Page 3337 - Cote clinical veterinary advisor dogs and cats 4th

Consent to Perform Thoracocentesis

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

INTRODUCTION Additional procedures planned for your pet at the same time
We want to make sure that you understand the planned medical as the thoracocentesis:
procedure to be performed on your pet. You should know why the
procedure has been suggested, what the potential benefits are for ____________________________________________________________
your pet, and the most common/important risks of the procedure.
Alternatives to this procedure, when applicable, will be discussed USE OF SEDATIVES OR ANESTHESIA
with you. It is also important that you recognize that medicine is Mild sedation may be required regardless of the reason for the
not an exact science, and that the outcome cannot be guaranteed. procedure. This involves the administration of medications that cause
We encourage you to ask us as many questions as required for your pet to become drowsy and relaxed, but to remain conscious.
you to make a well-informed decision. In general, there are fewer risks associated with sedation than with
general anesthesia, but adverse events, including the risk of death,
BENEFITS/OPTIMAL OUTCOME OF THE PROCEDURE can occur. Many medications used to induce sedation can be
During thoracocentesis, a needle is inserted into the chest cavity “reversed” by giving other medications to counter the sedative effect,
to allow for the removal of fluid or air that should not be there. allowing your pet to “wake up” more quickly after the procedure
This procedure can be used as a diagnostic tool when a sample has been completed.
of fluid undergoes analysis to help us determine the reason that
the fluid built up inside the chest in the first place. Additionally, FORESEEABLE RISKS TO THE PROCEDURE
thoracocentesis can be used to improve an animal’s ability to breathe • We may not be able to collect enough fluid for all of the planned
by removing fluid or air from the chest cavity. A similar procedure diagnostic tests. This risk can be reduced by using ultrasound
in human medicine is re-expansion of a collapsed lung. guidance to find pockets of fluid.
• We could lacerate (cut) the lung, which could cause pneumothorax
EXPLANATION OF THE PROCEDURE (return of lung collapse). This is an uncommon complication, and
There are two reasons for performing a thoracocentesis it usually resolves on its own. The risk is minimized by keeping
1) Diagnostic: to find out why the pet is ill the patient still during the procedure, which is the reason we
2) Therapeutic: to help the pet breathe better might opt to use sedation.
The pleural space is the area between the lungs and the inside • We could lacerate (cut) or puncture a blood vessel causing
of the body wall; normally, there is only enough fluid there (a few bleeding. Again, keeping the patient still will reduce this risk.
drops) to lubricate the lungs as they expand and contract with • We could introduce germs into the chest that cause infection.
breathing. Sometimes, as a result of disease or injury, this space This risk is minimized by shaving the fur and disinfecting the
fills up with fluid (called pleural effusion) or air (called pneumothorax). skin at the needle puncture site(s).
Either way, if there is enough accumulation of fluid or air the animal • There is also a risk that we might not identify a specific cause
will have a very difficult time breathing because the fluid or air of your pet’s illness despite performing the thoracocentesis, or
collapses the lungs. that breathing will not be eased by the procedure. Even if we
During thoracocentesis, an area on the chest is shaved and remove the majority of air or fluid at the time of the procedure,
cleaned. A needle or catheter attached to a syringe is inserted additional air or fluid can reaccumulate quickly unless the cause
through the skin, between the ribs, and into the pleural space. If only for the disorder can be corrected.
a small amount of fluid is present in the pleural space, we can use
an ultrasound machine to help guide our needle into a fluid pocket. Other anticipated risks specific to your pet:___________________
Once the needle is in place, we pull back on the syringe to aspirate
(withdraw) the fluid or air out of the chest. If we are removing air, _________________________________________________________
we simply continue to remove as much air as possible to help the
pet breathe. If we are instead removing fluid, multiple samples of
fluid will be saved for analysis. The fluid and cells will be examined ALTERNATIVES TO THE PROCEDURE
under a microscope, and the fluid might also be submitted for other The alternative to a therapeutic thoracocentesis is placement of
tests such as bacterial culture. If the volume of fluid was small, only an indwelling chest tube. A tube that is significantly larger than
enough fluid needs to be removed for diagnostic testing. On the the needle used for thoracocentesis would be inserted via a small
other hand, if there was enough fluid to make breathing difficult, we incision through the chest wall and left in place for intermittent
will remove as much fluid as we can do safely, the goal being to or continuous suction. This is a more invasive option and would
allow the lungs to re-expand by removing the fluid that compresses require continued hospitalization as long as the tube in in place.
them. Once we finish removing fluid or air, the needle is simply There is no good alternative for diagnostic thoracocentesis,
pulled out with no need for sutures (stitches). although other types of testing (e.g., echocardiogram, CT scan

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