Severn Pathology reports into the NHSE/I national Pathology Quality Assurance Dashboard.
Reports are collated and presented within the Model Hospital Insight - Model Hospital.
This information has been written by the teams who will look after you during surgery. It aims to help you understand the surgery, guide you through these various phases of your operation, and inform you how you can best prepare and recover afterwards.
You may be given a paper copy of this information which you should bring with you on the day of your surgery.
A joint replacement operation is done to improve your quality of life, It will hopefully allow you to do some of the things that have become difficult with your joint arthritis.
From the day you are admitted to hospital, the staff involved in your care will work together to assess your needs in preparation for leaving hospital.
We ask you to provide us with all the necessary information that will help with planning your hospital care, and timely discharge as early as possible.
You will need to make the arrangements for your own transport home prior to your admission. If you or your relatives/carers have any concerns about your hospital discharge or transfer, do not hesitate to ask a member of the team.
Where possible, discharge arrangements will be made so you are able to vacate your hospital bed. This may include transfer to the Discharge Lounge; we will prepare you and keep you informed.
The Discharge Lounge is a safe area providing nursing care and regular refreshments and meals, including breakfast, where you can wait to be taken home.
Recovering from joint replacement surgery has changed a lot over the years. We know the sooner we get you up and walking after your surgery, the better your outcomes will be. To help you do this, we have developed a pathway using the expertise of other hospitals in this region and across the country.
This should allow you to get back on your feet sooner and return home to do the things you enjoy.
As a result of expert surgery and anaesthetics, and a highly skilled team of doctors, nurses, and allied health professionals, many patients will not need to stay in hospital overnight and will be ready to go home the same day.
This is the usual pathway in many orthopaedic centres across the country, providing an excellent standard of care with very positive results and patient feedback.
However, some patients may not be ready to return safely home the same day and will need a little longer. If this is the case, we would expect you to be able to go home the day after your surgery, or as soon as all treating teams are satisfied.
We will only discharge you once you are recovered and you are able to safely return home.
It is important for you to have realistic expectations of having joint replacement surgery. You should have a clear understanding of what to expect at each stage. You must prepare appropriately for your surgery and work with the clinical teams you meet during your care.
The weeks leading up to your operation are as important as the operation day itself.
After your surgery, you will either return home on the same day, or stay in hospital for just one night. Therefore, you should plan ahead before your surgery and think about how things might be for you when you return home. You must also attend all your appointments before your surgery date.
You should arrange for a family member or a friend to collect you after your surgery. The hospital does not routinely provide transport for your return home.
You have probably been living with joint pain for some time before your operation and will already have ways of adapting to certain situations at home. However, when you are recovering from your operation you may also need some extra help with general tasks initially, like cooking, shopping, and cleaning. You must organise this help before your operation date.
To ensure that your return home is successful and safe, you will need to have someone to stay with you overnight post discharge, and for a few days after returning home. This is essential if you are to go home on the day of surgery.
Very few people require professional care support at home. If your personal choice is to have this help, you must arrange this privately.
The NHS can only provide professional care based on specifically assessed needs and cannot arrange convalescent care.
Preparing your home environment in advance is really helpful for when you get discharged.
For example, you can:
The fitter you are before your operation, the less likely you are to have complications during and after your surgery.
You should seek to make some lifestyle improvements, such as:
If you have any long term health conditions, you should aim to control these as well as possible before your operation to help prevent any complications and to avoid your operation being postponed.
Check your own blood pressure if you are able to do so or get it checked at your GP. If it is above 160/90 you are likely to require medication and the sooner this is started, the sooner we will be able to go ahead with your surgery.
Similarly, if you suffer from diabetes and your HbA1c has not been checked for 6 months or was over 69mmol/mol the last time it was checked, please arrange to have this checked again, and work with your diabetic adviser to improve it. It is very unlikely that your surgery will be undertaken if your diabetes is not well controlled and your HbA1c is above this value.
The pre-operative assessment process is important as it helps the hospital plan your care.
You will be asked by the hospital to provide some information about your general health and current medications. You may be asked to provide this information via:
This allows us to inform and advise you about your procedure, for example, we can provide you with instructions about medications and fasting times before your operation.
At your pre-operative assessment appointments, we will check various medical details, such as:
We will also review your medicines. It is fine to continue taking most medicines and to take them on the day of your surgery. However, there are certain medications we may need you to stop taking for a few days before your operation, such as:
We will give you clear instructions if this is needed and tell you when you should start these medications again after your surgery.
