Your doctor has requested that you have a rhizolysis procedure. We hope the following information will answer some of the questions you may have about this procedure.

What is Rhizolysis or radiofrequency lesioning?

This is a technique that deliberately damages the nerve that supplies the facet joint. These nerves are responsible for transmitting the pain that is caused by the facet joints. 

Why do I need to have a Rhizolysis treatment?

If you have had success from facet joint injections in the past but the effects have not lasted, this procedure may offer improved long-term pain relief. The effect of this procedure may take longer to act (a few weeks), however could last up to a year and beyond. 

The doctor in charge of your case feels this is an appropriate procedure for you. However you will have the opportunity for your opinion to be taken into account; if you do not want the procedure carried out then you can decide against it.

How do I prepare for this procedure?

• There is no preparation for this procedure; you can continue to eat and drink as normal.
• If you are taking any blood thinning tablets which include anti platelets for example: Aspirin, Clopidogrel, or anti-coagulants for example: Warfarin, Dabigatran, Rivaroxaban and Apixaban please contact the department using the number on your appointment letter before the appointment, as you may need to consult your GP before undergoing this test.

Are there any side effects?

• Occasionally patients may have flare up pain afterwards, which may be short lived but could last a few days. (If this does occur you may take your usual pain relief medication).
• Bleeding or haematoma (a bruise under the skin), this should settle down by itself.
• Infection – contact your GP if you experience any redness or tenderness at the injection site.
• Failure of the procedure to help. 

The procedure uses X-rays to confirm that the needle is in the correct place. The amount of radiation used is small, however, please inform us if you think there is a chance you may be pregnant before attending the appointment.

What will happen during the procedure?

• The procedure is performed by a radiologist, under x-ray guidance.
• It is performed as an outpatient, which means you will be asked to arrive shortly before the procedure and allowed home 15-30 minutes after it has finished. Please allow up to 3 hours for this procedure.
• You will arrive at the Imaging Department (Gate 19) and be accompanied into the procedure room.
• A nurse will take a brief medical history. It would be helpful to bring a list of any current medications along with you.
• The radiologist will talk to you before the procedure to ensure you have read this leaflet and understood it. They will explain the procedure and answer any questions you have.  
• Should you wish to proceed, you will be asked to sign a consent form.
• You will be then asked to position yourself face down on the X-ray couch. It is important that you are comfortable as you will need to stay in that position for anything between 30-60 minutes.
• The radiologist will image your spine first before starting the procedure.
• The skin will be marked and cleaned with antiseptic solution, which may feel cold.
• The radiologist will use local anaesthetic in the skin first before directing a fine needle using X-ray guidance, into the nerves that supply the facet joints.
• Once in the correct position, a probe will be passed through the needle and more local anaesthetic will be injected, before the probe is heated. The radiologist will ask you a series of questions to determine the correct position before treatment is performed.
• Local anaesthetic may also be added after the treatment, in order to decrease discomfort caused by the procedure.
• This may occur several times, depending on how many facet joints are being treated.
• At the end, a dry dressing will be placed over the puncture site/s. 

After the procedure

• You will be asked to stay in the department for up to 30 minutes after the procedure has finished, if necessary to ensure you are feeling ok before going home.
• If you need assistance to your car, there are wheelchairs and porters available at reception.
• You should not drive for 24 hours after as your insurance may not be valid if you are involved in an accident. 

What happens next?

• You will be asked to fill in a pain chart, for the next month. This is so that the doctors can track whether the procedure has had an effect.
• The radiologist will send a report to your referring doctor.
• Follow up appointments will be with the doctor who referred you for the procedure.

Finally we hope this information is helpful. If you have any questions either before, during or after the procedure the staff in the Imaging department will be happy to answer them.

The telephone number for the Imaging department can be found on the appointment letter.

References

Journal of spinal disorders and techniques. 2011 Apr;24 (2) 69-75

Spine. 2008 May 20; 33 (12): 1291-7

How to contact us

Southmead Hospital, Bristol, BS10 5NB

See your appointment letter for the number to phone with any queries you may have.

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002796

Welcome to the Radiology Department

The Radiology Department may also be called the X-ray or Imaging Department. It is the facility in the hospital where radiological examinations are carried out using a variety of equipment.

Radiologists are the doctors who are specially trained to interpret the images and carry out more complex examinations. Radiologists are supported by Radiographers who are highly trained to carry out the examinations. You have been referred for an MRI scan. The results will go back to the clinic that referred you.

What is a MRI scan?

The MRI scanner is a circular tube which is open at both ends. MRI uses a very strong magnet to produce cross-sectional images of the body.

The magnet in the scanner collects information and sends it to the computer in the control room which displays your images.

The scanner is very noisy while it collects the images, and it is important you stay still so clear pictures can be taken.

Risks, alternatives, and benefits

MRI does not use any form of X-ray. MRI is now the alternative for some X-ray and operative procedures. The images produced by MRI are very detailed and show bones and soft tissue.

