Pre-procedural Patient Evaluation and Informed Consent
Domain 3: Pre-procedural Patient Evaluation and Informed Consent
This domain tests structured pre-procedure assessment, device planning, and consent that is genuinely informed rather than a signature.
Core rules
- Confirm indication, prescribed therapy, expected duration, solution properties, and alternatives. Review allergy (chlorhexidine, lidocaine, latex), anticoagulants and antiplatelets, bleeding history, thrombosis, prior lines, surgery, radiotherapy, lymphoedema, mastectomy, renal impairment, and patient preference.
- Preserve future access: avoid subclavian veins in dialysis candidates and avoid limbs with lymphoedema or axillary node clearance.
- Coagulation tests are not routine for peripheral IVs. For central access, assess bleeding risk clinically and with local policy; abnormal INR or platelets may require discussion, not automatic cancellation.
- Consent requires capacity, relevant risks, benefits, and alternatives, and freedom from coercion. Document who consented, what was discussed, interpreter use, and questions.
- Perform a time-out: patient identity, procedure, site, allergies, consent, equipment, and sterility.
Worked example
A patient on warfarin for atrial fibrillation has an INR of 3.1 and needs a PICC for four weeks of antibiotics. Reasoning: do not simply refuse. Assess bleeding history, recent INR trend, platelet count, and whether antibiotics can be given another way. If PICC is needed, use ultrasound, avoid arterial puncture, apply prolonged pressure, and involve the prescriber about warfarin. Document the risk discussion.
Traps
Treating consent as a form; ordering routine coagulation screens; ignoring prior venous thrombosis; missing allergy to chlorhexidine; and failing to document capacity or interpreter needs.