Ward staff will inform you of the pain relief that your surgical team have prescribed for you when you leave hospital. This discussion will also include advice about paracetamol and ibuprofen, where we advise patients to source their own supplies if they are able to do so, in line with North Bristol NHS Trust Policy.
The exercises in the Physiotherapy section of this page should be completed both before and after your surgery. Doing these exercises before your operation will strengthen your muscles and will help you to recover more quickly after surgery.
You will be given a specific time to arrive, depending on the time of your operation.
You must follow the instructions about fasting times. It is important that you follow the fasting instructions correctly or your operation may be cancelled on the day. You must not have any food or very milky drinks for 6 hours before your surgery.
We encourage you to continue to drink plain water until you arrive at hospital and after your admission this will be provided according to your anaesthetist’s instructions.
Please try to avoid bringing in a large number of items with you and minimise items of high value or cash.
When you arrive, you will be greeted by a member of the reception team. They will book you in and confirm some details with you. You will then be seen by one of the nursing team who will run through some additional questions.
The surgical team will confirm with you the operation that they are planning to perform, and check your consent form. They will use a pen to draw an arrow on the leg that is going to be operated upon.
They will be able to answer any last-minute questions you may have.
Before your operation, you will meet your anaesthetist. They will explain the type of anaesthetic that is going to be used, and answer any questions you may have about the anaesthetic.
When it is time for your operation, you will be asked to change into a theatre gown. You will then walk to the operating theatre with one of the team. There, you will be greeted by your anaesthetist, and you will also meet the operating department practitioner, who works with the anaesthetist, helping to look after you.
Some routine checks will be carried out to confirm your identity and to check if you have any allergies. We will confirm again your operation, and what side you are having it on.
One of the team will attach some standard equipment to monitor your heart, blood pressure, and oxygen levels while you are having your anaesthetic and operation.
Your anaesthetist will also be giving you various medicines through a drip in the back of one of your hands. These include antibiotics, anti-sickness medicines and fluids.
In most cases, your anaesthetist will give you a spinal anaesthetic. This is very safe, and avoids the need for having a general anaesthetic, which may cause unpleasant side effects.
Spinal anaesthetic also helps you to recover quickly and receive the best post-operative pain relief.
Local anaesthetic is placed around some of the nerves in your lower back. This numbs your pain nerves so that you do not feel pain during the operation.
Once you are in the operating theatre, your leg will be painted with some cleaning fluid and then covered with drapes. You will not be able to see the surgery and the spinal block will prevent you from feeling any of the operation.
Some people find listening to music through their headphones to be a good distraction. It helps them to relax, and this will be offered to you. You may wish to bring your own music on your phone or portable music device, and your own headphones. Some people prefer to have a small amount of sedation so that they have a light sleep through their surgery. Your anaesthetist will discuss and agree with you a plan depending on your medical history, and your wishes.
The operation typically takes about 1.5 hours. During this time, your observations will be continually monitored by your anaesthetist.
At the end of your operation, you will be transferred to the recovery area where the nurses will monitor your observations. You will be encouraged to eat and drink.
When your spinal anaesthetic has sufficiently worn off, you will be assessed by the therapy team. Our nursing and therapy teams will help you get up, stand, and practice walking with suitable walking aids. The team will practice with you getting on and off the bed, chair, toilet and give advice on how to dress. You will be encouraged to get dressed in home “day clothes” with supportive footwear (no mules or sliders). You will also be taught how to safely complete the stairs.
In order for you to return home, the team needs to be happy that you can manage these activities at home with walking aids. If you require any equipment to assist you this will be assessed and provided prior to your discharge. Please bear this in mind when organising your transport home.
Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or if you need to stay overnight with us at the hospital.
When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital.
If you live alone you will need to arrange for a friend or relative to stay with you overnight, post discharge and for a few days after returning home. You should arrange this before you come in to have your surgery.
Your wound is covered by a shower proof dressing so you can shower as soon as you feel able but do not aim water directly at the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound checked. Please leave any dressings in place and keep as dry as possible until this appointment.
The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle.
Joint replacement surgery is painful – just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild to moderate pain on movement. It is not going to be 100% pain free.
The pain relief package you receive has been specially designed to try and control your pain as well as possible. It starts from the day of your surgery and continues after your discharge home. We will give you the same pain relief tablets whether you stay in hospital overnight or return home on the same day as your operation.
The pain relief package requires you to take your medicines at specific times.
We will be asking you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses.
