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

This page is for patients whose doctor has requested that you have a gastrostomy - sometimes referred to as a RIG (radiologically inserted gastrostomy) or PIGG (per-oral image guided gastrostomy). We hope the following information will answer some of the questions you may have about this procedure.

What is a gastrostomy?

A narrow plastic tube is placed through the skin into your stomach. Once in place, the tube can be used to give you liquid food directly into your stomach to provide nutrition. Gastrostomies are placed by specially trained doctors called interventional radiologists.

Why do I need to have a gastrostomy?

You may be unable to eat or drink sufficient amounts to satisfy your nutritional needs or there may be a problem with swallowing that makes it unsafe for you to eat or drink.

You may have had a small plastic tube inserted through your nose, down into your stomach, to help with your feeding. This can only be left in place for a relatively short period of time.

What are the risks associated with a gastrostomy?

A gastrostomy is a very safe procedure however there are a few risks:

• Occasionally, it is not possible to place the tube into your stomach. This may require a different method of placement or occasionally you may need an operation to place the tube.
• Sometimes there is a leak around the tube. This can lead to the skin around the tube becoming very red, sore and painful (localised peritonitis). It may become necessary to remove the tube to allow healing to occur or an operation may be needed to sew up the hole in your stomach.
• Very rarely, a blood vessel can be punctured when passing the needle into the stomach. This can result in bleeding. This usually stops by itself, but if not, you may need a blood transfusion. Occasionally it may require another procedure to block the bleeding artery or an operation to stop the bleeding. However, this is extremely rare.
• Infection is a rare complication. If the skin around the tube becomes hot or inflamed or you have a temperature after tube insertion you may need a course of antibiotics.
• 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. This may be arranged to take place at your GP surgery.
• If you are taking any blood thinning tablets (e.g. aspirin, clopidogrel, warfarin, dabigatran, rivaroxaban or apixaban) please contact the Imaging Department before the appointment. These may need to be stopped to keep the risk of bleeding to a minimum.
• Usually you will be admitted to hospital before the procedure and you will stay for a few days following it so that feeding can be established before you go home.

On the day of the procedure

• You should not eat anything for 6 hours before your appointment. You may drink water until the time of your appointment.
• You may take your normal medication unless instructed otherwise. Please inform us if you are allergic to anything.
• You will be transferred to the Imaging Department (Gate 19) and be accompanied into our day case area.
• 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.

What happens during the procedure?

• 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. You will have monitoring devices attached to your chest and finger so that we can monitor you throughout the procedure.
• Using an ultrasound machine, the radiologist will scan your abdomen to help visualise the stomach, liver and bowel.
• If you do not already have one inserted, a small tube will be placed through your nose into your stomach (NG tube). This is so that we can inflate the stomach slightly with air for the procedure.
• An area of skin on your abdomen will be cleaned with an antiseptic solution and covered with sterile drapes.
• The radiologist will then inject local anaesthetic into the area where the gastrostomy tube will be inserted, which will briefly sting and then go numb. Most people feel a pushing sensation after this.
• A small needle is placed into the stomach wall through which a very fine wire is passed through. A catheter (very fine tube) is then navigated up the oesophagus (gullet or food pipe) and will come out of your mouth. This then allows the gastrostomy tube to be pulled down into your stomach and out through the abdominal wall.

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.
• Once you are feeling ok, you will be brought back to the ward where you will stay so that feeding can be established. You will see a dietician during this stay and follow-up care will be arranged for you at home.
• Once you go home, if you have any discomfort take your usual pain relief as prescribed, but if the pain is severe please contact the#
• Imaging Department on the phone number on your appointment letter.

You should check your travel insurance if you wish to travel within 4 weeks of this procedure.

Will this procedure be painful?

When the local anaesthetic is injected, it will sting for a short while, but this soon wears off. There may be a little discomfort during the procedure, but any pain that you have will be controlled with painkillers. You may be aware of the tubes being passed into your stomach, but this should just be a feeling of pressure and not of pain.

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 is on your appointment letter.

References

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003250.

Your doctor has requested that you have facet joint injections. This may be to diagnose the cause of your pain or to help relieve your pain. We hope that the following information will answer some of the questions you may have about this procedure.

What are facet joint injections?

Image courtesy of: Northwest Surgical Specialists

Inflammation of the facet joints may cause pain in the neck, back and/or the arms and legs.

There is usually muscle spasm in the area of the joint close to the centre of the spine (the facet joint). Muscle spasm combined with joint pain can make movements stiff and painful.

A facet joint injection provides important information for your doctor and may also provide you with some relief of pain.

Why do I need to have facet joint injections?

The procedure is designed to prove if the facet joint is causing your pain by placing temporary numbing medicine over the joint of concern. If your pain improves after the injection then that facet joint is the most likely cause of your pain. If your pain remains unchanged, then that joint is probably not the cause of your pain. If you have been given this injection as pain relief then your pain should improve.

What is injected in the facet joints?

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 begins to work within two to three days.

How do I prepare for facet joint injections?

There is no preparation for this procedure, you can eat and drink on the day of your procedure and take all your medication as normal.

If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, dabigatran) 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.

Please also inform a member of the imaging team if you are a diabetic as there is a possibility the steroid may affect 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. 

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 to the facet joint(s) using the x-ray machine.
• When the radiologist or specialist radiographer is satisfied with the needle position, the local anaesthetic and steroid will be injected.
• 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, during the injection of the pain killing medicine. This will last for only a few seconds. You should not drive for the rest of the day. You will need to arrange for someone to take you home. 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 tissue. Don’t worry if this happens, as it will settle down by itself.

Are there any risks associated with facet joint injections?

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 women may experience a change in their menstrual cycle. 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 contact 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 where you had your procedure will be happy to answer them.

