Praxis Medical Insights

Core Components That Must Be Discussed

The American Thoracic Society recommends that the doctor performing the chest tube insertion, or an appropriately trained individual, must obtain informed consent that includes explanation of the procedure's nature, significant foreseeable risks and their consequences, benefits, and alternatives including no treatment 1, 2
The procedure's nature and purpose must be explained, including the placement of a flexible plastic tube through the chest wall into the pleural space to drain accumulated air or fluid, and the rationale for the procedure must be clarified for the specific patient's condition 3, 4
The technique that will be used, such as small-bore or large-bore drain, Seldinger technique or blunt dissection, and whether imaging guidance will be employed, must be described 3, 4
Significant risks and complications, including common and serious complications, must be discussed, tailored to what the patient would consider relevant 3, 4
Alternative drainage methods, such as needle aspiration/thoracentesis, and conservative management must be explained, along with the risks and benefits of choosing no treatment 1, 3, 4

The choice of anesthesia, whether local, sedation, or general, and the rationale for the choice must be discussed, along with the associated risks, including nausea/vomiting, sore throat, and numbness at injection sites 1, 2, 3, 4

The physician performing the procedure, or an appropriately trained individual, must obtain consent, ensuring the person obtaining consent can answer questions accurately and address patient-specific concerns 1, 2, 3, 4
Consent must occur in a non-pressured environment with adequate time for explanation and discussion, and patients must have the capacity to process the information provided and the freedom to ask questions 5

Factors that increase procedural risk for the individual patient, such as coagulopathy, anticoagulant therapy, recent cardiac or thoracic surgery, and immunocompromised state, must be identified and discussed 1, 2, 6

The informed consent discussion must be documented clearly, including specific risks, benefits, and alternatives explained, patient questions and responses provided, and any patient-specific concerns or risk factors discussed 5, 7

The American College of Obstetricians and Gynecologists recommends that pain or discomfort expectations should not be minimized, and information should not be withheld because it might make the patient anxious or deter them from a beneficial procedure 5
The American Society of Anesthesiologists recommends that patients may withdraw consent at any time without penalty, and specific consent may be required if a trainee will insert the drain 9, 10