Swelling is common to have some generalised swelling of the leg below your hip replacement. Swelling will often get worse if you sit for prolonged periods, so we encourage you to remain gently active. To help reduce lower limb swelling you may need to rest for at least 20 minutes in the morning and / or afternoon on the bed initially. If you experience increasing swelling and pain, please seek medical advice.
Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain relief package. However, please ensure that you take these as prescribed, along with plenty of water to drink. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP.
Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises. Please make sure that you follow the pain management programme you were discharged with to help control your pain.
Sleepless nights: It is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. You can sleep in any position including lying on either side.
Deep vein thrombosis (or DVT) Blood clots in the leg can occur after joint replacement surgery. If your leg becomes hard, swollen, hot and painful, especially in the calf area then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms.
Infection is very rare. However, if your joint replacement or scar becomes hot, red and / or increasingly swollen or if you feel unwell, then please do seek medical assistance.
The Ward team will let you know what arrangements have been made for your follow-up appointments.
Following your discharge from hospital, there is always someone you can contact for advice.
If you would like more information before your operation or have any questions after you have been discharged home or concerns about your wound, please ring 0117 414 1331 and one of the nursing staff will be able to advise you directly or be able to contact people from your surgical team for you.
For therapy related queries, please contact Physiotherapy admin 0117 414 4412 or Occupational Therapy admin 0117 414 1272.
Completing the exercises on the following pages will benefit your recovery, improve movement in the hip joint and develop the strength of muscles around it.
These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery.
We recommend you continue these exercises for a minimum of 6 weeks post-surgery. Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.
To watch a video of exercises to do in bed visit:
Hip replacement - bed Exercises (youtube.com)
Lying on your back, point your toes up and down for the count of ten. Repeat every hour you are awake.
The aim of this exercise is to improve the circulation in the lower limbs, helping to prevent the formation of deep vein thrombosis (blood clots) and reduces swelling.
Lying down on your back with your legs straight.
Pull your ankle up towards you and push the back of your knee down against the bed.
Hold for 5 seconds, then relax.
Repeat 10 times.
The aim of this exercise is to strengthen your thigh muscles ready for standing and walking.
Lying down on your back with your legs straight.
You will need assistance to place sliding sheet under your heel.
Bend and straighten your hip and knee by sliding your foot towards your body and then away.
Repeat 5 – 10 times.
The aim of this exercise is to increase your hip movement.
Lying down on your back with your legs straight.
You will need assistance to place sliding sheet under your heel.
Slide your leg out to the side and back in.
Repeat 5 – 10 times.
Do not bring your leg back over your body’s midline.
The aim of this exercise is to increase your hip movement and strengthen the surrounding muscles to help with walking.
Lying down on your back with your knees bent and feet flat on the bed.
Tense your tummy and bottom muscles and lift your bottom up off the bed.
Hold for 5 seconds.
Repeat 5 – 10 times.
The aim of this exercise is to stabilise your pelvis during walking.
To watch a video of exercises to do while standing visit:
Hip replacement - standing hip exercises (youtube.com)
Bend your hip and knee up in front of you and lower back down.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your muscles at the front of your hip.
Keep your leg straight and take it behind you.
Try not to bend at the hips or knee.
Try to stand up tall.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your bottom muscles to help with walking.
Lift your foot off the floor behind you, bending your knee.
Try not to bend at the hips.
Repeat 5 – 10 times.
The aim of this exercise is to stretch the muscles at the front of your hip and strengthen your muscle on the back of your leg.
Keep your leg straight and take it out to the side.
Try not to bend at the knee.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your bottom and hip muscles to help with walking.
Bend both your knees, pushing your bottom out behind you.
Keep your knees behind your feet.
Repeat 5 – 10 times.
Do not bend your hip more than 90 degrees.
The aim of this exercise is to strengthen your leg and hip muscles.
Raise up onto your toes on both feet.
Lower back down onto your flat feet.
Repeat 5 – 10 times.
The aim of this exercise is to strengthen your calf muscles.
Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis and to steadily increase the distance as you recover. It is normal to be allowed to put full weight through your operated leg.
As soon as possible, try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking, continue to use your walking aids.
The therapist will practice with you how to safely complete the stairs before going home. To go up and down the stairs, use a banister rail if there is one.
Go up leading with the unoperated leg first, followed by the operated leg and then the crutch.
Going down, put the crutch on the step below then step down with the operated leg, followed by the unoperated leg.
