Healthy eating with diabetes
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Read more information on the Diabetes UK website
10 tips for healthy eating with Diabetes
Gestational diabetes
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What is gestational diabetes (GDM)?
Gestational diabetes (GDM) is high blood sugar (glucose) developed during pregnancy and usually disappears after giving birth (post-delivery). It can happen at any stage of pregnancy but is more common in the second or third trimester. It happens when your body cannot produce enough insulin – a hormone that helps control blood sugar levels – to meet your extra needs in pregnancy.
Key features of GDM:
- Insulin resistance is due to an increase in circulating hormones that cause glucose levels to rise.
- It is usually temporary – post-birth your hormone levels return to normal and blood glucose levels fall
- In some cases, post-birth blood glucose remains high – this can be type 2 diabetes.
- You will have an increased risk of type 2 diabetes later in life.
Why did I get GDM?
Any woman can develop gestational diabetes during pregnancy, but you have a higher risk if:
- You are over 40.
- You have a raised BMI (above 30).
- You have South Asian, Black Caribbean, African or Middle Eastern heritage – certain ethnicities have a higher risk.
- There is a family history of diabetes (one of your parents or siblings has diabetes).
- You had gestational diabetes in a previous pregnancy.
- You have polycystic ovary syndrome (PCOS).
- You have had a previous baby over 4kg.
Some women with no risk factors at all will also develop GDM. The key message is that GDM can happen through no fault of your own but there are lots of things you can do to help manage it.
What are the risks associated with GDM?
Most women with GDM have otherwise normal pregnancies with healthy babies. However, gestational diabetes can cause problems such as:
- Your baby growing larger than normal. This may lead to difficulties during the delivery (shoulder dystocia) and increases the likelihood of needing induced labour or a caesarean section.
- Small increased risk of stillbirth, though this is rare.
- Intrauterine growth restriction (when baby does not grow as big as it should).
- Pre-eclampsia – this is a condition that causes high blood pressure during pregnancy and can lead to complications if not treated.
- Polyhydramnios – this is when there is too much amniotic fluid (the fluid that surrounds the baby) in the womb, which can cause premature labour or problems at delivery.
- Risk of lower blood sugars (hypoglycaemia) in your newborn baby.
How is it monitored and treated?
If you have gestational diabetes, the risks associated with GDM can be reduced by controlling your blood sugar levels.
You’ll be given a blood sugar testing kit and asked to test a minimum of four times a day. The instructions are included and you will be sent links to the Agamatrix user video.
Blood glucose targets:
- Fasting: 3.5-5.2mmol/l
- 1 Hour after meals: 3.5-7.7mmol/l
When should I be concerned?
- More than 3 readings out range in 48 hours.
- More than 2 high readings on waking over 1 week.
What should I expect during pregnancy?
- Testing your blood glucose levels 4 times a day.
- Dietary changes.
- Medications is sometimes required (metformin tablets/insulin).
- Appointment and scan in GDM clinic every 4 weeks.
- Support from diabetes midwives on 0117 4141 072
- Induction of labour/elective caesarean section/delivery suite birth usually recommended.
- Colostrum harvesting recommended from ~36/40.
What happens after birth?
- You will stop diabetes medications (unless advised not to).
- Postnatal (after the birth) stay in hospital of at least 24 hours.
- Test your blood glucose levels for first 24 hours. It is useful to bring your blood glucose testing kit in from home so you are able to test your blood sugars when on the ward.
- Early first feed and skin to skin contact.
- Baby observations and blood glucose tests (every 3 hours until 2 normal readings).
Long term effects of gestational diabetes
Gestational diabetes normally goes away after birth. But woman who have had it are more likely to develop:
- Gestational diabetes again in future pregnancies.
- Type 2 diabetes.
You should have a blood test to check for diabetes 13 weeks after giving birth, and once every year after that if the result is normal.
See your GP if you develop symptoms of high blood sugar, such as increased thirst, needing to wee more often than usual, and a dry mouth, losing weight, repeated thrush, slow healing wounds– do not wait until your next test.
You should have the tests even if you feel well, as many people with diabetes do not have symptoms.
There is a type 2 prevention programme which your GP can refer you to or you can self refer to.
Healthy eating with gestational diabetes
A healthy diet is an important part of a healthy lifestyle at any time but especially for women who are pregnant or planning a pregnancy. What you eat and drink plays a key role in managing your blood glucose levels during pregnancy when you have GDM. The right balance of a variety of food is also important to make sure you and your developing baby get the nutrition you both need.
We base our healthy eating advice around the Eatwell guide, which you can find links to below. The Eatwell Guide divides the foods and drinks we consume into five main groups. Cultural and ethnic versions of the Eatwell Guide have been created which include foods commonly eaten in African and South Asian communities. Try to choose different foods from each of the food groups to help you get a wide range of nutrients that your body needs to stay healthy and work properly.
After monitoring glucose levels, the second step for managing gestational diabetes involves looking at your diet and exercise and making changes where possible to help control your blood glucose levels.
Planning your meals
We recommend you base your meals around the portion plate model which is pictured below. This includes half a plate or vegetables or salad, a quarter of a plate of starchy carbohydrate foods, and a quarter of a plate of protein.
Counting the amount of carbohydrates in your meals is not usually necessary, however if you find it helps, here is a guide, per meals:
- Breakfast: 20g
- Lunch: 40-50g
- Evening meal: 40-50g
- Snacks: 15-20g or carbohydrate free
Note: This is just a guide, everyone has different degrees of insulin resistance with their GDM. By regular blood glucose monitoring you’ll be able to adjust your diet as you need to.
Carbohydrates
Carbohydrates have the biggest impact on our blood glucose levels. Your body breaks down carbohydrates into glucose (sugar).
It is important to not cut these foods out completely as they are the main source of energy for your body and your growing baby. They also provide important vitamins and can be a source of fibre.
You can eat all types of carbohydrate, but some will raise your blood glucose levels more than others, even when an appropriate portion size is eaten. Try to eat more of the higher fibre/low GI carbohydrates, as per the table below.
Our starchy carbohydrates are foods within the yellow section of the Eatwell guide. Examples include:
- Bread
- Pasta
- Noodles
- Rice
- Flour
- Cereals
- Plantain
- Yam
- Dosa
- Polenta
- Oats
A note on breakfast cereals
Many women find that breakfast cereals cause blood glucose levels to rise too much and must avoid them completely during pregnancy.
Try a lower carbohydrate breakfast such as natural or Greek yoghurt with one portion of fruit or eggs/avocado/cottage cheese, with one slice of seeded bread.
Glycaemic index
All food that contains carbohydrate have a glycaemic index value (GI). This is the speed that the body breaks down carbohydrate into glucose and absorbs it into the blood.