It may not be possible to have an MRI if you have a metal implanted device, this may include:

• Cardiac devices including pacemakers and defibrillators.
• Aneurysm clips.
• Metal fragments in your eyes.
• Implanted electronic stimulators.
• Implanted pumps.

Please let the MRI unit know as soon as possible if you have any implanted devices. The phone number is on your appointment letter.

Before your MRI scan, you will be asked some questions to check that you are safe to enter the scan room. People with dental fillings, bridges, joint replacements or stents can all be scanned if you have had them for at least 6 weeks. The Radiographers will need to be aware of these so they can optimise your scan.

Pregnancy

Claustrophobia

Contrast injections (dye)

Children

What happens during the MRI scan?

How long will it take?

How will I get the results?

References

Questions

Please do not hesitate to ask questions either before or after your scan. Contact details can be found on your appointment card.

© North Bristol NHS Trust. This edition published July 2024. Review due July 2027. NBT002009

Your doctor has requested that you have a vertebroplasty. We hope the following information will answer some of the questions you may have about this procedure.

What is a vertebroplasty?

Vertebroplasty is used to relieve the pain caused by compression fractures of the spine, which can be caused by osteoporosis, multiple myeloma or less commonly cancer and trauma. The procedure involves injecting a substance called “bone cement” into the vertebral body which can reinforce the weakened vertebral body and prevent further vertebral collapse. The cement is injected under x-ray guidance by the radiologist. 

Why do I need to have a vertebroplasty?

The purpose of vertebroplasty is to stabilise the vertebral body, which will in turn alleviate pain and improve posture.
Who has made this decision?

Your suitability for the treatment will have been made by the consultant radiologist at the hospital. The purpose of the procedure and potential complications will have been explained and will be explained again when you attend for treatment.

What are the risks associated with vertebroplasties?

Generally it is a very safe procedure. Potential complications are uncommon and include:

• Bleeding or haematoma (a bruise under the skin) around the injection site, which should settle down by itself
• Infection. Contact your GP if you experience any redness or tenderness at the injection site
• Allergic reaction to the drugs or cement used at the time of the procedure
• Leakage of the cement which might compress the spinal cord or block a blood vessel to the lungs
• Rib fractures
• X-rays are used in this procedure but with modern equipment the risk from the x-rays is low (Public Health England 2014).

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

What happens before the procedure?

Prior to the procedure you may have already:

• Had an assessment for your suitability for the treatment by the consultant radiologist
• Attended for an MRI
• If necessary, you may have been asked to attend the pre assessment clinic, to perform standard checks, including blood tests, ECG and discussed existing medication.

On the day of the procedure:

• Depending on the time of the procedure, you may either have a light breakfast or you will be sent instructions by letter, of what times you can eat and drink beforehand. Please take a sip of water with your regular medication only.
• You will arrive at Radiology Day Case (Gate 19), where a suitable day case bed will be allocated for you. However if you use warfarin routinely, you may need to stay in hospital overnight.
• You will be asked to change into a hospital gown.
• A nurse or doctor will put a cannula into a vein in your arm. This is so that we can give sedation, antibiotics, fluids and painkillers you might need during the procedure.
• The consultant radiologist will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to proceed with the procedure you will be asked to sign a consent form.  
• The procedure will be carried out under local anaesthetic, which numbs the area to be treated, together with some sedation. 
• Once brought to the x-ray room, you will have to lie face down on the x-ray table. There will be a small team of nurses, doctors and radiographers throughout.
• A hollow needle is introduced into the vertebral body through the skin of the back. The radiologist will position the needle into the correct place by use of x-ray guidance. Once the tip is precisely positioned within the affected vertebral body the liquid cement is injected. The cement hardens inside the fractured vertebral body over the next few minutes.
• A CT scan is then performed in the same room, to confirm the position of the cement.
• The procedure will take approximately 30 minutes for each fracture that needs to be treated.

What happens after the procedure?

• You will be taken back to a recovery area initially, so that nursing staff may monitor you closely as the sedation wears off.  After the effects of the sedation have worn off, you will rest for a few hours before being allowed home.
• You are likely to have some discomfort in the area of the wounds, please inform the staff if you require painkillers.
• If you are allowed home on the same day, you will need someone to stay with you at least overnight and until the effects of the sedation have worn off.

What happens next? 

• Please continue your regular painkiller medication for three days after the procedure. If the pain is eased at this point, you may then wean off your painkillers under doctor supervision.
• You will be invited for a follow up appointment with the consultant radiologist 4 weeks after the procedure.
• If you experience any symptoms you are concerned about, please contact the imaging department directly or alternatively contact your GP or the emergency department.

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.

The telephone number for the Imaging department can be found on the appointment letter.

Reference:

• National Institute for Health and Clinical Excellence - Percutaneous Vertebroplasty
• Radiologyinfo.org - Vertebroplasty & Kyphoplasty
• Public Health England - Exposure to ionising radiation from medical imaging: safety advice - GOV.UK

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

This information is for patients whose doctor has requested they have a liver biopsy. We hope the following information will answer some of the questions you may have about this procedure.