Walking is good for your new hip but remember your hip is an artificial joint. Pace your activity, walk and exercise regularly, little and often. The risk of dislocation is greatest in the first six weeks following surgery. To reduce the risk of dislocation whilst the tissues around your hip are healing, avoid forcing or overstretching movements. Avoid the combination of bending the hip and knee across the body towards the opposite shoulder as shown in the picture below.
You may sleep in any position including lying on either side. Initially when you lie on your non-operated side it may be more comfortable with a pillow between your legs to support the operated hip. When getting into bed, position your bottom back towards the centre of the bed and then slide yourself around into bed lifting your legs onto the bed.
Sit in a comfortable supportive chair after your operation (ideally with chair arms) to help you get up and down safely. Avoid low soft seating initially after your operation.
To put pants or trousers over your feet, hold the waistband and lower garment to your feet, inserting the operated leg first followed by the other leg before pulling them up.
To undress, complete in reverse. When putting on shoes and socks, reach down on the inside of the operated leg to avoid uncomfortable twisting of your hip. A long handled reacher, shoehorn and sock aid can make dressing easier. These are readily available from mobility shops, pharmacies and online.
Relationships
It is normal for your sex life to change initially following a joint replacement. Sexual intercourse may be resumed when you feel comfortable.
You can travel as a passenger in a car immediately following your operation.
You can usually resume driving around four to six weeks after your operation. Stop regularly on longer journeys so you can get out of the car to change position and move around. You must be safe to drive and be able to do an emergency stop.
We recommend that you inform your insurance company you have had a hip replacement before you start driving.
Most people are ready to return to work at six to eight weeks after their operation. Air travel should be avoided whenever possible for the first six weeks. Depending on the sensitivity of the security scanner, your hip replacement may set off the alarm.
You can resume most physical activities as soon as you feel comfortable and confident. You can swim once your wound has healed, swimming any stroke including breaststroke. Exercise bikes and treadmills can be used from six weeks, returning to outdoor cycling once comfortable. If you play golf, we suggest you can resume gradually after six weeks.
For activities such as tennis, badminton and cricket we suggest resuming from around 3 months.
Contact sports are not advised following this surgery.
The walking aids and any equipment prescribed to you after your surgery are provided by an equipment supplier. Please ring the number on the sticker on the equipment, to discuss its return.
© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003678.
The Bristol M.E. Service recognises the impact that ME/CFS and Long Covid can have on people’s ability to work and therefore on their finances. We cannot advise you directly about finances and accessing benefits as this is a specialised area, but we can help you with:
These two key areas can both be included in our standard clinic letters. However, if you need to appeal a decision regarding your benefits and there is a request for further information, we can write a letter for you to add this appeal. This can include more information about the condition, the therapy approach that we offer and an outline of your functional ability.
Personal Independence Payment (PIP) https://www.gov.uk/pip
Employment and Support Allowance (ESA) https://www.gov.uk/employment-support-allowance
Universal Credit (UC) https://www.gov.uk/health-conditions-disability-universal-credit
Carer's Allowance https://www.gov.uk/carers-allowance
We advise that you contact specialist support to establish which benefits you can apply for, and have some help in completing the application forms. Here are some of the places that can offer this:
Citizens Advice Bureau https://www.citizensadvice.org.uk/
North Bristol Advice Centre https://northbristoladvice.org.uk/
Bristol Law Centre https://www.bristollawcentre.org.uk/
Bristol Law Centre provides skilled assessment, triage & signposting for social welfare legal issues. They may be able to offer free legal advice & casework, depending on capacity, funding and your circumstances. If they can’t help you, they will always give you information on your options. For free legal advice if you live in Bristol and beyond. The Centre can help with housing issues, welfare benefits, discrimination and other disputes at work, mental health tribunals and Court of Protection, immigration and asylum, family disputes and tribunal appeals.
The M.E. charities also support people with Long Covid and provide up-to-date information on benefits and advice on how to complete the forms.
The M.E. Association guides to benefits: https://meassociation.org.uk/free-literature-downloads/
Action for M.E. guide to welfare benefits: https://www.actionforme.org.uk/get-information/care-and-support/welfare-benefits/
You will need to contact the social services department you live in, which is provided by the council that you pay your council tax to. There will be a number you can call or a weblink to apply for help.