Low GI foods are the best choices as they are absorbed and raise the blood glucose more slowly so can help to keep your blood glucose levels within the target range and regulate your appetite much better. High GI foods are absorbed quicker and raise the blood glucose quickly.
Therefore we recommend that you try and choose foods from the Low GI food list.
The table below shows you some examples of low and high GI foods.
| Refined carbohydrates to avoid (High glycaemic index (GI)) | Try instead (Low glycaemic index (GI)) |
|---|---|
All white breads:
|
|
Low fibre and sugar coated breakfast cereals:
|
|
Rice, pasta, grains:
|
|
Processed potato products:
|
|
Fruit and vegetables
- These are the other largest section in the Eatwell guide. They give us a wide range of vitamins, minerals and fibre.
- Choose a variety of different coloured fruit and vegetables as they contain different combinations of important nutrients our bodies need to stay healthy.
- We encourage you to bulk out meals with vegetables or salad items as these are low GI and help fill you up at mealtimes whilst increasing our overall vegetable intake.
- It is important to moderate fruit intake as their natural sugar content directly affects our blood glucose levels and so we therefore recommend you limit fruit intake to 2-3 portions per day and to spread these portions out over the day.
- You can combine a fruit snack with some protein food such as natural yoghurt, a cube of cheese or a handful of nuts or seeds (see protein section below) which will help in preventing a rise in glucose.
- One portion of fruit is the size of your palm for example:
- One handful of berries.
- One small- medium apple, orange or pear.
- Two smaller fruits such as a plum, satsuma, or one ‘fun’ size banana.
- We recommended avoiding melon, pineapple, or papaya.
- Avoid fruit juice and fruit smoothies. If using tinned fruit avoid ones in syrup and drain off the juice.
- Fresh and frozen vegetables are equally as beneficial.
Protein
- Protein is an important nutrient in the diet. It plays a key role in muscle repair and development. High protein foods can also be a good source of iron, other vitamins and minerals, and omega 3.
- Foods that are high in protein include all meat, fish, eggs, beans, pulses, tofu, meat substitutes, nuts and dairy. When unprocessed, these high protein foods by themselves do not directly affect your blood glucose levels. When added to carbohydrate containing foods can actually reduce the impact on your glucose levels
- Most people in the UK easily meet their protein requirements if they have a protein portion at 2-3 meals per day. A portion of protein is equivalent to the palm of your hand or the size of a deck of playing cards.
- For general health, weight, and glucose, it is important to:
- Opt for lower fat cuts of meat where possible
- Limit your intake of processed and cured meats.
- Remove any of the visible white fat from meat, or skin from poultry.
- Try to use healthier cooking techniques like grilling, dry roasting, boiling or poaching rather than frying.
- White fish is a good source of lean protein. Oily fish such as salmon, trout, mackerel and herring provide the beneficial omega 3 fats. Pregnant women should eat no more than 2 portions of oily fish per week. Tuna does not count as oily fish but should also be limited to 4 medium-size cans per week. More information on food safety during pregnancy can be found on the NHS website – link to website in ‘other useful links section’.
Dairy
- Dairy foods are important within a healthy diet as they are a key contributor of calcium which is important for making strong bones and teeth. They are also a key source of iodine which is important for your baby's neurological (brain) development.
- Examples of dairy foods includes cows’ milk, yoghurts and cheese.
- If you don’t eat dairy due to personal choices, or due to allergy or intolerance, then it is important that you ensure your dairy alternatives are fortified with calcium and iodine.
- Aim for 3-4 servings of dairy per day to meet your calcium and iodine requirements. Examples of a portion include
- 200ml of milk, a 125g pot of yoghurt.
- 30g of cheese.
- For non-dairy sources portions may need to be larger.
- Additionally, dairy foods can be high in fat, and in particular saturated fats. So it is important to be mindful of our portion sizes and consider lower fat varieties where possible.
- It is important to be aware that milk contains a natural sugar called lactose and drinking large amounts of milk can have an unhelpful effect on glucose levels. However, adding small amounts of other dairy products to carbohydrate-containing foods can help to reduce the impact on glucose levels.
- For example, having a tablespoon of Greek yoghurt with your berries, or having a small chunk of cheddar cheese with an apple as these add additional protein.
Fats
Fats are needed in the diet as they play an important role with different aspects of health. Such as providing energy, warmth, protection of the internal body and key fat-soluble vitamins. However, it is important to note that all fats are very high in calories which can contribute to unhelpful weight gain.
Examples of food sources that are high in fats include:
- Oils.
- Butter.
- Spreads.
- Avocado.
- Nuts.
- Seeds.
- Cheese.
- Cream.
- Processed foods like cakes, biscuits, chocolate, pastry items and crisps.
We generally don’t need to deliberately add high fat foods into our diet as most people get enough fats within their normal diets. However, it is appropriate to try to keep our intake of high fat foods to 2-4 portions per day. Examples include a tablespoon of oil or butter, half an avocado, or 20g of nuts.
All fats are high in calories, but not all fats are the same in other ways, such as their impact on cholesterol level. It is important for everyone to try to limit their intake of saturated fats, such as those from animal products, and swap to unsaturated fat where possible, such as those in nuts, plant based oils and avocado.
Foods high in free sugars
Free sugars are sugars added to food such as in cakes, biscuits, chocolate and desserts. They are also naturally in honey, syrups and unsweetened fruit juices. However, the term free sugars excludes lactose in milk and milk products, and the sugars in whole fruit.
All sugars are a form of carbohydrate and therefore provide a rapid source of energy for our body, but foods high in free sugars often provide very little other nutritional benefit.
Free sugars also have a very quick impact on our blood glucose levels. This is normally unhelpful and pushes the levels above the target ranges unless our blood glucose levels are too low to start . It is important to reduce your intake of free sugars as much as possible, including in drinks.
Hydration
- Aim to drink 11-12 cups (200ml cups) (2.3L) a day. There is 300ml increase in how much fluid you need per day during the whole of pregnancy.
- Avoid drinks high in sugar: full sugar fizzy drinks and squash, energy drinks, fruit juice and smoothies.
- Current NHS guidelines on caffeine: no more than 200mg/day.
- This equals 2 cups of instant coffee or tea/day. Caffeine is also found in energy drinks, cola and chocolate. More information on this can be found on the NHS website.
Exercise in pregnancy
- Exercising during pregnancy has many benefits, including reducing stress and anxiety, improving sleep patterns.
- Exercise can also help your insulin work more effectively, which keeps your blood glucose level under control, especially walking or being more active post eating.
- We recommend trying to remain active for at least 15-20mins straight after eating; this can be going for a short walk or just being active around the house.
For more information on this please check: Exercise in pregnancy - NHS
Weight gain during pregnancy
Weight gain is generally inevitable during pregnancy due to all the physical changes that happen to help your baby grow and develop, but it is important to try not to gain too much weight throughout your pregnancy, particularly if you were overweight before.
