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This document is a consent form for patients undergoing uterine fibroid embolization, detailing the procedure, associated risks, benefits, and consent for anesthesia or sedation.
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How to fill out consent for uterine fibroid
How to fill out Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation
01
Start by reading the consent form thoroughly to understand the procedure.
02
Fill in your personal information, including full name, date of birth, and contact details.
03
Ensure you provide details about any allergies or previous anesthetic reactions.
04
Indicate whether you have discussed the risks and benefits of the uterine fibroid embolization with your physician.
05
Sign and date the form at the bottom, confirming your consent to the procedure and anesthesia.
06
If applicable, have a witness sign the consent form as required by your healthcare facility.
Who needs Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation?
01
Patients diagnosed with uterine fibroids who are candidates for embolization.
02
Individuals who require anesthesia or sedation for the procedure.
03
Those who have discussed and understood the risks and benefits of the treatment with their healthcare provider.
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People Also Ask about
Are you sedated for UFE?
The routine use of midazolam (Versed) and fentanyl citrate (fentanyl) during the procedure is effective intraprocedurally and is largely used in interventional radiology for moderate sedation. However, most UAE patients do not develop pain until after the procedure is complete.
Does uterine fibroid embolization require anesthesia?
One of the main benefits of UFE is that general anesthesia is not required, as the procedure itself is not particularly painful. Patients cannot feel the catheter moving inside them during the procedure, nor can they feel the particles being infused.
Are you put to sleep for a uterine fibroid embolization?
UFE (also referred to as Uterine Artery Embolization or UAE) is performed in an outpatient setting under light sedation and does not involve general anesthesia or sutures. A local anesthetic is administered to prevent you from experiencing pain during the procedure, and then a catheter is inserted.
Are you put to sleep for a uterine fibroid embolization?
UFE is performed under conscious sedation. The interventional radiologist locates the patient's femoral artery in her leg and numbs the area with local anesthesia. A needle is used to create a pathway for a catheter (thin plastic tube) to be threaded through the artery to reach the uterine artery.
What kind of anesthesia is used for uterine fibroid embolization?
What to Expect During Uterine Artery Embolization. You will be given sedation medication to help you relax, but you will be awake and able to communicate during the procedure (this is often called conscious sedation). You will also receive a catheter to drain your bladder during the procedure.
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What is Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation?
Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation is a legal document that patient signs to acknowledge understanding and agreement to undergo the procedure and receive anesthesia or sedation.
Who is required to file Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation?
The healthcare provider performing the procedure, along with the patient undergoing uterine fibroid embolization, is required to file the Consent.
How to fill out Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation?
To fill out the consent, the patient must provide personal information, details about the procedure, understand the risks and benefits, and then sign and date the document, often in the presence of a witness.
What is the purpose of Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation?
The purpose of consent is to ensure that the patient is fully informed about the procedure, its potential risks and benefits, and to legally protect the healthcare provider.
What information must be reported on Consent for Uterine Fibroid Embolization and Administration of Anesthesia or Sedation?
The information that must be reported includes patient name, date, details of the procedure, risks involved, alternative treatment options, and the signatures of both the patient and the healthcare provider.
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