Bristol City Council https://www.bristol.gov.uk/residents/social-care-and-health
North Somerset Council https://n-somerset.gov.uk/my-services/adult-social-care-health
South Gloucestershire Council https://beta.southglos.gov.uk/health-and-social-care/
Gloucestershire County Council https://www.gloucestershire.gov.uk/health-and-social-care/adults-and-older-people/
Other help can be provided by the Red Cross, who are able to offer short-term support https://www.redcross.org.uk/get-help/get-support-at-home
We can offer advice about the potential benefits of mobility aids. Please ask your clinician if you would like to discuss this. The NHS web pages about mobility aids are a helpful guide: https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/walking-aids-wheelchairs-and-mobility-scooters/
If you want a short-term wheelchair loan, the Red Cross offer a rental or hire service.
Rent or hire a wheelchair: https://www.redcross.org.uk/get-help/hire-a-wheelchair
To access an NHS wheelchair for regular use please ask your GP for a referral.
You could also search the Internet for mobility centres as there are a number in the area, for example:
The Bristol Mobility Centre https://www.bristolsmobilitycentre.co.uk/
Ableworld Gloucester https://gloucester.ableworld.co.uk/
Members of the public and staff are able to attend our Trust Board meetings in public. If you would like to attend, please let us know by emailing trust.secretary@nbt.nhs.uk and we can provide details of the location, and print papers if required. If you wish, you can ask a question to the Trust Board.
The Trust Board meets in public at 10am.
Download Integrated Performance Reports (IPR):
Download Meeting Papers:
This information is for patients who have been referred to receive regular replacement antibody therapy using immunoglobulin (IgG). This page tells you about the treatment, including risks and benefits, and where you can obtain further information.
Immunoglobulin (IgG) is a fluid containing antibodies, (proteins produced by the immune system), that help protect against infection. It has been available for the treatment of antibody deficiency syndromes for more than 30 years. It has been proven to be a very effective and well tolerated treatment. IgG is extracted from blood derived from donor pools of at least 10,000 individual blood donors.
There is an extremely small risk that some bloodborne infections may be passed on through the use of immunoglobulin.
Immunoglobulin products have been prepared from fully tested blood and have also been treated during manufacture to destroy blood-borne agents known to cause infection. However the risk of blood-borne infection cannot be completely eliminated. No recipients of IgG have contracted HIV or CJD (the human form of mad cow disease). No proven cases of hepatitis C have been identified since the mid 1990s, when the manufacturing process was altered to include elimination of this virus.
There is very strong clinical evidence that if you are not treated with IgG you are likely to have recurrent infections, which may lead to tissue damage, including long-term chest complications.
As with all medicines there is a small chance of side effects. However, immunoglobulin has a good safety record. Adverse reactions may be categorised as mild, moderate or severe.
Your treatment will probably be life-long.
You will be asked to have regular blood tests to monitor your IgG levels. The dosage and frequency of treatment may then be adjusted as necessary. Failure to achieve acceptable IgG levels can lead to recurrent infections.
It is also normal practice to store small samples of your blood at the start of your treatment and before any change of product. Should any blood-borne infections occur this will enable us to determine whether it is related to your infusion.
Further information is available from the manufacturers of the individual IgG product. (The name of the manufacturer can be obtained from your clinician).
Brennan V.M, Cochrane S, Fletcher C, Hendy D and Powell P (1995) Surveillance of adverse reactions in patients self infusing intravenous immunoglobulin at home. Journal of Clinical Immunology, 15, (2) 116-119.Campbell J (1997) Anaphylaxis. Professional Nurse, 12, (6) 429-432.
Hammarstrom L and Smith C.I.E (1986) Anaphylaxis after administration of gamma globulin for hypogammaglobulinaemia. The New England Journal of Medicine, 315, (8) 519.
RCN Community Nursing Association (1995) Anaphylaxis. Guidance for Nurses, Midwives and Health Visitors. Revised edition. London: RCN.
Stangel M, Hartung H-P, Marx P and Gold R (1997) Side effects of high dose intravenous immunoglobulins. Clinical Neuropharmacology, 20, (5) 385-393.
Unsworth J.D and Wallington T.B. (2001) Practical Transfusion Medicine: Use of Intravenous Immunoglobulin. Blackwell Science. Ed. M.F. Murphy and Derwood H Pamphilon.
A.J Wills, D.J Unsworth (1998) A Practical Approach to the Use of Intravenous Immunoglobulin in Neurological Disease. Emergency Therapies in Neurology, 39, 3-8.
Subcutaneous Immunoglobulin
Gardulf A, Hammerstrom L and Smith C.I.E. (1991) Home treatment of hypogammaglobulinaemia with subcutaneous gammaglobulin by rapid infusion. The Lancet, 338, 162-166
Gardulf A, Anderson V, Bjorkander J et al (1995a) Subcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs. The Lancet, 345,(8946), 36-369.