- As mentioned previously, you do not need to eat for two and it is only in your last trimester when you need just 200 extra calories per day.
- It is also important not to follow an overly restrictive diet as this could harm you and your baby. Focus on making small changes to your diet, such as those discussed earlier on this page and keeping physically active.
Food safety in pregnancy
There are certain foods that are best to avoid while you are pregnant as they can put your baby’s health at risk. These include some types of cheese and raw or uncooked meat. For more details, please see websites below.
Meal pattern
Try to eat regular meals (breakfast, lunch, and evening meal). Spread your intake over the day to help to manage your blood glucose levels.
If you skip meals, you might be more likely to overeat at the next meal or end up on snacking on things that can have a big impact on your blood glucose.
Avoid eating carbohydrates late in the evening. Having your dinner too late at night can affect your fasting blood glucose the next day. If you can, try to have your dinner 2-3 hours before you go to bed. If you need to snack after dinner, opt for low carb options like nuts, cheese or a small portion of Greek yogurt.
Menu planning ideas (choose one from each section)
Breakfast:
- Rye/granary toast with eggs/nut butter/egg/cheese/ham/marmite.
- 20-30g Jumbo oats with skimmed milk or Greek yoghurt and seeds/nuts.
- Plain natural or Greek yoghurt with a handful of berries/nuts and seeds.
- 1 small chapatti made with wholemeal flour with dhal or meat/fish curry.
Mid-morning snack:
- 1x Ryvita with peanut butter/cottage cheese/cream cheese/cold meat.
- 1x portion of fruit.
- A small pot of natural or Greek yoghurt.
- Small handful (30g) of plain popcorn.
Lunch:
- A sandwich (1-2 slices of wholemeal granary bread) containing salad and a protein choice such as tuna/egg/cheese/meat.
- ½ a jacket potato with protein topper and salad on the side.
- Omelette with salad and a granary roll.
- 2-3 tablespoons of cooked basmati rice with meat/fish or vegetarian curry (avoid adding potato to the curry).
- 1 medium chapati with meat/fish or dhal and salad.
- 2 small samosas with plenty of salad and plain yoghurt.
Mid-afternoon snack:
- Veggie sticks and hummus.
- Sugar free jelly.
- Handful of nuts.
- A piece of fruit with a cube of cheese.
- 1 small samosa.
Evening meal:
- Stir fry bulked out with vegetables and meat/fish and 2-3 tablespoons of cooked basmati rice or noodles.
- 1 medium chapati and curry (meat/fish/lentils) and salad.
- Roast meat with vegetables and 3 egg sized potatoes (avoid Yorkshire pudding and stuffing or swap out for potatoes.
Bed time snack:
- 1 small cup of cows or plant based milk.
- Handful of nuts.
- Small pot of natural or Greek yoghurt.
- Small handful of olives.
Summary
- Eat three regular meals every day.
- If hungry in between meals aim for a small snack containing carbohydrate between 10 – 15g (preferably low GI) or have a carb free snack,
- Avoid large meals – spread your carbohydrate portion as evenly as possible over the day.
- Balance your main meals with other nutrients coming from lean meat, fish, chicken or meat alternatives and plenty of salads/vegetables.
- Ensure good fluid intake, aim for 2 litres of sugar free fluid per day.
- Choose lower carbohydrate toast toppings such as peanut butter, cheese, marmite, and avocado instead of jam, marmalade, and honey.
- Exercise is important in pregnancy so aim for 30 mins of exercise daily. For instance, 15 – 20 minutes’ walk or longer after meals will help to control your blood glucose.
Other useful links
- Your guide to gestational diabetes | Free diabetes information
- Recipe finder - Enjoy Food | Diabetes UK
- Healthy eating in pregnancy - Start for Life - NHS
- Gestational diabetes | RCOG
© North Bristol NHS Trust. This edition published September 2025. Review due September 2028. NBT003601.
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Looking after yourself whilst you are receiving kidney treatment
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Living with a long term health condition can have an impact on your emotional wellbeing. Looking after your emotional health is just as important as looking after your physical health.
Evidence* suggests there are five steps we can all take to improve our mental wellbeing. If you give them a try, you may feel happier, more positive, and able to get the most from life.
- Connect – connect with the people around you. Spend time developing supportive relationships with people that have a positive impact on your wellbeing.
- Be active – you don't have to go to the gym. Take a walk, spend time outside, stretch, or play a game. Find an activity that you enjoy and make it a part of your life. You might need to think creatively about getting more activity into your life in a way that feels manageable.
- Keep learning – learning new skills can give you a sense of achievement and a new confidence. So why not sign up for that cooking course, start learning to play a musical instrument, learn another language, or figure out how to fix your bike?
- Give to others – even the smallest act can count, whether it's a smile, a thank you or a kind word. Larger acts, such as volunteering at your local community centre, can improve your mental wellbeing and help you build new social networks.
- Be mindful – be more aware of the present moment, including your thoughts and feelings, your body and the world around you. Some people call this awareness "mindfulness". It can positively change the way you feel about life and how you approach challenges.
NHS Psychological Therapies
Psychological therapies, sometimes called talking therapies, can help with common difficulties like stress, anxiety and low mood. If you are registered with a GP you can refer yourself directly to free services (or you can ask your GP to refer you).
These services are also known as Improving Access to Psychological Therapies (IAPT) services and provide psychological support in a variety of ways including face-to-face, online, over the phone, and courses.
Bristol, North Somerset and South Gloucestershire:
VitaMinds
0333 200 1893
refer.BNSSG@nhs.net
B&NES: B&NES Talking Therapies
01225 675150
Wiltshire: Wiltshire IAPT Service
01380 731335
awp.wilts-iapt@nhs.net
Swindon: LIFT Psychology
01793 836836
lift.psychology@nhs.net
If you have any concerns about your mental wellbeing or physical health you can always contact your GP. If you need urgent help please call 999 or attend A&E.
If you are feeling distressed and would like a confidential listening service, you can contact the Samaritans. They are available 24 hours a day, 7 days a week.
Telephone: 116 123
Email: jo@samaritans.org
Other ways to access free support
- Mind for mental health problems - www.mind.org.uk
- Cruse for bereavement care - www.cruse.org.uk
- Relate for relationship counselling - www.relate.org.uk
Kidney Peer Mentor Service
The Kidney Peer Mentor Service aims to give short term practical and emotional support to people living with kidney disease, their families, and carers. All trained peer mentors are people who have lived with kidney disease themselves, and are allocated to you based on their experiences. If you would like to find out more please email: kidneypeermentorservice@nbt.nhs.uk
Renal Psychology Service for Renal and Transplant Patients
We have two clinical psychologists based within the Renal Team at Southmead to support people with a wide range of issues. Sometimes people experience emotional difficulties as a direct result of adjusting to and living with kidney problems, at other times difficulties may come up independently making it more difficult to cope with the demands of living with kidney problems and treatment. If you would like an appointment with one of the renal psychologists please speak to a member of staff who will be able to refer you.