What is a liver biopsy? 

A liver biopsy is a medical test, where a small sample of tissue is removed from your liver with a needle. The sample is then sent to the pathology department where it is examined under a microscope.  

Why do I need to have a liver biopsy?

A liver biopsy helps to assess and diagnose the problem, if any, in your liver.  This helps your doctor to make a correct diagnosis and plan any necessary treatment.

Are there any alternatives to a liver biopsy?

There is no other procedure that will give your doctor the same information as a liver biopsy.  

What are the risks associated with liver biopsies?

Liver biopsy is usually a safe procedure. Potential complications are uncommon and include:

• Some people experience pain, which is usually not severe and can be controlled with simple painkillers.
• Bleeding or bruising around the puncture site which should settle down by itself.
• There is a small risk of internal bleeding after the biopsy.  This risk is around 1 in 100.  The nurse will monitor your blood pressure and pulse during and after the procedure and you will stay in hospital for up to five hours after the procedure, so that we can monitor you.
• Occasionally people will have a significant bleed, in which case it may be necessary to do a further procedure to try to stop the bleeding. 
• There is a very small risk of death.  This risk is around 1 in 1,000. 

What happens before the procedure?

• You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy. This may be arranged to take place at your GP surgery.  
• You can continue taking your normal medication.  If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure. These may need to be stopped to keep the risk of bleeding to a minimum. 
• Please make arrangements for someone to collect you from the hospital and take you home by car, as we advise not to use public transport.
• You are not permitted to drive for 24 hours post procedure and we would like someone to stay with you at home in the first 24 hours. Please inform the department if this is not possible, as we will need to identify alternative arrangements. 

On the day of the procedure:

• You should eat nothing for six hours before your appointment. You may drink water until the time of your appointment. 
• You will arrive at Gate 19 and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you are allergic to anything.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm.
• A doctor will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
• Once all the checks have been performed and consent signed, you will be taken to the angiography suite on the trolley. There will be a nurse and a doctor with you throughout the procedure.
• The doctor will use an ultrasound machine to look at your liver to find the correct area to take the biopsy from.
• Your skin will be cleaned with an antiseptic solution and covered with sterile drapes. 
• The doctor will then inject local anaesthetic into the area selected for biopsy, which will briefly sting and then go numb. Most people will feel a pushing sensation, but the biopsy is not usually painful. A special needle is used to remove a small piece of liver tissue. Occasionally it is necessary to take more than one sample. 
• Once the doctor has taken the sample, the needle will be removed and the doctor will apply a dressing. 

What happens after the procedure?

• You will be taken back to the day case area so that nursing staff may monitor you closely.
• If you are in pain tell the nursing staff so you can be given appropriate painkillers.
• You will be required to stay flat for one hour and then sit up for a further two hours. Then walk around for half an hour.
• You will be able to eat and drink as normal.
• If everything is satisfactory, you will be free to go home.  Please arrange for someone to collect you on discharge rather than drive yourself. 
• Have someone stay with you overnight.
• You should rest for the remainder of that day and the following day, avoiding any strenuous activities for 36 hours.
• Keep a regular check on the biopsy site. The dressing can be removed after 24 hours.
• If you have any discomfort take your usual pain relief, as prescribed, but if the pain is severe please contact the Imaging department using the number on your appointment letter.

Please check with your travel insurance provider if you wish to travel within 4 weeks of your procedure. 

What happens next? 

The results of the biopsy will be sent to the consultant who referred you, who in turn will either contact you or write to your GP with the results.  

If you experience any symptoms you are concerned about, please contact the Imaging department directly on the number on your appointment letter or alternatively contact your GP or the emergency department.

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.

References

© North Bristol NHS Trust.  This edition published January 2024. Review due January 2027. NBT003106.

This page is for patients whose doctor has requested that you have your PEG (percutaneous endoscopic gastrostomy) tube removed. We hope the following information will answer some of the questions you may have about this procedure.

Why does my PEG need to be removed? 

It could be that your dietician/doctor has decided that you are now able to take sufficient food orally. Alternatively it might be because your tube is not functioning correctly, therefore it needs to be changed. 

How is the PEG removed? 

The PEG is held in place inside your stomach by a circular piece of plastic (the internal flange) about the size of a 10 pence coin. This is what stops it being accidentally pulled out. Because of this piece of plastic it is not possible to remove your tube by pulling it from the outside. PEG tubes can be removed endoscopically, however, for some patients this method is not always possible. In your case it is necessary to use another way to remove the PEG. This is the “cut and push” method. The PEG tube is cut away close to the skin on the outside and the circular piece of plastic (the internal flange) is pushed into your stomach. 

What are the risks associated with a PEG removal? 

There is a small risk that the internal flange could get stuck somewhere in the stomach or bowel. This could cause an obstruction and require another procedure. 