References and sources of further information

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003242

This leaflet has advice for what to do if the dye that has been injected into your veins escapes into your surrounding soft tissue. 

What is extravasation? 

For certain MRI and CT scans we may need to inject you with a dye, to help with the diagnosis. We usually inject it into a vein in your arm or hand. Sometimes this dye can escape from your vein at the place where we inject you. This is known as ‘extravasation’ and can result in a swelling. It can also cause temporary pain but this should not last more than half an hour. 

Immediate help from staff 

If you do experience extravasation we will apply pressure to the place where you have been injected, and lift your affected arm. We will sometimes apply a cold compress and, if possible, we will complete the scan. We may need to give you another injection but we will discuss this will you. 

For severe incidents a doctor will review your arm before you leave the department. 

What you can do at home 

This is usually a minor injury that doesn’t require treatment but to reduce any pain you can:

• Massage the affected area.
• Lift your arm if it is swollen. At night you can use pillows to elevate it.
• Apply an ice pack or a bag of frozen vegetable for no longer than 15 minutes at a time. Do not apply the ice pack or frozen vegetables to the skin directly - a clean cloth must be used to prevent you getting frostbite on your skin.
• You can take over the counter painkillers to help with any pain.

Things to be aware of

Seek medical attention from your GP or an emergency department if you experience any of the following:

• Increased pain, which is not eased by painkillers.
• Increased swelling of your arm or hand.
• Change in colour of your arm or hand.
• Pins and needles or altered sensation in your arm or hand.
• Blistering or an ulcer developing close to the injection site.

Important information 

The radiographer will write down the following information and give it to you. You should take this with you to any future appointments you have related to the extravasation: 

• The date.
• The type of contrast.
• The amount of contrast extravasated.
• The amount of saline extravasated.
• The site of the extravasation. 

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003212.

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

What is a defecating proctogram?

It is an examination of the lower bowel and rectum using X-rays. It shows how your rectum functions during the emptying of your bowels.  The images obtained will help us understand what is causing your symptoms.  

How do I prepare for a defecating proctogram?

There is no preparation for this examination, you may eat and drink normally. Continue to take your normal medication unless otherwise instructed; however please inform us if you are allergic to anything. 

If you also have an appointment for a colonoscopy or MRI, please contact us on the number on your appointment letter as it may be necessary to delay this proctogram appointment.

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

On the day of the procedure

• You will arrive at Gate 18 where a member of the Imaging team will take you through to the fluoroscopy waiting room.
• Following confirmation of your details, you will be asked to drink two cups of diluted barium to allow us to visualise the position of your small bowel.
• The barium takes a little time to reach your small bowel, so you will be sent away and asked to return one hour later for the main part of the examination. In this time you may eat and drink as normal and use the toilet if required.
• On return to the main waiting area at Gate 18 a member of staff will take you to our waiting room again.
• Before the examination starts the radiographer will check your clinical history, give a further explanation about the procedure and will try to answer any questions you may have.  You will be asked to change into a gown.
• If you are female, a small amount of barium will be introduced into your vagina much like you would introduce a tampon. This will allow visualisation of the position of your vagina on the resultant images.
• At the start of the examination you will be asked to lie on your side on the x-ray table whilst barium paste is introduced into your rectum via a small tube.
• Whilst lying down on the table, three x-ray images will be taken with you resting, squeezing and straining your pelvic floor muscles.
• You will be helped off the x-ray table. The x-ray table is then repositioned and a portable toilet is placed onto the step in front of the x-ray table for you to sit on. At this point we would like you to try and retain the paste.
• When the equipment is ready and you are sitting on the portable toilet the radiographer will begin to record images whilst you are asked to push out the paste until you feel empty. Do not worry if you cannot push out the paste, we will still be getting relevant and helpful information from the images obtained.
• Finally we will take three images at rest, squeezing and straining whilst you remain seated.

The examination is performed respecting patient privacy. Please do not feel embarrassed about the procedure.  

After the examination

• There will still be some barium retained in the bowel and your motions will appear whitish in colour for a couple of days.
• Barium can occasionally cause constipation, so we recommend that you drink plenty of fluids afterwards. If you feel it necessary, you may take a mild laxative to get rid of the remaining barium but please seek advice from your GP or pharmacist.
• You can eat and drink normally after the examination. Eating a high fibre diet like bran or wholemeal bread can help but the main thing is to drink plenty of fluids.
• If you have problems with your heart or water retention, you may not be able to drink this much safely.  If in doubt or you find you become breathless or your legs swell up, contact your GP.  

What are the risks associated with a defecating proctogram?

Proctograms are generally regarded as a very safe test and problems rarely occur. Potential complications are uncommon and include:

• We need to make you aware the barium we use for this procedure is described as “off-label”. This means the medicine has a license for investigating some conditions but the manufacturer of the medicine has not applied for a license for it to be used to investigate your condition. “Off-label” medicines are only used after careful consideration and in your case the barium is quite safe for this particular examination.
• Pain, discomfort or a feeling of fullness when the paste is introduced. Occasionally, if pain is part of your symptoms, this pain may be replicated by this procedure.
• Damage to the bowel wall (such as a small tear in the lining of the bowel) occurs rarely, in fewer than 1 in 2000 tests. This damage is usually minor and may not produce any symptoms.
• Fluoroscopy involves the use of x-rays; however with modern equipment the risk is low. Your doctor has recommended this examination because he/she feels that the benefits are greater than the risk of not having the examination.

How will I get the results?

You will not get an indication of the result at the time of the examination, as analysis of the images will take place after you have left the department.

The consultant radiologist will report on your examination at the earliest opportunity and this will be sent to your consultant, who will discuss the results with you at your next appointment.

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

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

References

© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT003173