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This document provides consent for the medical procedure balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices, detailing the procedure, risks, benefits, alternatives, and
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How to fill out consent for balloon-occluded retrograde
How to fill out Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation
01
Obtain the 'Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation' form.
02
Read the introduction section carefully to understand the purpose of the procedure and anesthesia or sedation.
03
Fill in the patient's personal information, including name, date of birth, and medical record number.
04
Provide details regarding the proposed procedure, including risks, benefits, and alternatives.
05
Discuss any potential side effects or complications with the patient.
06
Ensure that the patient has the opportunity to ask questions and discuss concerns.
07
Have the patient or legal guardian sign the consent form to acknowledge understanding and agreement.
08
Include the date and time of consent signing.
09
Obtain the signature of the healthcare provider or witness as required.
10
Make a copy of the signed consent form for the patient's records and for the medical team.
Who needs Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation?
01
Patients diagnosed with gastric varices who are candidates for balloon-Occluded retrograde transvenous obliteration (BRTO).
02
Patients who require anesthesia or sedation during the procedure.
03
Legal guardians of patients who are minors or unable to provide consent themselves.
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People Also Ask about
What is the CPT code for balloon occluded retrograde transvenous obliteration?
The occlusion component of the procedure should be reported with the appropriate embolization code (37241 or 37244) depending on the clinical situation.
What is transvenous obliteration for gastric varices?
Evidence-based recommendations on transvenous obliteration for gastric varices. This involves inserting a tube with a tiny balloon on the end into a vein in the thigh or neck. The tube is then passed into the enlarged vein in the stomach (gastric varix) and the balloon is inflated to stop blood flowing into the vein.
What is balloon occluded retrograde transvenous obliteration of varices?
A BRTO procedure involves occlusion of outflow veins of the portosystemic shunt, such as a gastrorenal shunt, using an occlusion balloon followed by the injection of a sclerosing agent directly into the varix endovascularly.
How is brto done?
For the conventional BRTO procedure, a large infradiaphragmatic “left-sided” portosystemic collateral is required. The most common shunt to be occluded during a conventional BRTO procedure is a gastrorenal shunt, which provides venous outflow in 90% of gastric varices cases.
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What is Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation?
Consent for BRTO involves a formal agreement from the patient acknowledging that they understand the procedure, its potential risks, benefits, and alternatives.
Who is required to file Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation?
The physician performing the procedure is typically required to obtain and file the consent, ensuring that the patient or their legal representative has fully understood and agreed to the treatment plan.
How to fill out Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation?
The consent form should be filled out by providing patient information, details about the procedure and anesthesia, highlighting risks and benefits, and obtaining the patient's or guardian's signature.
What is the purpose of Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation?
The purpose of the consent is to ensure that the patient is informed and agrees to the procedure and anesthesia, thereby protecting both the patient and medical provider legally.
What information must be reported on Consent for balloon-Occluded retrograde transvenous obliteration (BRTO) of gastric varices and administration of anesthesia or sedation?
The consent form must report the patient's name, details of the procedure, risks involved, potential benefits, any alternative treatments discussed, and signatures of the patient or their representative along with the healthcare provider.
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