If you or the individual you are caring for need support reading this please ask a member of staff for advice.
How to contact us:
Clinical Psychology Service
Renal & Transplantation Directorate
Gate 10 Level 6
Southmead Hospital
Westbury on Trym
Bristol
BS10 5NB
0117 414 7696
www.nbt.nhs.uk
Peritoneal dialysis catheter insertion
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Peritoneal dialysis catheter insertion: Placing a Tenckhoff catheter in the abdomen
Why do I need a Tenckhoff catheter?
Your doctor has recommended you start dialysis treatment for kidney failure because of your blood test results and how you feel. You have chosen peritoneal dialysis.
The peritoneum is a membrane that lines the organs in the abdomen (tummy). Peritoneal dialysis (PD) filters the blood to “clean” it, when your kidneys don’t work well enough to keep you healthy.
A permanent tube called a Tenckhoff catheter is placed in the lower part of your belly. This is used to put in and drain out dialysis fluid. It is a soft, flexible tube, that lies flat against your body. There is a cap on the end of the tube so no opening.
How does it work?
For Peritoneal Dialysis the fluid is left in your abdomen to do the dialysis for several hours, then drained out. This fluid takes away some of the waste products and excess water that are normally removed by the kidneys. Fresh fluid is then put into the abdomen.
This exchange of fluid takes about 30 minutes and you will do it 2 - 4 times a day. The fluid comes in a range of volumes and “strengths”. The type of fluid you use depends on your needs.
The catheter is inserted by a surgeon at Southmead Hospital. The operation will usually be a day case (you will not stay overnight) using general or local anaesthetic.
Where will the catheter be?
There are a few things to think about when choosing the position of your catheter. You will discuss this with your surgeon before the operation and the community dialysis nurse will mark the place you agree on your skin.
Things to think about:
- Where do the waistbands on your clothes and underwear sit? You may not want these to be on top of your tube or exit site as this could interfere with healing.
- Do you prefer to sleep on one side? You do not want the tube to come out of the side you sleep most on as it can be uncomfortable and may interfere with healing.
- Where are your natural skin folds when you are sitting? The exit site should not be in a fold.
Preparing for the procedure
Infection screening
Before the procedure we will take swabs of your nose and groin. This is to check if you are carrying any bacteria on your skin that could cause infection of the catheter.
If the swabs are positive you may need treatment to clear the bacteria before the procedure.
The usual treatment is:
- Cleaning your skin with antibacterial wash (Hibiscrub or Octenisan) for 5 days before the procedure.
- Applying antibacterial ointment (Mupirocin or Naseptin) to both nostrils 3 times a day, for 5 days before the procedure.
If for any reason you haven’t had the swab tests done before the procedure, they will be done when you are admitted. If treatment is required it will be started then for at least 5 days.
Medications
If you take warfarin, clopidogrel or any other blood-thinning tablets, you will need to stop taking these before the procedure. Your doctor or pre-operative assessment clinic (POAC) nurse will tell you when to stop taking them.
What happens before the operation?
If you are having general anaesthetic
You will be given a date to attend the pre-operative assessment clinic (POAC). Some blood samples and swabs will be taken, and measurements of your blood pressure, pulse, temperature, and oxygen level.
If you are having local anaesthetic
Blood samples and swabs will be taken at the initial visit to your home. Before your surgery a member of the Renal Community Team will come to your house to go through the details of peritoneal dialysis (PD) including:
- Storage of dialysis fluids.
- Ordering stores and delivery.
- The area where you will do peritoneal dialysis.
- Handwashing technique and cleanliness.
- Instructions for how to keep the tube safe when you get home after the operation.
You will be given a date for your surgery. It is important your bowels are empty so you will be asked to take laxatives called sodium docusate and senna 3 days before the operation.
You will continue to take laxatives after the operation to make sure the PD tube won’t move because of constipation.
On the day of the operation
If you are having general anaesthetic
You will go to the medirooms.
If you are having a local anaesthetic
You will go to the renal ward 8b.
- If your operation is planned for the morning don’t have anything to eat or drink after 00:00 (midnight). If your operation is in the afternoon you will be given an early breakfast at around 06:00 - you won’t have anything to eat or drink after that.
- If you have diabetes that is treated with medication is it essential that you tell the nurses.
- You will be given antiseptic solution to shower with and then put on a clean theatre gown and anti-embolism compression socks.
- We cannot give you an exact time for your operation. Theatre lists need to be flexible in case of any emergencies. Everything possible will be done to make sure you don’t have to stop eating/drinking for any longer than necessary.
- Please don’t bring any valuables or large amounts of cash as we cannot be responsible for them.
- A member of the Renal Community Team will see you before the procedure to mark the position of the PD tube exit site.
- You will be asked to sign a consent form. The surgeon will explain what you should expect, including the reason for inserting the catheter and any possible complications to make sure you are aware of them.
What happens after the operation?
- When you have recovered from the anaesthetic you will be given painkillers if you need them. You will be encouraged to eat and drink as soon as you feel like it.
- If you had general anaesthetic you will have blood tests to check kidney function and haemoglobin level.
- You will have dressings on your abdomen and a stitch (suture) closing the tube exit site. The stitch is usually dissolvable but if not you will have it removed 10 days later.
- You are likely to have some bruising on your abdomen.
- You will be able to go home the same day in most cases.
- You will have a phone number to ring if you have any problems.
What immediate follow-up care will I have?
- The day after your operation a member of the Renal Community Team will phone you to check your recovery. They will give you a date to come for check-up usually 7 days later.
- We will check your wound and flush the PD tube to check it’s working.
- 2 - 3 weeks after your operation, you will have PD training which usually takes 3 days.
- 2 - 3 weeks after training you will come to the PD clinic to check your progress.
Will I need to take time off work?
Most patients are advised to take 7 days of work to recover.
Some people need more than this, particularly if you have a manual job.
What complications might happen?
There are 4 main possible complications that may happen.
Functional problems
Occasionally the catheter might not work. This might be because the tip of the catheter is in the wrong place or is covered by internal tissue which stops it working. At Southmead this happens in less than 7 in 100.
Bleeding
Bleeding can happen, mostly because of bruising around the wound. It usually stops on its own. In rare cases (less than 1 in 100) you may need surgery to stop the bleeding.
Infection
You will have intravenous (IV) antibiotics when the catheter is inserted to prevent infection. Despite this, some patients develop infection at the catheter exit site which needs further antibiotics. This happens in less than 1 in 100 cases, and very occasionally the catheter may need to be removed.
There is also a risk of infection deeper in the abdomen, causing peritonitis in the first 2 weeks after insertion. This happens in about 3 in 100 cases, and will be treated with different antibiotics.