If you experience any vomiting, abdominal pain or constipation in the days following the procedure contact your GP and let him/her know that you have recently had a PEG removed by the “cut and push” method. If you are feeling very unwell you should go directly to your nearest Emergency Department. 

The procedure uses X-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging Department before attending the appointment.

On the day of the procedure

• You should not eat or drink anything for 6 hours before your appointment.
• You may take your normal medication unless instructed otherwise.
• You will arrive at the Imaging Department (Gate 19) and be accompanied into our day case area. Please inform us if you are allergic to anything. 
• You will be asked to change into a hospital gown and a cannula (a small tube) will be placed in a vein in your arm for pain relief if needed.
• The interventional radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form.
• Once all the checks have been performed and a consent form signed, you will be taken to the angiography suite (X-ray room) on the trolley. There will be a radiologist, nurses and a radiographer with you throughout the procedure.
• You will be asked to lie on your back on the X-ray table.
• The skin around the PEG tube will be cleaned with an antiseptic solution and covered with a drape.
• The PEG tube is then cut close to the skin on your stomach and the circular piece of plastic is then pushed into your stomach.
• If you still need a tube for feeding then a new replacement tube will be inserted into the hole immediately following the “cut and push”. This procedure will be similar to when the PEG was initially fitted and will be discussed with you.

What happens after the procedure?

At first, when the PEG is removed some patients experience a small amount of leaking of fluid - but the hole in the stomach wall usually heals within 24 hours and the hole in the skin within a few days. 

You will be given a small dressing to use for the first few days. You may take a shower straight away however, we advise that you wait 24 hours before taking a bath. 

Once the procedure has been completed, the internal flange will pass through your system and leave through your bowels when you go to the toilet. It’s painless and most people do not realise that the flange has been passed.

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging Department will be happy to answer them. The phone number can be found on your appointment letter.

Reference

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003258

Your doctor has requested that you have an oesophageal stent inserted. We hope the following information will answer some of the questions you may have about this procedure.

What is oesophageal stent insertion?

The oesophagus, or gullet, is a hollow, muscular tube which takes food from the mouth down to the stomach. If it becomes blocked or narrowed, then there will be a problem with swallowing. 

One way of overcoming this problem is by inserting a metal, mesh tube, called a stent, down the oesophagus and across the blockage or narrowing. Food can then pass down the gullet through this stent, and this should make swallowing easier. This procedure is called oesophageal stent insertion, and is usually very helpful to people.

Why do I need an oesophageal stent insertion?

Other tests that you probably have had done, either an endoscopy (telescope test) or a barium swallow, have shown that your oesophagus has become blocked or narrowed. Your doctor will have discussed with you the likeliest cause for this and the possible treatments. It is likely that an operation has been ruled out, and that a stent insertion is considered the best treatment option for you.

Who has made the decision?

The doctors in charge of your case, and the consultant clinician performing the oesophageal stent insertion will have discussed the situation, and feel this is the best treatment. However, your opinion to be taken into account, and if, after discussion with your doctors, you do not want the procedure carried out, then you can decide against it.

Who will be doing the oesophageal stent insertion?

A specially trained Radiologist or Gastroenterologist who are both doctors with special expertise in using X-ray equipment, and in reading the images produced. They need to look at these images while carrying out the procedure, to make sure that the stent is positioned correctly.

How do I prepare for oesophageal stent insertion?

• The procedure uses X-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.
• You should eat nothing for 6 hours before your appointment. You may drink water until the time of your appointment.
• You will arrive at the Imaging department (Gate 19) and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you are allergic to anything.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm in case you need painkillers or sedatives during the procedure.
• A doctor will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
• Once all the checks have been performed and consent signed, you will be taken to the procedure room on the trolley. There will be a doctor, nurse and radiographer with you throughout the procedure.

What actually happens during an oesophageal stent insertion?

• You will be asked to lie on the X-ray table.
• Monitoring equipment will be attached to you so we can record your pulse and oxygen level, as well as monitor your blood pressure and heart rhythm.
• You will be given a local anaesthetic throat spray to help numb the throat.
• We will give you oxygen through a small soft tube placed into your nostrils.
• A plastic mouth guard will be placed in your mouth. This allows the endoscope (small camera) and/or a soft guidewire to pass through your mouth.
• A nurse will stand by your head and monitor you for the whole procedure.
• Once you are comfortable the endoscope and/or guidewire will be passed through your mouth, down your gullet into the stomach.
• The stent is then passed over the guidewire into the correct position across the blockage. Finally, the endoscope and/or guidewire is removed.

Will it hurt?

Some discomfort may be felt in your throat, but this should not be too sore. There will be a nurse standing next to you and looking after you. If the procedure does become painful for you, then they will be able to arrange for you to have painkillers through the cannula in your arm.

How long will it take?

Every patient’s situation is different, and it is not always easy to predict how complex or straightforward the procedure will be. It will probably be over in 45 minutes, but occasionally it may take an hour.

What happens afterwards?

