Even though you are well enough to leave hospital, you are still at risk of developing a Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE). This risk will continue until you return to your usual level of mobility.

What is a DVT?

A DVT is a blood clot that forms in a vein. It is possible for a DVT to form in any vein but it most commonly occurs in the leg.

What is a PE?

A PE is a blood clot in the lungs, caused when part of a DVT breaks off and travels in the bloodstream to the lungs.

What can I do to reduce my risk of getting a DVT or PE?

• Stay as mobile as possible. If walking is difficult, exercise your legs and feet by flexing your knees and ankles, rotating your feet and wriggling your toes. Do this as often as you can.
• Drink plenty of fluids, as dehydration increases the risk of getting a DVT or PE (Renal patients, please check your fluid allowance with your renal clinical team).
• If you have been given stockings or injections to reduce the risk of getting a DVT or PE, please use them as instructed.
• Eat a healthy diet and maintain a healthy weight.
• Don’t smoke.

How do I know if I have a DVT or PE? 

Signs of a DVT include:

• Pain.
• Swelling.
• Discolouration of the skin (red, purple, or blue).

Signs of a PE include:

• A cough with or without blood-stained phlegm.
• Breathlessness - more than usual for you.
• Chest pain. Collapse (this is an emergency - phone 999).

If you develop any of the symptoms of either a DVT or PE, please get medical advice the same day. Phone 111 or your GP surgery, or go to the nearest A&E Department.

© North Bristol NHS Trust. This edition published October 2022. Review due October 2025. NBT002899

Falls prevention in hospital

The aim of this page is to advise you how we will help reduce the risk of you falling whilst you are in hospital. 

Reducing falls is important for maintaining everyone’s health, wellbeing, and independence. Older people often have more falls and are more at risk of injury. Falls can become recurrent and cause injuries including hip fractures and head injuries. Falls can be life changing through the injuries they cause and the fear of falling that they create. 

A fall happens when someone accidentally ends up on the ground or a lower surface. It’s not caused by a major health issue like a stroke or a dangerous situation. Falls can happen to anyone and can be just a natural part of how our bodies work.

Falls often happen because of multiple risk factors. These include:

• Muscle weakness.
• Poor balance.
• Visual impairment.
• The use of certain medications or a combination of several medications.
• Environmental hazards such as steps, trailing cables, or wet floors.
• Some specific medical conditions might make people more likely to fall, such as dementia, stroke, or Parkinson’s disease

Each month North Bristol NHS Trust supports around 29,400 admitted patients. Around 180 falls are recorded for these patients each month (2023 data).

Can we prevent falls?

Like in normal life, it is not possible to prevent all falls in hospital. However, we can work together to reduce the chances of this happening.

Research has shown that the best chance of reducing falls is when staff such as doctors, nurses, and therapists work together. You and your family can also help by being aware of the risks and the actions you can take, as well as talking to the people looking after you about falls prevention.

North Bristol NHS Trust sees preventing falls as a priority and aims to reduce the risk of falls during your hospital admission by:

• Assessing all patients when admitted for the risk of falls and delivering individual care to manage this.
• Regularly reassessing patients if their condition changes.
• Responding quickly to hazards.
• Patients with higher risk of falls will be identified and provided with the appropriate level of care. This can include additional checks, supervision or moving to more visible area on the ward.
• Patients will be assessed individually for equipment, bed rails, and aids.
• Making the hospital environment as safe as possible. Training staff with regular updates.
• Encouraging staff, patients, and visitors to report any falls. This allows us to learn from previous falls

What can we do together?

This list can be used by patients, their carers, and families.

Hospital staff will ask you as part of your assessment. Tell the staff if you have

• Fallen in the past year.
• Are worried about falls.
• Have a history of falls.

Talk to staff if you feel confused or disorientated

• This could be a sign on delirium, and staff can give support for this.
• If you are a visitor and notice your friend or relative is not acting themselves, please alert the staff.

Use your call bell

• Use your call bell if you need help to move.
• Especially if you need help going to the toilet.
• When ward staff or visitors leave, make sure they leave your call bell where you can reach it.

Use your glasses

• Make sure your glasses are clean and used as prescribed.
• Ask for help if you are having trouble seeing.
• Use a night light to make sure you can see in dim light.

Use your walking aid

• Keep your usual walking aid close by.
• Check for wear and tear, particularly on the rubber feet.
• Never lean on hospital furniture as it often has wheels.
• Ward staff can provide walking aids to use while you’re in hospital.