Bowel perforation
Very rarely during the procedure the bowel is cut by mistake. This happens in less that 1 in 100 cases. It is a serious complication that may need another operation and a stay in hospital.
How will I be looked after long-term?
A community nurse will look after your ongoing care, and they will keep in contact with you. This will involve some visits to your home. A follow-up clinic appointment will be arranged with one of the renal doctors after your training.
Hospital transport can be arranged for appointments and training, but this is only for patients who meet certain criteria. We encourage you to make your own arrangements if possible.
© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002131.
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Contact Renal Community Team
Renal Community Team
Level 1, Gate 5
Brunel building
Southmead Hospital
BS10 5NB
Looking after yourself whilst having kidney treatment (Renal Psychology Service)
Regular
Off
Off
Living with a long-term health condition can have an impact on your emotional wellbeing. Looking after your emotional health is just as important as your physical health.
Evidence suggests there are five steps we can all take to improve our emotional wellbeing. If you give them a try you may feel happier, more positive, and able to get the most from life.
- Connect - connect with the people around you. Spend time developing supportive relationships with people that have a positive effect on your wellbeing.
- Be active - you do not have to go to the gym. Take a walk, spend time outside, stretch, or play a game. Find an activity that you enjoy and make it part of your everyday life. You might need to think creatively about getting more activity into your life in a way that feels manageable.
- Keep learning - learning new skills can give you a sense of achievement and a new confidence. Why not sign up to learn a new skill, pick up a musical instrument, or develop your DIY skills. Is there a new craft you would like to learn?
- Give to others - even the smallest act can count, whether it’s a smile, a thank you, or a kind word. Larger acts, such as volunteering at your local community centre can improve your emotional wellbeing and help you build new relationships.
- Be mindful - this can positively change the way you feel about life and how we approach challenges. This means learning to focus on the present, for example, what are we thinking, feeling, and noticing about the world around us?
Further support for emotional wellbeing available
NHS Psychological Therapies
Psychological therapies, sometimes called talking therapies, can help with common difficulties like stress, anxiety, and low mood. If you are registered with a GP you can refer yourself directly to services, or ask your GP to refer you. These services used to be known as Improving Access to Psychological Therapies (IAPT) services. They provide psychological support in a variety of ways including face-to-face, online, over the phone, and courses.
Find NHS Psychological Therapies in your area
Bristol North Somerset an South Gloucestershire
Bath and North East Somerset
Wiltshire Talking Therapies
- NHS Talking Therapies - Wiltshire Talking Therapies
- 01380 731 335
- awp.wiltshiretalkingtherapies@nhs.net
Swindon Talking Therapies
If you have any concerns about your emotional wellbeing or physical health, you can always contact your GP. If you need urgent help please call 999 or go to A&E.
If you are feeling distressed and would like a confidential listening service, you can contact the Samaritans by phoning 116 123. They are available 24 hours a day, 7 days a week.
Other ways to access free support
- Mind for mental health problems - Home - Mind
- Cruse for bereavement care - Home - Cruse Bereavement Support
- Relate for relationship counselling - Home | Relate
Social prescribing
Social prescribing is available through all GP practices. It aims to help people improve their health, emotional wellbeing, and social networking by connecting them to community activities and resources. For example, social prescribers can discuss your interests with you and help find local activities that you might want to get involved in.
Kidney Peer Mentor Service
The Kidney Peer Mentor Service aims to give short-term practical and emotional support to people living with kidney disease, their families, and carers. All trained peer mentors are people who have lived with kidney disease themselves, and are allocated to you based on their experiences. If you would like to find out more please email: kidneypeermentorservices@nbt.nhs.uk
Renal Psychology Service for Renal and Transplant patients
We have two clinical psychologists based in the Renal Team at Southmead to support people with a wide range of issues. Sometimes people experience emotional difficulties as a direct result of adjusting to and living with kidney problems. At other times difficulties may come up independently, making it more difficult to cope with the demands of living with kidney problems and treatment.
If you would like an appointment with one of the renal psychologists, please speak to a member of staff who will be able to refer you.
How to contact us
- Clinical Psychology Service, Renal and Transplant, Gate 10 level 6, Brunel building, Southmead Hospital, BS10 5NB
- 0117 414 7698
© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003225
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What to expect when you see the stroke specialist
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Transient Ischemic Attack (TIA) clinic
What may have caused my symptoms?
Possibly a Transient Ischaemic Attack (TIA): this can take place because of a temporary blockage in a blood vessel in a part of the brain.
This can be similar to a stroke with symptoms such as weakness, numbness, talking problems or trouble with your vision.
TIA is different as it only lasts between a few minutes to a few hours.
There are other possible causes for these type of symptoms and over half of the people attending the clinic turn out not to have a TIA.
Why is an urgent appointment with a stroke specialist so important?
About one in ten people who have a TIA develop a stroke within the next week but we can greatly reduce this with the right treatment.
The right medication can reduce your chance of a stroke, as can changes to your diet and exercise. Rarely an operation may be useful. We will discuss all this when you see us in clinic.
What may we need to do? (each case is different – you may not need all these investigations)
- A blood pressure check
- A heart recording (ECG)
- A scan of the arteries in your neck
- A brain scan
- A blood test
- A consultation with a stroke specialist - this may be a consultant, registrar or an advanced nurse practitioner for stroke
You can expect to be at the clinic for 3-4 hours.
What happens now?
The clinician who initially diagnosed you may give you medication to take. You need to take this each day until you are seen in our clinic.
There are clinics at Bristol Royal Infirmary and Weston General Hospital and weekend clinics at Southmead Hospital. If you are told to attend a TIA clinic, the TIA co-ordinator will tell you which clinic to attend.
Every day, the stroke specialist on duty will review all new referrals. If we decide that we need to see you urgently over the weekend or at a bank holiday, the co-ordinator of the TIA Service will phone you on the day tell you what time to come to the unit.
Otherwise, the TIA co-ordinator will be in touch on the next working day to arrange an appointment for you to come in. In some cases, the appointment will be a telephone consultation only. The appointment will usually be on the same day. If you have not heard from us within two working days, please ring the TIA co-ordinator on 0117 342 4800.
What do I need to bring?
Please bring a list of all the prescribed tablets you take – this is very important. If there are other tablets you buy over the counter, please tell us about these. If possible, it will be helpful for the person who witnessed you having your symptoms to come to the appointment as well.
There is a Costa Coffee, a small shop and a League of Friend’s coffee shop on Level 1 of the Brunel building where you can purchase refreshments. Alternatively, you may want to bring your own provisions.
What about driving?
It is not safe or legal for you to drive until you have been seen in clinic. We will discuss any possible further driving restrictions related to your diagnosis with you in the clinic.
What if I have further symptoms before the specialist appointment?
