Page 3284 - Cote clinical veterinary advisor dogs and cats 4th

Consent to Perform Arthrocentesis

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

INTRODUCTION sedation can be “reversed” by giving other medications to counter
We want to make sure that you understand the planned medical the sedative effect, allowing your pet to “wake up” more quickly
procedure to be performed on your pet. You should know why the after the procedure has been completed.
procedure has been suggested, what the potential benefits are for
your pet, and the most common/important risks of the procedure. FORESEEABLE RISKS TO THE PROCEDURE
Alternatives to this procedure, when applicable, will be discussed Complications of arthrocentesis are uncommon, but can include:
with you. It is also important that you recognize that medicine is • Introduction of germs into the joint that can cause infection.
not an exact science, and that the outcome cannot be guaranteed. Meticulous cleaning and the use of sterile materials minimizes
We encourage you to ask us as many questions as required for this risk.
you to make a well-informed decision. • Bleeding within the joint space; although rare, this is most likely
in animals with bleeding disorders.
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE • New or worsened lameness following the procedure; this usually
Arthrocentesis, also known as a “joint tap”, is the removal of a resolves on its own, but pain control medications can be used
very small amount of fluid from inside a joint space. Normal joints until then.
contain a small amount of synovial fluid that lubricates the joints as • Sometimes, no fluid can be withdrawn from the joint. Usually
they move; inflammation or infection in the joints can be identified at least a few joints will produce a usable sample.
by changes in the fluid. Samples of the synovial fluid obtained by • The sample obtained might not be representative of disease.
arthrocentesis can be analyzed under a microscope and/or by Polyarthritis is arthritis of many joints. It is possible that a joint
microbial culture in a laboratory. Arthrocentesis is not a treatment chosen at random will not be representative of the primary
for disease but is meant to help us determine the cause of disease. disease process. It is for this reason that we usually sample
Arthrocentesis is also used to determine how effective medications two to four joints rather than just one.
have been at treating diseases of the joints. If joint fluid that was • The joint fluid can be contaminated with blood, making interpreta-
formerly abnormal becomes normal, it is likely safe to reduce or tion difficult. Sedation keeps the pet still, which in turn reduces
even discontinue medications. the risk of blood contamination.
• Finally, you should know that there is a risk that we will not
EXPLANATION OF THE PROCEDURE identify a specific cause of your pet’s illness despite performing
Reasons to perform an arthrocentesis include: the arthrocentesis. However, the recommendation for performing
1) Joint pain, often manifest by an abnormal walk arthrocentesis is based on our belief that the features of your
2) Swollen joints or joints that are warm to the touch pet’s case indicate a greater likelihood of a positive, informative
3) Evidence of unexplained joint disease on x-rays result than a negative result.
4) Unexplained fever or lameness
Usually, more than one joint will be sampled at the same time. Other anticipated risks specific to your pet:___________________
Although any affected joint could be tested, the most commonly
sampled joints include the carpus (the wrist) and the hock (the heel). _________________________________________________________
The fur is clipped and the skin cleaned over the joint(s) that will be
sampled. A needle attached to a syringe is introduced into the joint(s)
and a fluid sample is obtained. Fluid samples will be submitted for ALTERNATIVES TO THE PROCEDURE
cytology to look at cells under a microscope. Depending on the Alternatives of this procedure include:
situation, samples might be submitted for bacterial culture or for • X-rays of joints: can be useful in detecting bone lesions or
other testing. The number and kinds of cells we find, as well as osteoarthritis associated with the joint swelling.
results of special tests, will allow us to determine if joint disease is • Bone scan: allows for identification of abnormal joints involved
present, determine what is causing the diseases, and/or to evaluate but this test does not provide a diagnosis as to why the joints
joint disease control. are diseased.
Additional procedures planned for your pet at the same time • Synovial biopsy: a biopsy of the joint capsule might be helpful
as the arthrocentesis: if the capsule is thickened or deformed or if the fluid analysis
did not provide a diagnosis.
____________________________________________________________ If none of these diagnostic procedures were pursued, we would
need to develop a treatment plan without a confirmed diagnosis,
USE OF SEDATIVES OR ANESTHESIA which might lead to a suboptimal outcome.
Sedation is required for arthrocentesis. Sedation involves the
administration of medications that cause your pet to become AUTHORIZATION
drowsy and relaxed, but to remain conscious. In general, there are By signing this form below, you agree that:
fewer risks associated with sedation than with general anesthesia, • You understand how/why the procedure is likely to help your
but adverse events can occur. Many medications used to induce pet

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