Footwear

• Make sure your shoes and slippers fit well, grip well, and don’t fall off.
• Ask relatives to bring in well fitting shoes or ask the ward staff for socks with grips.

Do simple exercises before getting out of bed

• Point your toes and release them a few times.
• Tighten the muscles in your calves and then release them.
• Move your legs up and down if you can.
• This will get the circulation going.

Getting out of bed

• Sit up straight for a few moments on the edge of your bed before standing.
• Get up slowly.
• Make sure you feel steady before walking.
• Ward staff may check your blood pressure while sitting and standing as part of the falls assessment.

Eating and drinking

• Drink and eat regularly.
• Staff will provide jugs of water and can give you light snacks.

Going to the bathroom and toilet

• Take care when using the bathroom and toilet.
• Ask for help if you need assistance.

Keep active during your stay

• Complete exercises in the chair.
• Take opportunities for supported walks with visitors or staff. This helps you maintain your strength.
• Be aware of your environment and ask for clutter to be moved if your path isn’t clear.
• If you feel dizzy: stop, sit down, let the ward staff know.

If you fall whilst in hospital

Despite our best efforts some patients will fall whilst in hospital. If you do fall, the nurses and doctors will check for signs of injury and provide treatment if needed. We will record the fall in your medical notes as well as on our incident reporting system. With your consent we will inform your chosen representative (usually a friend or family member).

What you can at home

STEP is an exercise programme you can do sitting in a chair. If you feel well enough, you can start them in hospital and carry on when you return home. The exercises aim to increase your strength and balance and they are designed for people who find it difficult to get out and about.

To find out more about STEP go to: Start Today Exercise Programme (STEP) - Sirona care & health

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002264.

Information for patients referred for treatment with ferric derisomaltose at North Bristol NHS Trust. 

What is ferric derisomaltose?

Ferric derisomaltose (FDI) is dark brown intravenous iron. It is used to treat iron deficiency – when your body does not have enough iron. It is used when other treatments like tablets aren’t suitable, or if you need treatment quickly. The FDI we use is Pharmacosmos 100mg/ml solution.

Why am I being treated with FDI?

Your healthcare professional has recommended you have treatment with FDI to correct the level of iron in your body. 

Why do I need iron?

Iron is important for the formation of red blood cells, and allows red blood cells to carry oxygen around the body. It is also found in enzymes in the body, helps produce proteins in the muscle (myoglobin), and helps the immune system. The human body has around 3-4 grams of iron, and two thirds of this is in red blood cells. You may need to have your iron stores improved for upcoming surgery.

A lack of iron can cause:

• Tiredness.
• Dizziness.
• Irritability.
• Not being able to sleep.
• Dry skin.
• Hair loss.

Before your treatment

You do not need to do anything special to prepare. You can eat and drink as normal – make sure you are well hydrated. 

Continue taking all your usual medications but stop any iron tablets at least a day before your appointment. 

Wear loose, comfortable clothes and a short-sleeved shirt. You can also bring along a book, or something to watch during and after your treatment.

You will go through your medical history with a member of the team. Please ask them if you have any concerns or questions about your treatment. 

How is FDI given?

It is an intravenous treatment, meaning it goes directly into your vein through a drip. A nurse will monitor you.It should not hurt but you may feel a cold sensation in your arm.

How long will it take? 

Like all medicines FDI can cause side effects, although not everyone will get them. A member of the team will discuss these side effects with you before starting treatment.

There is a low risk of an allergic reaction. Symptoms include breathing difficulty, dizziness, and swelling in the mouth. You will be monitored closely to make sure you are responding well to the treatment.

Around 1 in 100 people have a Fishbane reaction. This can make you feel flushed. This is not an allergic reaction and is very common. If this happens the infusions can be paused, and continued once the flushing has stopped.

Another uncommon risk is iron leaking and causing a permanent stain to your skin.

Please tell a member of the team if you notice any leaking or have any side effects like flushing, pain, or discomfort. They can stop the treatment if necessary and look after you.

A few days after the treatment you might have a headache, mild fever, or joint pain. These usually go away on their own.

What happens after treatment?

A few weeks or months after treatment you will have a blood test to see if your iron levels are back to where they should be.

Some people may only need one treatment, this depends on whether you have ongoing issues that affect your iron levels.

If you normally take oral iron tablets this will need to be stopped for 7 days after the infusion. Please ask your healthcare professional for more information.