If you think you are having a stroke, don’t wait – call 999!
Angiogram, angioplasty, and stents
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Imaging Patient Information
Angioplasty and stents
Stents
Angiogram, angioplasty, and stents
There are two types of treatment to open up blocked or narrowed arteries, without the need to make an opening in the skin. These are called “angioplasty” or “stenting,” and can be done using X-ray guidance. They are usually performed while you are awake, using local anaesthetic to numb the skin.
What is an angiogram?
The first stage of your procedure is called an angiogram. This is used to make a detailed map of your arteries, because blood vessels do not show up on ordinary X-rays. A needle, followed by a thin plastic tube (catheter) is inserted into your artery to do this.
What is an angioplasty?
After the angiogram, a soft guidewire is inserted into the artery through the catheter. The wire must then be passed through the blockage or narrowed section of artery, if this is not possible we will discuss your options with you. A special balloon is then passed over the top of the wire. This balloon is inflated to stretch open the blockage or narrowing and allow more blood to flow through.
Once the artery has been stretched the balloon is removed and another angiogram is done to look at the result. If it is not possible to pass through the blocked artery we will discuss your options with you.
What is a stent?
A stent is a hollow mesh tube about the size of your little finger. It is made of fine, sterile metal and is used to open an artery. When it is used, unlike an angioplasty balloon, it is left inside the artery after the procedure and remains there forever. Once it is in position the stent will not give you any discomfort or sensation. It is important to remember it is there and to tell any doctors treating you in the future that you have it. It can be placed in the artery using similar equipment to the angioplasty and usually requires no additional anaesthetic.
Stents are often used if there is a long blockage in a large artery. It may also be used if you have an angioplasty and the result is not as good as hoped for, or if the artery is not smooth enough for an angioplasty.
If with time, a narrowing that was treated with an angioplasty reoccurs, a stent can be used to decrease the likelihood of it narrowing again. Narrowing can also develop within or around a stent, or the stent could get blocked. If the stent blocks, your symptoms may return or get worse.
Where will the procedure be done?
Most angioplasties/stents are performed by the Major Arterial Centre in Southmead Hospital. They are done by specialist radiology doctors called interventional radiologists, who are part of the multidisciplinary team involved in treating patients with vascular disease. Unless you live alone, are frail, or have certain other medical needs, you will usually go home the same day as your procedure.
The procedure is done in a specially adapted room called an “Interventional Radiology (IR) room”. Some patients will have surgery at the same time as angioplasty or stenting. This is done in a specialist operating theatre (hybrid theatre) which has X-ray equipment.
Who will be doing the angiogram or angioplasty?
The procedure will be performed by a team of specialists. In most cases the team is led by a consultant interventional radiologist. The lead doctor may be assisted by another specialist, or a doctor training in radiology or vascular surgery. Other members of the team in the IR room will include radiology nurses and radiographers.
How do I prepare for an angiogram?
Before the procedure
- There is no preparation for this procedure; you can eat and drink as normal unless we tell you otherwise.
- If you take blood thinning tablets (including anti-platelets) please contact the Imaging Department before your appointment using the phone number on your appointment letter as they may ask you to speak to your GP.
- Please inform us if there is any possibility you are pregnant.
- Please make arrangements for someone to collect you from the hospital after your procedure and take you home by car. We advise you do not use public transport. For the first 24 hours following your procedure you are not permitted to drive, and we advise someone stays with you at home. Please tell the Imaging Department if this is not possible so we can make alternative arrangements.
On the day of the procedure
- You will arrive at the Imaging Department (Gate 19) and will be accompanied into our day case area.
- Please bring a list of your regular medications with you.
- Please inform us if you are allergic to anything.
- You may take your normal medication unless instructed otherwise.
- An interventional radiologist will discuss the procedure with you including the benefits and potential risks to you. You will have an opportunity to ask questions about the procedure. If you choose to have the procedure you will need to sign a consent form.
- You will be asked to change into a hospital gown.
- We will place a small plastic tube (cannula) into a vein in your arm or hand – this allows us to administer medications or intravenous fluids during the procedure if necessary.
- Once all the checks have been performed and consent form signed, you will be taken to the IR room. You will be asked to lie down on the X-ray table for the procedure. There will be a small team of nurses, doctors, and radiographers with you throughout.
- Monitoring equipment will be attached to you so we can monitor your blood pressure, heart rate, and oxygen levels throughout the procedure.
- The nurse will then clean the area at the top of your leg with an antiseptic solution and cover you with sterile drapes. The X-ray machine at this point may move around you but will not touch you.
- An ultrasound machine will be used to find a suitable blood vessel.
- The interventional radiologist will then inject local anaesthetic into the area at the top of your leg, which may briefly sting and then go numb. After this, you may just feel a pushing sensation when a small plastic tube (catheter) is inserted into your artery and the catheter fed through.
- Once the catheter is moved into the correct position, contrast medium (X-ray dye) will be injected into different blood vessels and X-ray images are taken. The injection of the contrast medium, may give you a momentary warm feeling. n The injection will be repeated until all the necessary images have been obtained.
- The interventional radiologist will then usually discuss the map of your arteries with you and go through the pro and cons of proceeding with treatment to open up the blocked or narrow segments.
- Sometimes the interventional radiologist may find that the pattern of artery disease is different to what we were expecting. It may be that that the risks of doing a procedure under X-ray guidance to improve the circulation are not advisable. This will be discussed with you.
- At the end of the procedure the catheter will be removed from your leg.
- Usually one of the team will press on the area where the catheter was inserted for 10-15 minutes to prevent any bleeding. If more appropriate, the specialist will use a plug or “closure device” to seal up the artery where the catheter was inserted.
Will the procedure hurt?
When the local anaesthetic is injected it will sting to start with, but this soon wears off. The skin and deeper tissues should then start to feel numb. After this the procedure should not be painful but you may feel pressure or pushing. If the procedure becomes uncomfortable we can give you some painkillers through the cannula in your arm.
As the contrast medium passes around your body you may get a warm feeling, which some people find a little unpleasant. This will soon pass and should not concern you.
Some people feel a bit of discomfort when the angioplasty balloon is inflated or when the stent is expanded. This usually passes quickly when the balloon is removed.
How long will it take?
Every patient’s situation is different, and it is not always easy to predict how straightforward the procedure will be. For example, those with a large artery in the leg are usually straightforward and do not take long – around half an hour. Other times the vessels may be much smaller and complex, and the procedure can take 2-3 hours.
It is important to be aware of rare, but serious complications:
- Bleeding can occur from the place where the catheter entered the artery in the groin. This may result in a large, painful bruise (haematoma) which requires you to stay in hospital and have surgery. The occurs in: angiogram: 3 in 100 patients; angioplasty/stent: 4 in 100 patients.