Gardulf A, Anderson V, Bjorkander J et al (1995b) Lifelong treatment with gammaglobulin for primary antibody deficiencies: the patients’ experiences of subcutaneous selfinfusions and home therapy. Journal of Advanced Nursing, 21, 917-927.
Gaspar J, Gerritsen B and Jones A (1998) Immunoglobulin replacement treatment by rapid subcutaneous infusion. Archives of Diseases in Childhood, 79, (48) 51.
Remvig L, Anderson V, Hansen N.E and Karle H (1991) Prophylactic effect of self-administered pump-driven subcutaneous IgG infusion in patients with antibody deficiency: a triple-blind cross-over study comparing P-IgG levels of 3 gl-1 versus 6 gl-1. Journal of Irrational Medicine, 229, 73-77.
NHS Constitution. Information on your rights and responsibilities. Available at:
www.gov.uk/government/publications/the-nhs-constitution-forenglan
© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT002304.
This page contains information for patients who have been referred for an induced laryngeal obstruction test.
This test is required if your doctor thinks that you may have inducible laryngeal obstruction. This means the vocal cords and/or structures
around them become narrowed as a response to triggers, such as perfumes, dust, cleaning products or exercise.
Symptoms that may suggest you have this condition can include breathlessness, noisy breathing, wheeze, cough, or changes in your voice.
Phone the Respiratory Physiology team before your appointment if you have experienced any of the following:
You should bring your appointment letter.
If possible, you should bring the trigger/s of your symptoms. If they cannot be brought, then just phone our department on the number provided at the end of this leaflet.
If you are being tested for exercise induced symptoms then exercise equipment will be provided – please bring clothes suitable to exercise in.
When you arrive in the Brunel building, please go to Gate 12 and check yourself in at the reception desk. When your name appears on the television screen, go to the Respiratory Physiology waiting room.
You will be invited into the testing room where you will have the chance to ask any questions and the details of the test will be explained to you.
A simple breathing test will then be performed, and your oxygen levels measured by an oximeter being placed on one of your fingers.
A thin tube with a small camera will be gently placed in and through your nose so your throat can be observed. A helmet will be placed on your head to hold the camera in place. If you are being tested for exercise-induced laryngeal obstruction, then stickers will also be placed on yourchest to look at your heart rhythm throughout the test.
The physiologist and doctor will then safely expose you to the symptom trigger in a controlled manner, while observing your vocal cords via the camera.
After the test, we will inform you of the results and discuss a plan. This will be communicated to your GP via a letter, and you will receive a copy.
If you have any problems or concerns about coming for this test or are going to be late, please do not hesitate to contact us:
Respiratory physiology team
Phone: 0117 414 5400
We are happy to talk to you about any issues or concerns you have about your appointment.
© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003263.
This page contains information for patients who have/may have a lung nodule.
A lung nodule is a very small area of round shadowing, like a “spot” or “blob”, seen on a CT scan. Nodules are 3cm (1 inch)or less and do not cause any symptoms.
You may have several nodules. This is not always more serious than just having one.
Most nodules are benign (non-cancerous). In a very small number of people the nodule could be an early lung cancer.
It is not always easy to know the cause of a nodule from just one CT scan. Because they are very small, doing a biopsy on them (taking a piece of the nodule out and examining it) can be difficult or risky.
No. Benign (non-cancerous) nodules usually do not grow but cancerous ones will eventually get bigger. The best way to assess them is to repeat the CT scan after a period of time.
Even if your nodule does grow, monitoring them with repeat CT scans will allow your doctor to pick up any changes early and arrange further tests before the nodule causes symptoms or problems.
Your CT result will be sent to your hospital consultant, usually within 4 weeks of your scan. Your consultant will then get in touch with you to let you know the result, either via a phone call, a letter, or a clinic appointment.
Nodules are usually followed up for between 2 and 4 years, with CT scans every 3, 9, or 12 months.
Your GP will be kept fully informed of your progress and scan results. You should also receive a copy of all letters from your consultant. If you have any questions in the meantime, please contact the Lung Navigator at North Bristol NHS Trust.
NBT Lung Navigator
Phone: 0117 424 0654
© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003679.
A pleural vent is a medical device that is used to treat a pneumothorax. This page will explain what a pleural vent is, why it is used and how it is inserted.