If you become unwell in the days following your iron infusion, please contact your GP surgery or NHS 111. In an emergency phone 999 or go to your nearest Emergency Department.

Further information and references

© North Bristol NHS Trust. This edition published April 2025. Review due April 2028. NBT003783

The Metabolic Biochemistry Laboratory (previously Biochemical Genetics) at Southmead Hospital provides a regional diagnostic and monitoring service for the investigation of inherited metabolic diseases. Routine analyses performed include urine organic acids (including quantitative methylmalonic acid, if required), bloodspot/plasma acylcarnitines (including free carnitine), plasma/urine/CSF quantitative amino acids, qualitative galactosaemia screening test, plasma free fatty acids and 3-hydroxybutyrate.

In addition, the laboratory provides specialist testing for the investigation of peroxisomal disorders (plasma very long chain fatty acid analysis, including pristanic and phytanic acids), Smith-Lemli-Opitz syndrome (plasma 7-dehydrocholesterol and 8-dehydrocholesterol)

The Metabolic Biochemistry department is a Centre for Galactosemia investigations and offers a variety of tests for the diagnosis and monitoring of disorders of galactose metabolism including:

• first line galactosaemia screens,
• quantitative galactose-1-phosphate uridyltransferase activity for confirmation of classical galactosaemia;
• urine galactitol for screening and monitoring of galactokinase deficiency or screening for classical galactosaemia if infant has been transfused;
• galactokinase activity for confirmation of galactokinase deficiency;
• galactose-1-phosphate for monitoring treatment of classical galactosaemia.

The Metabolic Biochemistry Laboratory at Southmead Hospital is a member of the UK National Metabolic Biochemistry Network (MetBioNet). 

The Metabolic Biochemistry laboratory works very closely with the Southwest Newborn Screening Laboratory to aid in the diagnostic testing to support the newborn screening programmes and monitoring of patients identified though the Inherited Metabolic Disease screening programmes. Bloodspot monitoring for PKU (Phenylalanine and tyrosine) and CAH (17-OHP) for known patients and testing for hypothyroidism on bloodspot (TSH)

We provide a comprehensive advisory service and welcome enquiries to discuss appropriate patient investigation and result interpretation. Clinical and laboratory advice is available during working hours, via contacts listed.

Details of Sample Requirements and Transport can be found under “Requesting” and “Test Information” via the menu at the top of this page.

For any urgent analyses or additional testing on samples already received, please telephone the laboratory to discuss.

(Source: CSF amino acid reference intervals from the Cardiff Working Group, MetBioNet)

User Handbook

Request form

User Survey

Useful Links

National Metabolic Biochemistry Network (MetBioNet)
British Inherited Metabolic Diseases Group
Cardiff Porphyria Service

This page contains information for patients who have had a CT colonoscopy at North Bristol NHS Trust.

What can I expect after CT colonoscopy?

You can return to normal activities as soon as the scan is finished. You can return to your normal diet, but we suggest you eat little and often to reduce nausea and bloating. Drink plenty of water for the next 24 hours, as the preparation diet and medication can cause mild dehydration.

Feeling bloated and abdominal (tummy) pain

You may feel bloated, have tummy pain, or pass wind (fart) after the test because of the gas we put in your bowel. This should settle quickly, usually within 2 hours. Eating and drinking normally will help. Food may pass quickly through you for several hours after the examination. If you have diarrhoea up to 4 days after the procedure, contact your GP.

If you have any of these in the 5 days after your examination, phone NHS 111, your GP, or go to the nearest Emergency Department (A&E):

• Severe abdominal pain.
• Bleeding from your rectum (bottom) which is not normal for you.
• Sweating and/or feeling sick or generally unwell.

Possible symptoms from the hyoscine butylbromide (Buscopan) injection 

You may have been given an injection of hyoscine butlybromide (Buscopan) to help relax the muscles of the bowel, to get clearer images.

If you have any of these side effects please tell the radiographer:

• Blurred vision - if this happens you need to wait before driving. This side effect is very rare, and your vision should return to normal quickly.
• Sudden difficulty breathing or increased heart rate.
• Feeling faint.

If you have any of the following symptoms in the next 24 hours, please call NHS 111, your GP, or go to to the nearest Emergency Department (A&E):

• A skin rash and/or itching.
• Difficulty breathing and/or increased heart rate.
• Increased pressure behind the eye and/or eye pain (see below).

If you have eye pain in the next 24 hours it is important you go to your nearest eye hospital immediately. Take this leaflet with you as we will write down the drug information you need.

