02. Common Procedures

Included below are some tips for obtaining consent for common procedures, as well important* complications to mention to patient (*not an exhaustive list please ensure all complications even rare are divulged to patient). 

Jump to:

• OGD
• Colonoscopy
• ERCP
• MUA
• Angiogram
• Angioplasty
• Mastectomy
• Bronchoscopy
• Liver Biopsy
• Excision
• Cystoscopy
• Cardiology
• Lumbar Puncture
• Central Venous Catheter/PICC
• Renal Biopsy (Renal Intern)
• Renal

• Consent for OGD +/- biopsy +/- proceed
• Pain
• Bleeding
• Infection
• Reaction to sedation
• Perforation (1 : 10,000)
• Missed pathology/unable to proceed

• Consent for colonoscopy +/- biopsy +/- proceed 
• Pain
• Bleeding
• Infection
• Reaction to sedation
• Perforation (1 : 10,000)
• Missed pathology/unable to proceed

• Consent for ERCP +/- stenting +/- proceed
• Pain
• Bleeding - especially if a sphincterotomy is required
• Perforation (1 : 10,000)
• Cholangitis
• Pancreatitis - mortality 1 : 100 to 1 : 1,000
• Missed pathology/unable to proceed
• Repeat procedure 

• Consent for manipulation under anaesthetic +/- K-wiring
• Pain and bleeding
• Infection
• Joint stiffness

• Consent should be for an angiogram +/- angioplasty +/- proceed
• There is a specific angiogram request form that must be signed - it is available on most wards.
• A separate angioplasty consent form must also be signed.
• All of the complications are listed in details.
• Simply read through the consent form with the patient and answer any questions. 

• As above
• A specific angioplasty consent form is available on the wards.
• All that is required is to read through the form with the patient and answer any questions.
• All complications are listed in detail.
• Always ensure the patient signs both an angiogram and angioplasty form.

• Consent for mastectomy +/- proceed
• Other procedures include wide local excision, sentinel node clearance so clarify before consenting.
• Breast reconstruction
• Pain/bleeding
• Infection
• Scar formation
• Seroma
• Axillary node clearance

• Consent for bronchoscopy +/- biopsy +/- proceed
• May include bronchoalveolar lavage (BAL)
• Bleeding
• Infection/pneumonia
• Dysphagia
• Missed pathology/failure to proceed
• Atrial fibrillation/cardiac arrest
• Respiratory depression/arrest
• Pneumothorax - 1 : 20 if trans-brochial biopsy performed
• Hypoxia, transient fever - BAL 

• Consent for ultrasound guided liver biopsy +/- proceed 
• May be percutaneous transjugular - based on bleeding risk
• Pain
• Bleeding - can be catastrophic
• Infection
• Damage to local structures - pneumothorax, bowel perforation, bile duct injury
• Missed pathology 

• Consent for excision of lesion +/- proceed
• Pain
• Bleeding
• Infection
• Scar/keloid formation 

• Consent for flexible or rigid cystoscopy +/- biopsy +/ - stent
• Pain/infection
• Urethral/damage - false passage/sricture
• Bladder damage
• Haematuria
• Retention
• Failure of procedure

Note that all of the Interns can consent for Angiograms and Angioplasty.

In addition, the Cardiology Intern is also responsible for:

• Transoesophageal ECHO (TOE)
• DC Cardioversion (DCCV)
• Implantable cardioverter - defibrilator (ICD)/permanent pacemaker (PPM) changes
• Specific forms are available in CCU

• Consent for LP +/- CSF collection + sample analysis (+LA)
• Backache (1/3), Radicular pain (15%)
• Headache (Post LP - 22%, lasts up to 5 days post procedure)
  • Persistent post-lumbar puncture headache may need treatment with an epidural blood patch
• Haematoma of spinal canal (<1%)
• Paraparesis (1.5%)
• Infection (<1%)
• Brain herniation/coning (<0.1%, especially with CTB prior)
• Death (<0.1%, usually secondary to Brain Herniation)

• Insertion of Central Venous Catheter / PICC
• Minor pain/Bruising at site of insertion/minor bleed (~5-10%)
• Infection (<5%, increasing with duration line in, → Replace)
• Pneumothorax (<5%)
• Damage to nerves/veins/arteries (<5%)
• Arrhythmia (<1%)
• Embolus/thrombus (<1%)
• Death (<0.01%) 

• Biopsy +/- proceed
• Pain (10%)
• Infection (<5%)
• Bleeding, including haematuria (~5%)
• Blood Transfusion (<5%)
• Embolisation/coiling (<1%)
• Nephrectomy (<0.05%)
• Death (0.02%)

• Dr Casserly performs the Biopsies Tuesdays and Thursdays
• Usually will ask Reg’s to consent, but if they are busy, may ask you.
• There is a Biopsy protocol that needs to be followed, available from Dr Casserly, and begins the evening prior.
• If patient is being admitted late, ensure the Intern On Call is familiar with protocol.
• Ask the nurses in the Renal Dept for a copy of the biopsy protocol.