A pneumothorax occurs when air gets trapped in the space between the lung and the chest wall (the pleural space). The air gets there either from a defect on the surface of lung or through the chest wall. The air can squash the underlying lung and cause it to collapse.
You may experience some or all of the following symptoms; breathlessness, cough, or a sharp, stabbing pain on one side of the chest, which may be worse when breathing in.
There are different ways to treat a pneumothorax depending on the cause, how large it is and how severe your symptoms are. This includes conservative management (observation only), pleural aspiration and an intercostal chest drain. Your doctor will explain the benefits and risks of these options to you in more detail.
Sometimes, we can use a pleural vent instead of an aspiration or a chest drain.
A pleural vent is a small medical device. It consists of a small tube connected to a one-way valve inside a chamber. The tube sits inside the chest and the chamber sits on the front of the chest.
The pleural vent allows air to escape from the pleural space through the device to help the lung reinflate.
Unlike a chest drain, you can usually go home with a pleural vent in place and do not have to stay in hospital. The pleural vent stays in for a few days until the pneumothorax has healed.
The pleural vent is inserted in hospital by a doctor who will talk to you about the benefits and risks of the procedure and ask you to sign a consent form.
You must tell the doctor if you take any medications that thin your blood, such as warfarin, apixaban, rivaroxaban or clopidogrel. These medications can increase the risk of bleeding and may need to be stopped before the procedure.
The procedure takes about 15 minutes, and you will be placed into a comfortable position on your back on a couch. Then:
A pleural vent is simple and quick to insert with local anaesthetic, it allows continuous drainage of air from the pleural space, unlike an aspiration, and you can walk around as normal. If you feel comfortable, you may be able to go home with the pleural vent in place.
Inserting a Pleural Vent is a routine and safe procedure. However, as with any medical procedure, there are potential risks:
Call 999 or attend the Accident and Emergency Department immediately if:
Do check that the blue disk at the top of the Pleural Vent moves up and down when you breathe.
Do tell the nurses or doctors, using the contacts below, if the disk stops moving. This may mean the pneumothorax has resolved.
Do avoid heavy lifting, straining or vigorous exercise as this may displace the device or make the pneumothorax worse.
Do not take a bath, go swimming, or immerse the device in water. This can damage the device or dressing and increases the risk of infection.
Do not remove the device yourself.
Sometimes, fluid can come out of the chest in addition to air. The Pleural Vent can collect a small amount of this fluid in the chamber but may need to be drained periodically. If you notice the fluid collection chamber is full, please contact us using the numbers below.
The pleural vent must only be removed by a trained healthcare professional. Any dressings or stitches will be removed and then the device is pulled out. A simple dressing is placed over the area. This only takes a couple of seconds and is not painful. After it is removed, a chest X-ray will be repeated.
We will remove the pleural vent in the Pleural Clinic when the pneumothorax is resolved.
If you are an NBT patient and have queries or problems with your pleural vent device Monday to Friday 8am to 4pm, please contact:
Pleural Clinical Nurse Specialist Anna Morley 0117 414 1900
Respiratory Secretary Louise Brennan 0117 414 6451
In an emergency, please go directly to the Emergency Department.
© North Bristol NHS Trust. This edition published June 2022. Review due June 2025. NBT003482.
A pleural aspiration (also known as a thoracocentesis, pronounced “tho-rac-oh-sen-tee-sis”) is a simple procedure which involves passing a small needle through your chest wall, to remove fluid or air from the space between your lung and the rib cage (the pleural space).
We have recommended you have a pleural aspiration because fluid or air has collected in your pleural space. This is called a pleural effusion (collection of fluid) or pneumothorax (collection of air). These can both cause problems with breathing.
Laboratory analysis of any fluid taken from your pleural space can help us to find out the cause for the fluid build up and help us decide how best to treat it.
Removal of fluid or air from the pleural space can also help to relieve breathlessness.
Your doctor can do ultrasound, X-rays and CT scans of your lungs, which will give additional information about the cause of the pleural effusion or pneumothorax. However, there may not be an alternative way of getting the specific information we obtain from pleural fluid samples.
Breathlessness caused by the fluid or air in the pleural space can be managed with other supportive measures, but often removing the air or fluid is the most effective way of managing these symptoms.
If you are having the procedure done as an outpatient, please ensure we have the correct contact details for you and that you know when and where you need to come.
Please bring a list of all your current medication, allergies and other medical conditions with you to the appointment.