Bristol Eye Hospital is open 7 days a week 08:30-16:30. Outside of these times go to the nearest Emergency Department to you and you will be referred to the on-call eye team.

Alternatively call NHS 111. If you are unsure if you need to go to the Eye Hospital, please call 0117 923 0000.

Please be reassured that these side effects are very rare.

Possible symptoms from the contrast media injection

You may have been given an injection of contrast media to give us a more detailed scan. Complications are rare but some people may experience an allergic reaction.

Please tell the radiographer if you experience weakness, sweating, skin reactions, shortness of breath, or increase in heart rate.

If you have any of these symptoms at home please call NHS 111, your GP, or go to the nearest Emergency Department (A&E). Take this leaflet with you.

Your results 

The radiologist will examine the images from your scan in detail and send the results to the doctor who referred you. Waiting times can vary.

• If you were referred by an outpatient department at North Bristol NHS Trust, they will contact you with an appointment or to discuss the results.
• If your GP referred you, they will contact you. If you do not hear from them please call them directly.
• If you have come from the Bowel Screening Programme (BCSP) the results will be sent to the specialist screening practitioner who will contact you.

If you have any side effects or symptoms that require medical assistance from your GP or Emergency Department, please tell the Imaging Department by phoning 0117 414 8989.

The Imaging Department staff will write down

• If you have had hyoscine butylbromide (Buscopan):
  • The batch number
  • The expiry date
  • The dose
• If you have had contrast media:
  • The batch number
  • The expiry date
  • The dose

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT003705.

What is a tattoo?

Tattoos are caused by pigment or ink being embedded into the skin. The body forms a fibrous coating around the pigment particles so that they are not absorbed and removed by the body.

We can treat the following types of tattoo:

• Indian ink tattoos (often used in amateur tattoos).
• Single colour tattoos.
• Multicoloured tattoos.
• Accidental tattoos - where something like pencil graphite or gravel gets embedded in the skin during an accident.

How does laser treatment fade the tattoo?

We use Qswitched NdYag and Ruby lasers for treating tattoos. These lasers use short bursts of energy that are absorbed by the tattoo particles. This breaks up the pigment particles and fibrous coating around the pigment so the body can absorb them. This is a safe and effective way of treating tattoos.

How successful is treatment?

This depends on the type of ink used, and can be difficult to predict because there are hundreds of different ink recipes. Some tattoos clear completely following laser treatment but it is never possible to guarantee 100% removal.

Indian ink and single colour black or red tattoos usually respond well to treatment. Other colours like green, blue, purple, and orange do not respond as well.

How well your tattoo may respond will be discussed with you at your consultation.

What does treatment involve? 

The number of sessions needed varies depending on the type of ink and size of tattoo but may be around:

• Indian ink - 4-6 treatment sessions.
• Professional tattoos - 10-12 sessions.

Treatments are spaced at least 8 weeks apart to allow the body to absorb the pigment.

You will need to look after your skin carefully for 1-2 weeks after each treatment. You may also need to wear high factor sunblock on the tattoo for the whole course of treatment.

You are advised not to have a tattoo treated if you have a heavy suntan because this increases the risk of scarring and is not as effective.

We recommend you do not have tattoo removal laser treatment during pregnancy.

Are there any side-effects?

The risk of scarring from treatment with the Qswitched laser is low.

The treatment can occasionally cause the normal pigment in skin to decrease or increase, leaving a pale or dark mark where the treatment was. This usually returns to normal but can take a long time.

Side-effects are more common if your skin is tanned when treated. Laser treatment may not be suitable for people with very dark skin because of the increased risk of side-effects.

Some light-coloured tattoo inks can get darker with laser treatment, which may be temporary or permanent.

The risk of side-effects will be fully discussed with you at your consultation.

Funding for laser treatment

Laser treatment for tattoo removal is not routinely funded on the NHS. In severe or exceptional cases the Exceptional Funding Panel in your area may consider this. If you think you may be eligible, discuss this with your GP.

If you cannot get NHS funding you can self-fund your consultation and treatment at Bristol Laser Centre. We offer a sensitive, personal, honest approach.

An initial consultation with a specialist doctor is always required. This costs £120. During the initial consultation you will discuss your specific needs. We may then offer a test patch to show how well you may respond to the treatment

Tattoo removal laser treatments start from £70 per session.

How do I book in? 

If you have any questions or would like to arrange a consultation, please phone us on 0117 414 1212.

