Thoracic Diseases and Surgery

Declaration of Informed Consent for Bronchoscopy
Planned procedure (no specialist terminology): Bronchoscopy (examination of the lungs) using a flexible tube. This is preceded by an infusion (small cannula inserted into a vein on your forearm).

Alternative treatments:   None Reason for procedure (consequences of omission, urgency): Detection of respiratory (airway) or lung disease

Procedure:   (objective and subjective description, poss. including a sketch) Acc. to personal discussion with the help of sketch/Atlas: Local anaesthetic of nose and throat with lidocaine (liquid). Intravenous injection of Dormicum (sleep-inducing drug). Supply of oxygen via the nose. Monitoring of pulse and oxygen saturation level in the blood with a finger clip. Insertion of instrument (generally via the nose), followed by performance of bronchoscopy.

Complications (if possible, indicating percentages):   
Bleeding < 1%
Infection < 1%
Injury < 5% (in particular "collapsed lung")
Other < 1% irregular pulse
These complications (bleeding and collapsed lung) generally only occur when samples of tissue are taken from the lungs.

Risk factors for patient:   
Age
Medication (anticoagulation, thrombocyte aggregation inhibitors, immunosuppressants)
Diabetes
Heart conditions
Lung conditions
Other

After the procedure:   
Pain
Bed rest for around 2-3 hours
Monitoring for around 2-3 hours
Ability to work not possible throughout the day of the procedure
Ability to drive not possible throughout the day of the procedure
Miscellaneous

Aids used:   
Pictures/photos
Textbook
Model
Information sheet

Special remarks (e.g. patient refuses information or procedure):    
If a collapsed lung occurs, a drainage tube will have to be inserted through the chest wall (local anaesthetic, flexible tube connected to suction apparatus, for around 3 days). With lifethreatening bleeding possibly intubation and machine ventilation.

Declaration of consent   
I have been informed in detail about the necessity, events and possible complications of the above procedure by Dr. ______________________________.
I was able to ask questions and consent to performance of the procedure. _______________ _______________________ _________________________

Your doctor recommends that you undergo a thoracentesis. For different reasons, fluid can accumulate in the space between the lungs and the chest wall. When this occurs a thoracentesis is a procedure that removes this fluid from your chest for diagnostic and therapeutic purposes.
To collect the fluid, your doctor will place a needle or small catheter between your ribs. For this procedure, you will be sitting up and your doctor will be behind you or beside you. Your doctor will use a sterile technique to prevent infection and may use an ultrasound machine to locate the pocket of fluid. To prevent discomfort, your doctor will give you lidocaine injection to numb the skin and chest (please notify your doctor if you have an allergy to lidocaine).
Throughout the procedure, you will be able to breathe and speak. As the fluid is being removed you may notice that it is easier to breathe or that you feel the need to cough. These are normal sensations.
Complications due to thoracentesis are relatively uncommon. However, even the most straight forward procedures have potential risk and side-effects. Thoracentesis may cause minor and/or major side effects.
Minor side effects may cause you to cough, have some chest discomfort or have other strange sensations in your chest. Major side effects may be bleeding or collapsed lung. These complications are treatable, but may require transfer to a hospital.
A thoracentesis is a very useful procedure to diagnose lung problems. However, there are no guarantees that your thoracentesis will provide a definite answer.

Declaration of consent   

I have been informed that the diagnosis and/or management of my medical condition may be facilitated by undergoing thoracentesis. I understand and acknowledge that my consent to having this test performed is voluntary. I understand that I have had the opportunity to ask questions and that these questions were answered satisfactorily. I consent to the performance of thoracentesis.