Nature of the service
You are consenting to the placement of a peripheral intravenous catheter and the administration of fluids, vitamins, minerals, amino acids, or medications ordered by a licensed clinician, performed by a licensed registered nurse either in your home or at a partner office.
These services are elective and supportive in nature. They are not a diagnosis or treatment for any disease, and they do not replace care from your primary care provider or a specialist.
Risks you should understand
No procedure is risk-free. Recognized risks of intravenous therapy include, but are not limited to:
- Pain, bruising, bleeding, or swelling at the insertion site.
- Infiltration or extravasation of fluid into surrounding tissue.
- Phlebitis, cellulitis, or, rarely, a bloodstream infection.
- Nerve or arterial injury from needle placement.
- Vasovagal reaction, lightheadedness, or fainting.
- Electrolyte or fluid imbalance, and fluid overload in people with heart or kidney disease.
- Allergic or hypersensitivity reactions, which in rare cases can be severe or life-threatening.
- Flushing, metallic taste, headache, or nausea during infusion.
Alternatives
Alternatives include declining treatment, oral hydration and oral supplementation, dietary changes, and evaluation by your primary care provider. You may ask questions at any time and may withdraw your consent and stop the infusion at any point.
Your disclosures
You confirm that you have disclosed your known medical conditions, allergies, medications, supplements, pregnancy or breastfeeding status, and any history of adverse reactions to infusion therapy. Withholding this information can make treatment unsafe.
Emergencies during a visit
You consent to the administration of emergency measures, including epinephrine for a suspected anaphylactic reaction, and to activation of emergency medical services if your nurse judges it necessary. You are responsible for the cost of emergency transport and hospital care.
No guarantee of results
No promise or guarantee has been made to you about the results of treatment. Individual response varies.