Or fill in our online form: Contact Bristol Laser Centre

© North Bristol NHS Trust. This edition published April 2025. Review due April 2028. NBT002020

Anorectal physiology tests 

You have been asked to attend this test for problems associated with faecal incontinence or constipation, or other bowel problems.

Your consultant has requested these tests so that they can establish what exactly is causing your particular problem. They can then offer the most appropriated treatment.

Anorectal physiology tests are used to assess the function of the muscles in your anal canal to see if they are working normally, and also checks the sensitivity of the rectum to small volumes of air and its response to distension. 

This page outlines what to expect both during and after the test.

Upon arrival

• When you arrive you will be greeted and taken into a private room by the clinical scientist who will be performing the test.
• A chaperone will also be present to assist. The clinical scientist will ask you some questions about the symptoms you have been having and take a brief history. You will have the opportunity to ask questions or discuss any concerns you may have regarding the test.
• What does the test involve?
• You will be asked to undress from the waist down, put on a gown and lie, covered with a sheet, on your left side. Every effort will be made to preserve your privacy and dignity during the procedure.
• The clinical scientist will perform a gentle rectal examination and ask you to push and squeeze to check how your muscles are working.
• A thin, water-filled tube (catheter) with a small balloon on the end will then be put through the anus into the rectum. You will be asked to perform manoeuvres such as squeezing, pushing, and coughing to assess the functionality of the anal muscles. This catheter is approximately the width of a pencil.
• Next, the balloon on the end of the tube will be inflated with a very small amount of air, and you will be asked to comment on your sensations as this happens. This is the last part of the test.
• If your consultant has requested a treatment called “biofeedback”, the clinical scientist may show you the computer screen and talk you through techniques to improve the function of your anal muscles (but only if you need it). You may also be required to attend clinic on another day for further sessions of biofeedback.

Frequently asked questions

How shall I prepare for the test?

Are there any risks associated with these tests?

What happens after I have had the test?

How long does the test take?

Are there any alternatives to the test?

What will happen after your tests?

Further appointments 

If you require any additional information concerning the investigations or any advice please contact us using the details below. If unavailable please leave a message and you will be contacted.

References and sources of additional information

© North Bristol NHS Trust. This edition published June 2024. Review due June 2027. NBT002923

The Department of Cellular Pathology provides a wide-ranging and comprehensive Histopathology, diagnostic Cytopathology and Cervical cytology screening service to both North Bristol NHS Trust and University Hospitals Bristol and Weston NHS Foundation Trust, as well as GPs and other healthcare providers. The service is accredited to ISO15189:2022 with UKAS (Lab 8130) and relevant activities are licensed by the Human Tissue Authority (license 12413).  There is extensive participation in External Quality Assurance schemes.  The department is well-equipped and is housed in a purpose-designed laboratory opened in 2016.

The Department is open for service and opinion Monday to Friday, 09.00–17.00 hrs. Outside of these times, a renal on-call service exists and contact with on-call consultant staff can be made via switchboard. There is no general on-call service.

The diagnostic service in fully computerised with extensive databases. The current LIMS is Clinisys WinPath Enterprise. Results are all available through ICE and all requesting can be made through ICE.

The service has implemented specialist reporting to support the wide range of services at the Trusts. The consultants are members of one or more specialist teams working to common standards. Clinical consolidation of services had brought together the work of some teams whilst in others cellular pathology has instigated this. A number of the consultants support referral practices and, in all specialisms, consultants are core members of the multidisciplinary teams for cancer services.

The department works closely with the Bristol Genetics Laboratory for the provision of a portfolio of molecular genetics testing.

Services offered include consultation with clinical colleagues to assist in the interpretation of reports and to provide advice about the collection, handling, fixation and submissions of specimens for investigation.

A number of individuals in the department have research interests and the department as a whole is keen to support such activity within the Trusts.

The accreditation status of our tests can be found in the Quality section of the Severn Pathology website.

The automated laboratory provides a routine clinical biochemistry testing service to all inpatient, outpatient and GP surgeries in the North Bristol area.

It has a workload of 1 million specimen requests per annum, with a repertoire of over 50 tests. The laboratory offers a routine service and processes over 20,000 test requests per day.

Our laboratory is equipped with Beckman Coulter instrumentation, which processes the majority of routine biochemistry tests.

Endocrinology, cardiac and a number of tumour markers are also analysed using these systems. As well as processing routine samples, an urgent service is provided throughout the routine working day. Between 10pm - 8am the automated laboratory provides an out-of-hours service.