You will be taken back to the day case area on a trolley. Nurses there will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. You will generally stay in bed for a few hours, until you have recovered.

How soon can I eat and drink, and what happens next?

Most patients will be able to start on fluids within a few hours. It is then necessary to have a fairly liquid diet for a few days, until starting on soft solids. More solid food should be chewed properly before swallowing. Depending on how well the stent has overcome the blockage/narrowing, you may be back on a fairly normal diet within a week or so.

Things to remember:

• Do not continue to eat or drink if you feel something is stuck at the back of your throat. Contact your GP if this happens.
• If you feel your swallowing difficulty recurs, seek your GP’s advice, as there is a likelihood that the stent may be blocked and requires a further examination or treatment.

Are there any risks or complications?

Oesophageal stent insertion is a safe procedure, but there are some risks and complications that can arise, as with any medical treatment.

• It is possible that a little bleeding occurs during the procedure, but this generally stops without the need for any action.
• It is normal to experience moderate chest pain while the stent “beds in”, but this normally settles in a day or two. Some patients get heartburn afterwards and need to take medicine for this.
• Very rarely the stent may slip out of position, and it is necessary to repeat the procedure.
• Very, very rarely, putting the stent in may cause a tear in the oesophagus. This is a serious condition, and may need an operation, or insertion of another stent.

Despite these possible complications, the procedure is normally very safe.

Finally

We hope this information is helpful. If you have any questions, either before or after the procedure, the staff in the Imaging Department will be happy to answer them. The phone number for the Imaging Department can be found on your appointment letter.

Dietary advice and consideration: 

Remember to chew your food well before swallowing and have fluid available when having your meal. Supplementary high nutritious drink may be necessary to maintain your weight.

Example

Meat: Cut into small pieces, or minced.

Cheese: Grated or in sauce.

Puddings: Creamy yoghurt, custard etc

Fruit & veg: Well cooked, pureed or liquidised. Smoothies.

Cereals: Porridge, Ready Brek.

References

© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT003149.

Your doctor has requested that you have  a nerve root block to help diagnose the cause of your pain. We hope that the following information will answer some of the questions you may have about this procedure.

What is a nerve root block?

Nerve roots exit the spinal cord and divide into nerves that travel to your arms and legs. These nerve roots can become inflamed due to pressure from nearby bone spurs or  intervertebral discs. Inflammation of nerve roots may cause pain in the back, neck/arms and/or the legs. A nerve root block provides important information for your doctor and may also provide you with some relief from pain.

Why do I need to have a nerve root block?

The procedure is designed to prove which nerve is causing your pain by placing temporary numbing medicine over the nerve root of concern. If your pain improves after the injection then that nerve is the most likely cause of your pain. If your pain remains unchanged, then that nerve is probably not the cause of your pain.

What is injected around the nerve root?

The injection is a combination of local anaesthetic (a numbing agent) and steroid (an anti-inflammatory agent). The local anaesthetic works immediately and the steroid usually begins to work within two to three days but may take up to a week.

How do I prepare for a nerve root block?

You can continue to eat and drink as normal. 

If you are diabetic please inform the doctor before the examination as there is a possibility that your sugar levels will vary after the injection. It is important that you continue to monitor your levels carefully for several days and consult your GP if necessary.

You can continue taking your normal medication. If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging department on 0117 414 9110 as we may need to adjust your medication before undergoing this procedure. These may need to be adjusted to keep the risk of bleeding to a minimum.

The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

Afterwards your leg may feel numb or weak and you should not drive for 24 hours. You will need to arrange for someone to take you home. We advise against using public transport.

What will happen during the procedure?

• You will arrive at Gate 18 whereby a member of the Imaging team will take you through to the fluoroscopy waiting room.
• Following confirmation of your details and history you will be shown into the x-ray room and introduced to the staff performing the procedure. You will be cared for by a small team including a radiologist (x-ray doctor) and/or radiographer and an imaging support worker.
• Before the examination begins the radiologist or specialist radiographer will explain what they are going to do. You will be given the opportunity to ask any questions you  may have. If you are happy to proceed you will be asked to sign a consent form.
• You will then be asked to lie on your front on the X-ray couch. The skin will be cleaned and a small amount of local anaesthetic will be injected under the skin. This stings for a few seconds and the area then goes numb.
• A very fine needle will be directed just next to the nerve root using the X-ray machine. Sometimes the needle can touch the nerve itself in which case you may feel a sharp pain going down your leg. This will only last for a second or two. A special dye called contrast medium is then injected around the nerve root. This shows up on the X-ray machine to confirm the needle is in the correct position. When the radiologist or specialist radiographer is satisfied with the needle position, the local anaesthetic and steroid will be injected along the nerve root.
• Afterwards you will be asked to sit in our waiting room for 20-30 minutes so that we can ensure you are feeling well before you go home.

How long will it take?

You will be awake throughout the procedure, which lasts about 15–30 minutes.

Will it hurt?

