My answer is a definite Yes---No --- and Maybe!
Seriously, there is no single answer for this question. The literature on informed consent does not spell out specific procedures that require informed consent. Instead, the language in these published resources is “invasive procedures or treatments”. Therefore, your facility must make this decision.
First, let us discuss what is and is not “informed consent”. This is definitely a shared decision-making process. It begins with educating the patient and family about the procedure and ends with a signature on a piece of paper. Please do not think that the signed piece of paper alone is the informed consent.
The education comes from the professional performing the procedure because that individual is the most knowledgeable about that procedure. This education should not be delegated to others. This education should include a description of the procedure, the reason for it being recommended, the risks and benefits associated with the procedure, and the alternatives to treatment if the recommended procedure is rejected. Use learning methods and educational materials (written, video, etc) that are most appropriate for each patient and their needs. Confirm that the patient comprehends this information by using “teach back” methods. After confirmation that the patient comprehends all information given, a signature is obtained on a piece of paper. That is the complete process of informed consent.
Each facility must follow state laws or regulations, if present, about informed consent. Collaborate with the risk manager in your facility to discuss these laws or regulations and gain their thoughts on the need for informed consent for a midline catheter insertion. Some will say it falls under the general consent signed on hospital admission because it is a peripheral catheter. Other will say it is intended for a longer dwell time than a traditional short peripheral catheter and requires strict sterile technique for insertion and therefore requires “informed consent.” Alternative settings may have additional considerations for or against the need for informed consent.
In my opinion, everything that we do to all patients requires their informed consent. We cannot omit this educational process but that does not always require that the patient or family and a witness sign a document labeled as “informed consent” and listing the specific procedure.
Another approach is to document what was taught, how it was taught, the level of the patient/family comprehension, and how this was confirmed. This education is then documented on a specific form. This process provides an alternative when the “informed consent” document is not required. It could also be helpful to use such an educational documentation tool even with the “informed consent’ document.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.