En胸腔闭式引流术知情同意书.docxVIP

Modern Hospital GuangzhouInformed Consent of Closed-Chest DrainagePatient name：Sex：Age：Case No：Brief description of disease and treatment recommendationsClosed-chest drainageis a procedure that a drainage tube is placed in the chest wall and a water-sealed drainage bottle is linked to the other end of the tube, which relieves intrathoacicpneumatosis and fluid and helps lung recruitment and recovery. The major indications arepneumothorax, hemothorax, hemopneumothorax, empyema, and other conditions after lung surgery and thoracic surgery. After surgery, patients should cough and deeply breathe more and do proper physical exercise to help the drainage of intrathoacicpneumatosis and fluid. At the meantime, the drainage tube should be kept unobstructed and nottwisted, and also away from compression. The nurse should record the volume and nature of drainage as well as the fluctuation of water column. After the surgery, if there is no more gas relieved from the drainage tube, volume of drainage in 24 hours is less than 100ml (empyema is less than 30ml), and chest X-ray indicates satisfactory condition of lung recruitment, the chest tube can be removed.OtherPotential risks and handling:I have been informed that this procedure carries potential risks. However, certain uncommon risks are not included hereinto. The method of surgery should be individualized based on medical condition. I have been informed that I am entitled to discuss with my physician regarding the surgery and any associated special questions. 1．I understand that all anesthetic procedurescarry potential risks. 2．I understand that all drugs might cause unwanted side effects, including mild symptoms such as nausea and rashes, serious anaphylactic shock, and even life-threatening events.3．I understand the risks associated with this procedure and corresponding measures taken:Allergic reactions to local anesthetic medications and drug toxic reactions or other anesthetic accidents;Cerebro-cardiovascular complicat