- The artery may not seal up at all in the area where the catheter was inserted (a false aneurysm). This may happen in 1 in 500 patients. It may require a blood transfusion or further procedures including surgery.
- Sometimes it is not possible to cross the blockage in the artery. Occasionally the narrowing or blockage cannot be opened up, or the angioplasty/stent fails immediately. n
- Occasionally small fragments of blood clots break off and lodge in the artery below the angioplasty. This may require you to stay in hospital for close observation to take blood thinning medication, and/or have emergency surgery. n
- Occasionally the artery can rupture (leak) following the angioplasty. This can sometimes be treated in the Imaging Department by using a stent in the artery to seal the tear. If this is not possible an operation may be required.
Overall there is a 1 in 100 chance an angioplasty will fail and immediately make your leg worse. In this situation you may need urgent surgery. In severely diseased arteries the risk of requiring urgent surgery is 3 in 100. If urgent surgery fails to restore blood flow to the leg you may even need an amputation.
What problems can occur after this procedure?
Complications following an angioplasty are less frequent than following surgical alternatives but can include:
- Allergic reaction to the X-ray contrast medium. In most cases this is a minor reaction. Very rarely (1 in 1500) a reaction may be severe and need to be treated with medicines.
- X-ray contrast medium can affect kidney function. If you are at risk of this, special precautions will be taken to reduce the chances of problems occurring.
- A small risk from the X-rays used. The team will work hard to keep the dose as low as possible.
- Over time the treated section of the artery may narrow again. This can happen following both angioplasty or stenting. If you have a stent inserted into an artery, you may be referred for an ultrasound surveillance programme for a year after your procedure to detect this.
What will happen afterwards?
You will be taken back to our day case area on a trolley. Nurses in the day case area will carry out routine observations such as taking your pulse and blood pressure to make sure there are no problems. They will also look at your skin where the catheter was inserted to make sure there is no swelling or bleeding around it. In most cases you will be required to lay flat in bed for a few hours until you have recovered. If the specialist has used a closure device you will be able to sit up quite soon after your procedure.
Your specialist may make recommendations about your usual medication following the procedure. It is common to prescribe a short course (6 weeks) of tablets to help keep your angioplasty or stent open and working well whilst the artery repairs itself.
How soon will I recover?
If your procedure goes as planned, most patients come into hospital, and go home from hospital, on the same day.
If you go home the same day a responsible adult should accompany you home in a car or taxi. They should stay with you at home for 24 hours. You should not drive, operate machinery, or do any potentially dangerous activities for at least 24 hours. You should wait longer if you don’t feel fully recovered.
You should not do strenuous exercise for 1-2 days.
You should check your travel insurance if you wish to travel within 4 weeks of this procedure.
How effective is angioplasty or stenting?
The benefits you get from a successful procedure depends on many factors, especially whether you smoke, and the pattern of your arterial disease.
The results of angioplasty and stenting are most effective when they treat:
- Short sections of arterial disease.
- Narrowing rather than blockages.
- Large arteries like those higher in the leg such as thigh arteries rather than knee arteries.
- Patients who have single areas in the legs with narrowing/ blockages.
Is there anything I can do to help?
You cannot do anything to relieve the actual narrowing or blockage being treated.
You can improve your general health by doing regular exercise, stopping smoking, and reducing fat in your diet. These actions will help slow down the hardening of arteries which caused the problems in the first place, and may help you avoid the need for further treatment in the future.
When will I be followed up by the team?
Most patients will have a telephone follow-up with a clinical nurse specialist. This is a member of the specialist team.
If you have ongoing symptoms, we will arrange for you to be seen in an outpatients appointment.
If you have had a stent inserted in the thigh artery or behind the knee, the vascular team will arrange for you to have an ultrasound (arterial duplex) done at your closest hospital, around 6 weeks after your procedure. You will then be asked to attend further scans (surveillance) at regular intervals over the next 12 months. Sometimes the stent can develop narrowing without causing any symptoms. Your specialist would then discuss the pros and cons of intervention (further angioplasty).
We hope this information is helpful. If you have any questions 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.
Where can I find more information?
About vascular conditions and surgeries:
The Circulation Foundation | The UK Vascular Disease Charity
Patients and Referring Physicians | Society for Vascular Surgery
NICE | The National Institute for Health and Care Excellence
Peripheral arterial disease (PAD) - NHS (www.nhs.uk)
About our consultants:
A-Z of Consultants | North Bristol NHS Trust (nbt.nhs.uk)
Find a Vascular Society Member - Vascular Society
© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT003077.
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
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Imaging Patient Information
You have been advised by your hospital doctor to have an investigation known as ERCP (Endoscopic Retrograde Cholangio-pancreatography).
What is an ERCP?
This is a medical examination performed to diagnose and treat disorders of the bile duct, gallbladder, pancreas and liver.
Why is an ERCP performed?
The most common reasons to do an ERCP are jaundice (yellowing of the skin or eyes) or abnormal liver tests or if a scan (ultrasound or CT scan) shows a blockage of the bile of pancreatic ducts. Blockages can be caused by stones, narrowing of the bile ducts and growths or cancers of the pancreas and bile ducts.
During an ERCP, stents (small plastic or metal tubes) can be inserted into the bile ducts to allow bile to drain into the intestine. If indicated a therapeutic procedure can then be undertaken. This may involve the removal of gallstones by cutting a larger opening in the bile duct (sphincterotomy) allowing the stones to fall out. An ERCP can give more information about the pancreas and bile ducts and brushings and biopsies (specimens of cells) can be taken from the bile ducts or the pancreas for analysis.
What happens before the procedure?
- You will have attended pre-assessment clinic or completed a telephone assessment to perform standard checks e.g. blood tests, MRSA test and medication checks.
- You can continue taking your normal medication. However, if you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the interventional radiology department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.
On the day of the procedure
- You should not eat or drink anything from 6 hours before your procedure so that the upper intestine is clear of food and liquid.
- You will arrive at the Endoscopy department (Gate 13) and be accompanied into our day case area.
- Please inform us if you have any allergies.
- Please inform us if you think there is a chance you may be pregnant.
- A doctor specialising in the digestive system 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.
- You will be asked to change into a hospital gown and a small plastic tube (cannnula) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
- 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 doctor, nurses and radiographer with you throughout the procedure.
During the procedure
- A nurse will attach monitors to 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.
- You will need to lie on your left side and a plastic mouth guard will be placed in your mouth. This allows the telescope to pass through your mouth.
- We will give you oxygen through a small soft tube placed into your nostril.
- You will be given an injection of intravenous sedation and painkiller through the cannula in your hand. These medicines will relax you and may make you drowsy but will not necessarily put you to sleep.
- A nurse will stand by your head and monitor you for the whole procedure.
- Once you are drowsy the endoscope will be passed through your mouth, down your gullet into the stomach and then into the top part of the small intestine (duodenum).