It is important that you let us know in advance if you take blood thinning medications and why you are taking them as we will need to temporarily stop these before your procedure (the usual advice is given in the table below, although this may vary depending on why you need these medications, so please ensure you discuss it directly with the doctor or nurse). You should continue with all other medications as usual.
| Blood thinning medication | Instructions |
| Warfarin | Usually stopped 5 full days before the procedure. You will need an INR blood test 1-2 days before your procedure to ensure your INR is less than 1.5. |
| Aspirin | If you take 75mg once daily, this can be continued as normal. If you are on a higher dose, the dose may need to be reduced a full 7 days before the procedure - please discuss this with the doctor. |
| Clopidogrel (Plavix) Dipyrimadole (Persantin) Ticagrelor (Brilique) | Usually stopped 7 full days before the procedure. |
| Apixaban (Eliquis) Dabigatran (Pradexa) Rivaroxaban (Xarelto) Edoxaban | Usually stopped 2 full days before the procedure. |
| Dalteparin (Fragmin) Enoxaparin (Clexane) | Usually stopped 1 full day before the procedure. |
Before the procedure is performed, a member of the team will take your blood pressure, heart rate and oxygen saturation. They will also ask you questions about your medical history, medications and allergies
Pleural aspiration is generally a very safe procedure. However, as with all medical procedures, there are certain risks, although serious complications are very rare.
© North Bristol NHS Trust. This edition published October 2022. Review due October 2025. NBT003501.
This page aims to answer your questions about giving your own insulin while in hospital (self-administration). It explains the benefits, risks, and alternatives, as well as what you can expect when you come to hospital.
If you have any further questions, please speak to a doctor, nurse or pharmacist caring for you.
If you are staying in hospital and have diabetes treated with insulin, we will ask if you wish to continue to make decisions about your diabetes. This will happen as long as you are feel well enough to do this.
Your nurse will work with you to make sure that it is safe and in your best interest to administer your own insulin. If you are very unwell or other changes have been made to your treatments that can affect your glucose, it may not be possible. In this case the nurse will discuss with you if the safest option is for the nurses to support you with your insulin.
If you and your nurse both agree that it is safe for you to self-administer insulin, you will be asked to provide verbal consent. You should read this leaflet and ask any questions that you have first.
We recognise that people with diabetes are experts in their condition and its treatment. You know better than anybody how your glucose level responds to different situations and insulin doses.
Supporting patients with diabetes to inject their own insulin in hospital has been shown to improve the timing of doses and achieve better glucose levels.
Giving the wrong dose of insulin can be dangerous. This is why we need to make sure you are well enough to give yourself doses.
Sometimes being unwell can affect how you make decisions, the nurse will assess this before supporting you to self-administer.
Other medicines like steroids, can affect your blood glucose levels. If we need to give you these, it may not be safe for you to self-administer insulin.
You do not have to self-administer your insulin. If you prefer, the nurse can continue to give you your doses. Choosing not to self-administer your insulin will not affect your treatment in any way.
If you have any questions after reading this leaflet, ask your nurse. When your questions have been answered, you will be asked to provide verbal consent.
Make sure you have enough supplies of your insulin and needles for your hospital stay.
To keep other patients on the ward safe, insulin must be stored out of sight - either in your locker or your bag.
After a dose, tell the nurse the time you have given it, and the actual dose injected. You can write this in the chart on page 7 to help us. The nurse will write this in your medicines chart.
It is your decision. You can change your mind at any time, even in you have previously given consent. Let staff know immediately if you change your mind. Your wishes will always be respected.
We will monitor your blood glucose using the ward meters. These are very precise and are not affected by other medicines you could be given during your stay.
You may wish to self-monitor as well as the ward tests. Please tell the nurse about any readings you take.
Alert the nurse if your reading is
They will confirm the result with the ward meter and treat you if needed.
If you are using a continuous glucose sensor please be aware that staff are asked to continue to monitor using the ward meter and base your treatment on these results. Continuous sensor results may not be as accurate when you are acutely unwell, so this is an extra step to keep you safe.
We cannot provide test strips or continuous glucose monitoring sensors for patients’ own use. You will need to provide your own supply.
If you wish to take responsibility for managing your insulin during your admission you are asked to agree to these points:
You will be asked to give verbal consent to confirm this which will be documented in your records.
If you would like to see a member of the Diabetes Specialist Team during your admission, please ask one of the nurses.
Please write down the time and dose of your insulin when you have given it.
| Date | Time given | Insulin given | Dose given |
|---|---|---|---|
© North Bristol NHS Trust. This edition published February 2026. Review due February 2027. NBT003104.