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Consent to Perform Abdominal Ultrasound

VetBooks.ir Patient name:_________________________________
Pet owner’s name:_____________________________ Med rec #____________
Best contact during/after procedure (e.g., cell phone number):____________________

INTRODUCTION USE OF SEDATIVES OR ANESTHESIA
We want to make sure that you understand the planned medical In most cases this procedure is performed without sedation or
procedure to be performed on your pet. You should know why the anesthesia. If your pet is not able to stay still, or if there is a plan
procedure has been suggested, what the potential benefits are for to obtain a fine-needle aspirate or biopsy, it may be necessary to
your pet, and the most common/important risks of the procedure. use sedation. Sedation involves the administration of medications
Alternatives to this procedure, when applicable, will be discussed that cause your pet to become drowsy and relaxed, but to remain
with you. It is also important that you recognize that medicine is conscious.
not an exact science, and that the outcome cannot be guaranteed.
We encourage you to ask us as many questions as required for FORESEEABLE RISKS TO THE PROCEDURE
you to make a well-informed decision. Ultrasound examination is an extremely safe procedure. Complica-
tions can include irritation or nicks to the skin from shaving, or
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE bruising in pets that have bleeding disorders. There are additional
An abdominal ultrasound is a minimally invasive procedure that risks associated with aspirates or biopsies that might be performed
can allow us to see images of the different organs in the abdomen during the ultrasound procedure. Finally, you should be aware that
(belly). Unlike an x-ray that shows all of the abdominal organs on performing an ultrasound examination will not always lead to a
top of each other, ultrasound allows us to see inside each organ. diagnosis, and that it is possible that small or isolated abnormalities
Many people are familiar with the use of ultrasound to examine a might not been seen during the examination.
pregnant woman’s baby; we use the same technology in animals
to examine organs such as the liver, kidneys, and urinary bladder. Other anticipated risks specific to your pet:___________________
This procedure is not a treatment for disease, but a tool to help
evaluate the architecture of abdominal organs, in order to identify _________________________________________________________
a cause for your pet’s clinical signs.

EXPLANATION OF THE PROCEDURE ALTERNATIVES TO THE PROCEDURE
In order to perform this procedure, the patient is positioned on his/ Abdominal x-rays (radiographs) are complementary to ultrasound
her back on a wedge cushion to keep him/her comfortable. The examinations but are not a replacement. They each have advantages
hair on the belly is shaved and a small amount of ultrasound gel or and disadvantages. Importantly, x-rays do not allow us to evaluate
rubbing alcohol is applied to the skin. An ultrasound wand (probe) each organ separately, and they do not allow us to “look inside”
is used to apply light pressure against the abdomen to visualize the organs in the same way that ultrasound can.
organ(s) of interest on a nearby screen. This imaging modality is Another alternative is to perform a computed tomography scan
often used to help visualize a small needle while performing other (CT, or “CAT scan”). In many ways a CT scan allows even more
diagnostic procedures. The most common diagnostics that can detailed visualization of the abdominal organs than does ultrasound,
be performed with ultrasound guidance include: and CT scan can facilitate the use of contrast to better evaluate blood
• Cystocentesis – Inserting a small needle into the urinary bladder vessels. However, CT scan usually requires general anesthesia or at
to obtain a sterile sample of urine for culture. least heavy sedation, it is not as readily available as is ultrasound,
• Abdominocentesis – Inserting a small needle into the abdominal and the cost is greater for CT.
cavity to obtain a sample of fluid.
• Fine-needle aspirate – Inserting a small needle into an organ to AUTHORIZATION
obtain cells that are then evaluated under a microscope. By signing this form below, you agree that:
• Ultrasound-guided biopsy – This procedure is similar to a fine- • You understand how/why the procedure is likely to help your
needle aspirate, but it is more involved because instead of a pet
small needle, a larger specialized biopsy needle is used to obtain • You understand what will be done to your pet during the
a piece of tissue rather than just cells. procedure
Additional procedures planned for your pet at the same time • You understand the known risks that accompany the procedure,
as the abdominal ultrasound exam: and also understand that unforeseen complications may occur
• You understand that the procedure may not produce the results
____________________________________________________________ we hope to achieve

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.