- The doctor will insert a fine wire through the scope into the bile duct and inject a dye which shows up on x-ray.
- If stones need to be removed from the bile or pancreatic ducts, a small cut (sphincterotomy) may be made in the lower end of the bile duct to allow a fine tube to pass through. This also allows a small basket or balloon to be inserted to grasp a stone or stones.
- Specimens may be taken from the bile ducts using a small brush or forceps, and a plastic or metal tube (stent) may be inserted to help with the drainage of bile or pancreatic juice.
An ERCP usually lasts between 30 and 60 minutes depending on its complexity.
Taking your medications:
It would be helpful to bring a list of your current medications.
It is advisable to take your regular medications with a small amount of water no less than two hours before your test i.e. blood pressure tablets. Except:
- Diabetic Tablets or Insulin: Please contact your diabetic nurse or GP in advance of your procedure to discuss the appropriate measures. If necessary your GP surgery can seek further specialist advice from the hospital diabetes Centre.
- Anticoagulant and Anti-platelet drugs: eg. Warfarin, Coumadin, Clopidogrel, Rivaroxaban, Dipyridamole, Apixaban, Dabigatran.
Please make sure that you are told when to stop this medication by the doctor who referred you for this procedure. The level of the blood test (INR) must be <1.3 on the day of your procedure. If necessary your GP surgery can seek further specialist advice from the hospital haematology department.
What to expect after the procedure
- You will be taken back to the radiology day case unit, 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 in our day case unit for 6 hours.
- 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.
Furthermore, you should avoid the following activities after the procedure:
- Driving.
- Operating machinery.
- Drinking alcohol.
- Signing any legally binding documents.
- Carrying out any activities involving cooking, heights, bending, exercises.
- Caring for young children (sole responsibility).
Please check with your travel insurance if you wish to travel within 4 weeks of your procedure.
If you start to feel unwell or feverish, or develop severe abdominal pain, you must contact your GP or the local GP Emergency Service as soon as possible, it may be necessary to re-admit you to hospital.
You may resume a normal diet when able to do so.
Side effects and possible complications of ERCP
After the procedure your throat may feel sore for up to twenty-four hours. The indication for this test will have been determined by previous tests, such as an ultrasound scan, and considered to be the safest way to help you. However, an ERCP is not risk free.
You should be aware of the following possible complications:
- Failure to gain access to the bile duct due to differences in anatomy which occurs in 1/10 cases and may require a repeat or alternative procedure at a later date.
- Inflammation of the pancreas (pancreatitis) is due to irritation caused by contrast and occurs in 4/100 cases. This causes abdominal pain and is usually self-limiting. However, in 1/100 cases it can require a prolonged stay in hospital.
- Sometimes a cut is made in the intestine (sphincterotomy) which allows the release of displaced gall-stones. In 1/140 cases bleeding occurs which is usually controlled during the ERCP. Perforation of the intestine can occur in 1/1000 cases. Both situations can require open surgical correction.
- Death is a very rare outcome after ERCP. It occurs following severe complications of the type outlined above. The national mortality figure following ERCP is one in 3000 cases lead to complications that can result in death.
References
Bennet, J.R (1981). Therapeutic Endoscopy. Chapman and Hall.
Doctor Online (1999). ERCP www.doctoronline.nhs.uk
Gelton, P. and Williams, C (1997). Practical Gastrointestinal Endoscopy. Blackwell Science Ltd.
Hadley, A and Martin, D. Having an ERCP: A guide to the test.
Keymed.
“Having an ERCP” Guy’s and St Thomas’ NHS Foundation Trust 2018. Leaflet number: 2559/VER4 Accessed 24/07/2019.
© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002079
Imaging Department Contact Centre
If you are unable to attend your appointment please let us know as soon as possible. You can also contact the Imaging Department Contact Centre if you wish to change or discuss your appointment.
Telephone: 0117 414 8989
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Rhizolysis
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Imaging Patient Information
Radiofrequency lesioning (rhizolysis)
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
Your MRI Scan in the Radiology Department
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Imaging Patient Information
MRI scan
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
If you are pregnant at the time of your MRI scan, this should be discussed with the person referring you before attending the scan. If it is deemed necessary to still have your scan while you are pregnant, this will be discussed with the Radiologist and the appropriate safety precautions taken.
Claustrophobia
If you suffer from claustrophobia, we have experienced staff who can use a variety of techniques to help you through the scan. For severe claustrophobia, you may also be able to source sedatives from your GP however you will not be able to drive after taking these.
Contrast injections (dye)
Most MRI examinations do not require you to have an injection but in some situations, it may be deemed beneficial by the consultant Radiologist.
The contrast is injected into a vein and can help to give more information which can contribute to your diagnosis.
If you are having an arthrogram the contrast will be injected into the joint space.
MRI contrast is not the same as X-ray contrast.
Children
Children under 16 can be accompanied at all stages of the examination by an appropriate adult. Everyone coming into the scan room will be asked the safety questions about metal and implants, and be expected to change into appropriate clothing if required.
Please be aware that we are not able to supervise children while you have your scan.
What happens during the MRI scan?
- From reception you will be called through to the MRI preparation area.
- Please try to wear clothing without any metal. Please try to wear trousers with no metal fastenings or eyelets, tops and bras with no metal zips, patterns, clips or adjuster straps. If any of your clothing has metal on, it will need to be removed and a gown will be provided for you.
- A member of staff will go through the MRI safety questionnaire with you.
- You will be required to remove anything that is metal and removable, including jewellery, piercings, phone, watch, belt, wallet, and coin.
- It is not necessary to remove your wedding ring
- A team, possibly including a Radiologist, Radiographer and assistant will look after you and assist you into the scanner.
- They will assist you to lie down and make you comfortable. The couch top will then move you into the scanner.
- The Radiographer will ensure you are comfortable in the scanner before beginning your scan. You will be given a call bell if you need the Radiographer to come into the room.
- The scanner will make a series of loud noises as the images are being taken so you will be provided with headphones. Ear plugs can also be provided if required.
- You should keep very still throughout your MRI; this will ensure the images are good quality.
- The scan should not be painful and there are no side effects. You can continue as normal after your scan.
How long will it take?
You can be in the MRI department for between 20 minutes to 2 hours depending on your scan. Each area of the body takes approximately 20 minutes to scan.
Whilst we endeavour to ensure that you are seen at your appointment time sometimes emergencies may have to take priority. We ask for your patience and understanding should this occur, we will keep you informed of any delays.
How will I get the results?
You will not get any results at the time of your scan. A radiologist will report on your images and send the results to the doctor or clinic that requested the scan. You will receive the results from the clinician that requested your scan.
References
Royal College of Radiologists (RCR) 2001 Information for Adult Patients having an MRI Scan Available from: www.RCR. ac.uk [accessed April 2006].
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
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