Informed Consent for Arteriovenous Dialysis Shuntogram
An Arteriovenous Dialysis Shuntogram is performed by inserting a catheter into a blood vessel and injecting the contrast fluid to see the blood vessels on an x-ray.
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While the shuntogram is important to overcoming issues complicating dialysis treatment, the procedure can involve risk of infection, blood loss, or development of a fistula. Because of the risk involved, a patient must provide consent to undergo the shuntogram. The Arteriovenous Dialysis Shuntogram Consent Form communicates procedure and risks between physician and patient. By signing, patients acknowledge the risk and permit the medical team to complete the Dialysis AV Shuntogram. Using this form, the physician can explain the diagnosis requiring the procedure and identify risk factors and potential outcomes. The form includes a section to describe the procedure step-by-step. The physician can include practical alternatives such as no intervention or surgical repair. Use of this form will allow patients to give informed consent for a Dialysis AV Shuntogram and give the medical team freedom to change the direction of the procedure in case complications arise.
For another helpful form, try our consent form for dialysis health status release or our dialysis patient consent form.
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