Page 3298 - Cote clinical veterinary advisor dogs and cats 4th

Consent to Perform Cystocentesis

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

INTRODUCTION your pet to become drowsy and relaxed, but to remain conscious.
We want to make sure that you understand the planned medical Adverse reactions to sedation are very rare. Many medications used
procedure to be performed on your pet. You should know why the to induce sedation can be “reversed” by giving other medications
procedure has been suggested, what the potential benefits are for to counter the sedative effect, allowing your pet to “wake up” more
your pet, and the most common/important risks of the procedure. quickly after the procedure has been completed.
Alternatives to this procedure, when applicable, will be discussed
with you. It is also important that you recognize that medicine is FORESEEABLE RISKS TO THE PROCEDURE
not an exact science, and that the outcome cannot be guaranteed. There is only a very, very minor chance of complications during
We encourage you to ask us as many questions as required for cystocentesis – it is a very safe procedure. There is a chance that
you to make a well-informed decision. we will not be able to recover enough urine if the bladder is empty, in
which case we may need to wait to let the bladder fill up. The most
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE important risks of a cystocentesis are bleeding or urine leakage into
Cystocentesis is performed to obtain a urine sample directly from the abdomen. If bleeding or urine leakage does occur, it is usually
the urinary bladder using a needle and syringe. Urine samples mild and does not require treatment. Serious complications are
allow us to look for bladder infections, assess urine concentrating extremely rare, and may be treated by administering fluids, blood
ability, check for protein loss in the urine, or to run other tests transfusions, or surgery to repair the injured tissue. In patients with
that provide crucial information about your pet’s health. Unlike a bladder tumors, cystocentesis could result in tracking of cancer cells
sample “caught” in a cup while your pet is urinating, urine obtained through the abdomen and skin when the needle is removed. We will
by cystocentesis does not have contaminants found in the lower not perform cystocentesis if we suspect that these complications are
parts of the urinary tract (the vagina or penis). These contaminants likely. Finally, there is also a risk that we will not identify a specific
include white blood cells, protein, and bacteria and can confuse cause of your pet’s illness despite obtaining this urine sample.
interpretation of a urinalysis. Obtaining uncontaminated urine can
help differentiate between bladder infections and bacteria that are Other anticipated risks specific to your pet:___________________
normal further down in the urinary tract. It is also a simple, quick
way to obtain urine from patients who are unwilling to urinate volun- _________________________________________________________
tarily while at their appointment. This procedure is not a treatment
for disease.
ALTERNATIVES TO THE PROCEDURE
EXPLANATION OF THE PROCEDURE Alternative methods of sampling urine include a mid-stream free
We will first feel to make sure that your pet has urine in the bladder catch during urination, or a sample obtained by passing a urinary
or will check for urine using an ultrasound machine. Your pet will be catheter. Both of these methods can result in contamination of the
gently restrained so he or she will lie still in a relaxed position. While urine. We would be happy to discuss if one of these alternatives
palpating the bladder, a small needle (the size of a vaccine needle) might be appropriate for your pet.
is inserted through the skin over the belly and into the bladder. The
attached syringe is filled up before the needle is removed. The entire AUTHORIZATION
procedure takes less than one minute. Very rarely, some patients By signing this form below, you agree that:
may need light sedation in order to lie still for this procedure. • You understand how/why the procedure is likely to help your pet
Additional procedures planned for your pet at the same time • You understand what will be done to your pet during the procedure
as the cystocentesis: • You understand the known risks that accompany the procedure,
and also understand that unforeseen complications may occur
____________________________________________________________ • You understand that the procedure may not produce the results
we hope to achieve
USE OF SEDATIVES OR ANESTHESIA • You understand the alternatives to this procedure for your pet
Usually cystocentesis is done without any need for sedation. • You agree that you have been given time to ask questions regard-
Occasionally, sedation may be required for animals that won’t be ing the procedure, that these have been answered satisfactorily,
still. Sedation will involve the administration of medications that cause and that you are free to decline the procedure.

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