You may feel a little pressure or discomfort, which may travel down the leg, during the injection of the local anaesthetic and steroid. This will last for only a few seconds.

Afterwards your leg may feel numb or weak for up to 24 hours. You will be asked to wait for 20 to 30 minutes before going home.  As your leg may feel numb or weak, you should not drive for 24 hours and you will need to arrange for someone to take you home. We advise against using public transport. 

Some people find that their pain feels worse for two to three days after the procedure. This is because the steroid can sometimes irritate the nerve. Do not worry if this happens, as it will settle down by itself. 

If your leg becomes numb you may need someone to stay with you overnight.

Are there any risks associated with a nerve root block?

Generally it is a very safe procedure. Potential complications are uncommon and include:

• An increase in your pain in the first 24 hours following injection. Should this occur, take your usual or prescribed pain medication and seek advice from your pharmacist or GP if necessary.  
• Bleeding or haematoma (a bruise under the skin) – this should settle down by itself.
• Infection developing at the injection site. This will happen to less than 1 in 5000 people. Contact your GP if you experience any redness or tenderness at the injection site.  
• Flushing of the face for up to 48 hours after the injection – this should settle down by itself.
• Skin dimpling or discolouration at the site of the injection – this should settle down by itself.
• A disruption in your mood – this should settle down by itself.
• Occasionally a change in menstrual cycle may be experienced. This is most likely due to the steroid but contact your GP if this happens to inform them.  
• If you are diabetic you may notice a rise in your blood sugar levels. It is therefore important you monitor your levels carefully for several days after the procedure and consult your GP if necessary.
• The procedure uses X-rays to confirm that the needle is 
  in the correct place. The amount of X-rays used is very small however patients who are or who may be pregnant should inform the department before attending for their appointment.

Finally

We hope this information is helpful. If you have any questions either before, during or after the procedure the staff in the Imaging department will be happy to answer them.
The telephone number of the X-ray department can be found on your appointment letter.

References

Overview | Low back pain and sciatica in over 16s: assessment and management | Guidance | NICE [Accessed January 2024]

British Association of Spine Surgeons - Booklets [Accessed January 2024]

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003237

Your doctor has requested that you have a nephrostomy tube exchange. We hope the following information will answer some of the questions you may have about this procedure.

Why do I need to have my nephrostomy tube exchanged?

Your nephrostomy tube will require changing at regular intervals which can vary from every few weeks to every few months. This is because the urine often contains a gritty sediment which can block the tube.  This will slow down or even stop the urine from draining out. If this happens then the kidney will become infected and possibly damaged and this will lead to you becoming unwell.

The nephrostomy tube is also a foreign body. Your body’s natural response is to coat the tube with a protective layer which itself can become the source of infection. The longer the tube stays in the more this layer builds up. Frequent changes of the tube will reduce the chances of infections happening.

What are the risks involved?

Changing the nephrostomy tube is a much simpler and quicker procedure than having the nephrostomy tube inserted for the first time. It is very safe but as with any medical procedure there are some risks and complications that can arise:

• Bleeding from the kidney – it is common for the urine to be bloody (pink or red) immediately after the procedure.  This usually clears over the next 24-48 hours.
• Infection – Urine in the kidney may become infected.  This can generally be treated with antibiotics.
• Sometimes the tube which is to be changed may be blocked inside and it can take a few minutes of manipulation by the operator to unblock the tube.
• Very occasionally the tube has come out of the system completely so a new nephrostomy tube will need to be inserted.
• The procedure uses x-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

It is important to notify your consultant if your tube stops draining so that a change of tube can be arranged for you.

What happens before the procedure?

You can continue taking your normal medication and you may eat and drink as normal.

You will arrive at the Imaging Department (Gate 19) and a member of the Imaging team will accompany you into the angiography suite (x-ray room).

A member of the team will check your details and go through a checklist with you.  Please inform us if you have any allergies.

What happens during the procedure?

A radiologist (x-ray doctor) or specialist radiographer will perform the procedure for you. They will explain the procedure to you and if you have any questions you can ask then.  

You will be asked to lie on the x-ray table, in a position where it is possible for us to access the tube – usually on your front.

The skin around the nephrostomy tube will be cleaned with an antiseptic solution and covered with a drape.

A soft guidewire will be passed into the existing nephrostomy tube, using x-rays to guide the passage of the wire. This then allows the radiologist/radiographer to remove the old nephrostomy tube and a new tube is passed over the guidewire. The new nephrostomy tube is secured in position and a dressing applied.  

To confirm the nephrostomy tube is in the correct position, the radiologist/radiographer will inject a small amount of x-ray dye through the tube.

The nephrostomy tube is then connected to the drainage bag.

What happens after the procedure?

Once you are feeling well you are free to go home.

Is there anything I should look out for after the tube exchange?

Call your GP for any of the following reasons:

• If you have a temperature.
• If you develop back or side pain.
• If your urine output stops, becomes dark or foul-smelling
• If the tube falls out or becomes dislodged - don’t attempt to re-insert it yourself. This needs to be done at the hospital.

Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them. The telephone number for the Imaging department can be found on your appointment letter.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003248

This page has information for patients who have been referred for a nephrostomy or ureteric stent. 

Who has made the decision to place a nephrostomy or ureteric stent?

A urologist (a surgical doctor specialising in disorders of the kidney, ureter and bladder) will usually have made the decision based on information from previous scans you have had. A radiologist (X-ray doctor) will perform the procedure.

What is a Nephrostomy?

Urine normally drains from the kidney via a tube called the ureter into the bladder. If the ureter becomes blocked then the kidney cannot drain urine to the bladder and cannot function. 

Sometimes the urine built up in the kidney can become infected and make you very unwell. If the kidney remains blocked longer term then it will eventually stop working completely. The most common cause for blocked ureter is kidney stones. Sometimes the ureter can be blocked due to other causes like prostate cancer or bladder cancer.

A nephrostomy is a tube that is inserted using ultrasound and X-ray guidance through a small incision in the back to the central part of the kidney where urine collects. The tube drains urine to a bag and allows the kidney to work. If you have a kidney transplant the tube would be inserted in your front directly into the transplant kidney.

What is a ureteric stent?

A ureteric stent is a plastic tube which sits in the ureter with one end in the kidney and the other end in the bladder. This tube can be inserted through the back like a nephrostomy tube.

If you have had surgery in the past to remove your bladder then sometimes a ureteric stent can be placed through an ileal conduit with one end through your stoma in the urine bag on your front and the other end in the kidney.

The ureteric stent will usually remain in place until the underlying reason for blocked ureter is treated. Ureteric stents can remain in place for 3 to 6 months. 
If there is a need for ureteric stents to be in place for longer than this then they would need to be replaced. Usually ureteric stents are replaced using a camera through the bladder by a urologist

Are there any alternatives to a nephrostomy or ureteric stent?

If the kidney is blocked and infected there is no effective alternative to a nephrostomy.

If the kidney is blocked, but not infected a ureteric stent can sometimes be placed using a camera through the bladder by a urologist without needing to place a nephrostomy. Depending on the nature and location of blockage sometimes this is not possible in which case a ureteric stent can only be placed though a nephrostomy.

A nephrostomy tube can be left in place without inserting a ureteric stent. A ureteric stent is generally preferred for longer term use as there is no need for a drainage bag, and a ureteric stent is less likely to become infected.

What are the risks with having a nephrostomy or ureteric stent inserted?

Serious risks associated with nephrostomy or ureteric stent insertion are rare.

• The procedure will be done under local anaesthetic. It usually only causes mild discomfort but can occasionally be more painful. If you are in pain strong painkillers can be given directly into a vein to control the pain.
• Often the urine is infected before starting the procedure. There is a small risk of the procedure itself causing a urine infection. This will happen to fewer than 1 in 100 people (less than 1%). Infection would be treated with antibiotics.
• Occasionally it might not be possible to place a nephrostomy or ureteric stent due to the anatomy of your kidney or ureter, in which case we would discuss other options with you.
• There is a small risk of causing bleeding from the kidney or structures next to the kidney. This will happen to fewer than 1 in 100 people (less than 1%). The procedure is done under a combination of X-ray and ultrasound control to minimise this risk. 
• A small amount of bleeding into the urine following the procedure is very common and is not serious. Occasionally people can bleed more severely, in which case it may be necessary to do further imaging and procedures to stop the bleeding.

The procedure uses X-rays and the amount of radiation used is small, however if you think you may be pregnant please inform the Imaging department before attending the appointment.

What happens before the procedure?

• You will need to have a blood test a few days before the procedure to check that you are not at an increased risk of bleeding and that it is safe to proceed. This may be arranged to take place at your GP surgery.
• You can continue taking your normal medication. If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging Department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure. If you are already an inpatient we will contact the ward to adjust your medication as necessary.

On the day of the procedure

• You should have nothing to eat but you may continue to drink water.
• You will arrive at Gate 19 and be accompanied into our day case area.
• Please inform us if you have any allergies.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
• A radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form.

During the procedure

• We will go through a check list to confirm it is safe to proceed and you will be taken into an X-ray room. There will be a doctor, nurse and radiographer with you throughout the procedure.
• You will be asked to lie on the X-ray table, normally on your front. Monitoring equipment will be attached to you so we can monitor your blood pressure, heart rate and oxygen levels throughout the procedure.
• You will be awake throughout the procedure.
• Your skin will be cleaned with antiseptic solution and covered with sterile drapes.
• If you are having a nephrostomy inserted then local anaesthetic will be injected into your back and access gained to the kidney using a needle.
• A nephrostomy tube or a ureteric stent will then be placed though this tract under x-ray guidance.
• If you already have a nephrostomy tube and are having a ureteric stent placed then the nephrostomy tube will be removed and the same tract used to place the ureteric stent.
• If you are in pain at any time during the procedure it is your responsibility to let the team looking after you aware so we can give you pain killers as required.

