Transition To Residency · Year 4 · from Transition To Residency
Case 3: Procedural Competence and Informed Consent
Clinical Image
Source: Wikipedia - Peripheral venous catheter - CC BY-SA 4.0
Case Presentation
A 26-year-old male emergency medicine intern is asked to place a peripheral IV catheter in a 45-year-old female patient presenting with dehydration and vomiting. The nursing staff has attempted twice without success. Before approaching the patient, the intern confirms the indication (IV access for fluid resuscitation), reviews his technique mentally, and gathers all necessary equipment. At bedside, he introduces himself, explains the procedure, discusses risks (pain, bruising, infection, need for additional attempts), benefits (ability to receive IV fluids and medications), and alternatives (oral rehydration if tolerable). The patient provides verbal consent. He performs a timeout, verifying correct patient identity. He applies a tourniquet, identifies a suitable vein in the forearm, prepares the site with alcohol, and successfully cannulates the vein on first attempt using sterile technique. He documents the procedure including indication, consent obtained, technique used, successful placement confirmed by blood return and saline flush, and no immediate complications. The patient receives IV fluids and antiemetics with rapid improvement.
Key Learning Points
- Procedure preparation includes confirming indication, obtaining informed consent, performing a timeout, and gathering all necessary equipment before patient contact
- Informed consent requires explanation of the procedure, risks, benefits, and alternatives in understandable language
- Procedure documentation must include indication, consent, technique, findings, complications, and any specimens sent to create a complete medical-legal record