanation and risks.

 

[Twiggidy]

We just explain what we're doing because it's part of that particular anesthetic, much like a thoracic surgeon will probably explain that a chest tube will be inserted at the end of the case but that surgeon doesn't need a separate consent for the chest tube.

 

[Twiggidy]

Let me just soap box for a minute to emphasize how dumb "anesthesia consents" are because what, are you NOT going to consent for anesthesia but consent for the surgery?

 

[Mehd School]

Let me just soap box for a minute to emphasize how dumb "anesthesia consents" are because what, are you NOT going to consent for anesthesia but consent for the surgery?

I mean, I get what you're saying but patients can be ... interesting. I once had to cancel a laparoscopic case because the patient refused intubation. She was an LPN and said that she was fine with an LMA but no tube as she had a sore throat for 2 days after her last intubation. Surgeon asked if I could do an epidural. I think these people all write oral board scenarios for the ABA now.

 

[Nexus5]

My pt’s want whatever I think is reasonably needed to keep them safe.