What happens after the procedure?

• You will usually stay in hospital overnight so we can monitor you. Occasionally depending on the exact procedure you have had done it may be possible for you to be discharged home the same day.
• You will be able to eat and drink as normal.
• If you have a planned admission you will usually be able to go home the following day. If you have an emergency admission you will stay in hospital for a few days until you are well.
• Ureteric stents can stay in for up to six months. If you have not received an appointment for it to be removed or changed in six months’ time please contact your urologist.

Nephrostomy tubes can stay in for up to three months. If you have not received an appointment for it to be removed or changed in three months’ time please contact your urologist.

You should check your travel insurance if you wish to travel within 4 weeks of this procedure.
            
Finally we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging Department will be happy to answer them.

References

Patient Information Leaflets | BSIR Accessed April 2024. 

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003107.

Your doctor has requested that you have a hysterosalpingogram. We hope the following information will answer some of the questions you may have about this procedure.

What is a hysterosalpingogram (HSG) and why do I need one?

A HSG is a special X-ray examination which looks at the inside of your uterus (womb) and fallopian tubes. It aims to show whether your uterus is normal and if your fallopian tubes are damaged, swollen, blocked or if there are any adhesions around the tubes.

It may explain why you have not been able to get pregnant and it will help your doctor decide the most appropriate treatment for you.

This test is only effective if carried out at very specific times, and therefore it is important that you read the information in this leaflet carefully.

How do I arrange my appointment?

We perform this examination within 10 days of the start of your period. The best time is between day 5 and day 10.

Please telephone us on the first day of your period (the first day that you have any spotting or bleeding). The phone number can be found on your appointment letter. Should you start your period over a weekend, please contact us as soon as you can on Monday morning and we will try our best to give you an appointment within the 10 days as above. 

Should you not have regular periods please telephone for advice.

Should you be bleeding heavily the day before your examination, please also telephone for advice.

If there is the slightest chance that you could be pregnant, we will not perform the examination as x-rays could put your pregnancy at risk. For this reason, do not have unprotected sexual intercourse from the first day of your period until after the procedure. We will also perform a pregnancy test before the examination is carried out.

On the day of the procedure

You will arrive at Gate 18 whereby a member of the Imaging team will take you to the fluoroscopy waiting room where your details will be checked.

You will be asked about your last period, whether you have followed the instructions regarding sexual intercourse, whether you have taken any pain relief, if you have allergies, and if you have been given a prescription for antibiotics.

The procedure will be explained and a pregnancy test will be performed – please do not empty your bladder before you are called as you will need to provide a urine sample for this. 

You will be asked to undress and put a gown on. 

You will then be taken into the x-ray room for the procedure.

What does the examination involve?

You will be asked to lie down on the x-ray table in a similar position to that used for a smear test. An instrument called a speculum will be inserted into your vagina (as in a smear test). A fine tube is inserted through the cervix into the neck of the uterus and held in position with a small balloon. 

A small amount of colourless dye is then injected into the uterus and fallopian tubes. This dye is visible on x-ray so images will be taken at this time.

The examination normally takes 10 minutes but sometimes may take a little longer – you should allow for 30 minutes which includes time to change into your gown, the test itself, and changing afterwards.

Is the examination painful?

You may experience some mild to moderate discomfort, rather like a bad period pain, as the dye fills your uterus and fallopian tubes. This discomfort should settle as soon as the test is finished.

As you may feel some discomfort we advise you to take some over the counter painkillers within the 2 hours before your procedure. This can be what you may usually take for period pains, for example paracetamol or ibuprofen. You may also need to take a further dose of painkillers 4 hours after your HSG.

You may wish to bring someone with you in case you are in any discomfort after the procedure, or to drive you home. Most people feel absolutely fine after the test, and often express how much better the test was than anticipated.

What happens after the procedure?

You will be given a sanitary towel after the procedure as there may be some slight spotting, and some of the dye will trickle out over the next 24 hours. (The dye is colourless but a little sticky). We advise you not to use tampons.

You are free to leave the department when you feel ready – as above, this will be after approximately 30 minutes.

If you have any problems with bleeding or offensive discharge after your test, or if you have severe pain which is not relieved by paracetamol or ibuprofen, please contact either the Fertility Clinic or your GP for an urgent review appointment.

Your results will be discussed with you when you next see your referring consultant or your GP. If you do not already have an appointment, please make one.

What are the risks?

The staff will make the test as safe as possible. However, complications can happen:

• There is a small risk of infection. Your referring doctor should have prescribed a course of antibiotics to take before the procedure.
• There is an extremely rare possibility of an allergic reaction to the x-ray dye. It is important to let the person who is doing the test know if you have any known allergies.
• Occasionally some patients feel ‘faint’ after the test. Should you feel faint we will ask you to remain in the room until you feel better.

Finally, we hope this information is helpful.  If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.  

The phone number for the Imaging department can be found on your appointment letter.

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003249