Advice after your nerve block for surgery
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Introduction
We have been advised by your hospital consultant that you need to have a Fibroid
Embolisation. These are done in the radiology department by Interventional Radiologist (doctor specialising in medical imaging) by guiding a needle into the body under ultrasound and fluoroscopic control to accessing a vessel to be able to guide wires and small plastic tubes (catheters) into the correct location. The procedures will be performed by a radiologist who will be assisted by radiographers and radiology nurses.
This information tells you about having the procedure, what is involved, and what the possible risks are. This is not intended to replace the discussion between you and your consultant, but may act as a starting point for discussion. If after reading this information you still have concerns or require further explanation, please contact us using the telephone number on your appointment letter, or ask the ward staff.
What is a Fibroid Embolisation?
Other tests that you have had will have shown that you have a fibroid or several fibroids in your uterus. Your gynaecologist will have discussed this with you and determined that these are the cause of your symptoms.
One option to treat fibroids is surgery to remove the fibroid from the wall of the uterus (myomectomy) or an operation to remove the entire uterus (hysterectomy). In your case, you and the medical team (the gynaecologist and an interventional radiologist who is going to perform the procedure) have decided that embolisation is the best option treatment. Fibroid embolisation is a minimally invasive technique of treating fibroids by blocking off the arteries
that supply blood to the fibroids and making them shrink. This is achieved with an injection of small particles or metal coils into the arteries that supply the uterus. Imaging which may be used in the planning or the procedure itself include fluoroscopy, ultrasound and CT scans.
What is Fluoroscopy?
Fluoroscopy is a process that uses X-rays to produce a real time moving image on a
television monitor.
What is Ultrasound?
An ultrasound scan is an examination that uses sound waves to take pictures of the part of the body being examined. It does not involve X-rays.
What is a CT scan?
A CT scan is an examination using X-rays by lying on a flat table inside a scanner that
produces detailed cross sectional images of your body. These images are cross-sectional (like slices) and are used to produce 2D and 3D images of the body’s organs
Before your appointment
Please let us know if:
- you are taking any medication which impair the bloods ability to clot (anticoagulation or blood thinning drugs) e.g. Warfarin or clopidigrel, or, if you are aware that you may have bleeding problems. The radiologist who will be performing your examination can be notified and may need to discuss this with you and your hospital consultant before your appointment can be confirmed as the medication may need to be stopped or changed before the procedure. The Interventional nursing team can be informed on 0300 613 2161 (Frimley) or 0300 615 3544 (Wexham).
Please also let us know if:
- you have limited mobility and will require assistance to get on and off the scanner.
- you will need an interpreter. We are not able to use family members or friends to interpret.
- there is any possibility that you may be pregnant. All patients from 12-55 years of age (regardless of gender) who will undergo a Radiology procedure will be asked about the possibility of them being pregnant.
- you are diabetic - please note that you are required to starve before the examination. You may be given an early morning appointment or alternative medication will be given on the ward.
In order to make your appointment run more smoothly, please let us know if any of these apply, in advance, by calling our bookings team (contact details are displayed on the main Radiology page).
Please review the contrast safety questionnaire enclosed in this letter and fill this in before your appointment. This can be completed on paper and where indicated this can also be completed online.
Eating and Drinking
You should have nothing to eat 6 hours prior to the time of your procedure. You can continue to drink clear fluids (water) up to 2 hours prior to the procedure but then nothing should be consumed.
What to bring with you
You will usually be admitted for the procedure as a day case. Occasionally it is necessary for patients to stay overnight in hospital after the biopsy. For this reason we advise that you prepare an overnight bag and bring this with you. You may wish to bring your own dressing gown, slippers and reading material.
Please bring with you to your appointment any sprays or inhalers that you are taking. Please bring a list of any regular medications you are taking
During the procedure
Referral and consent
You will be asked to sign a consent form confirming that you understand the procedure and are aware of the risks and benefits involved. Where practical this is usually done on the ward, before you come to the Radiology Department or in an outpatient clinic environment before your admission to hospital for the procedure.
The procedures are normally done as a planned procedure and you should have plenty of time to discuss the situation with your doctor or the nurse specialist looking after you before you sign the consent form. When you arrive for the procedure you will also discuss the procedure with the radiologist who will be performing the procedure who will again sign the consent form with you.
If after discussion with your hospital doctor or radiologist, you do not want the procedure carried out, then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary then they will explain this to you and they will communicate with the referring doctor who will review your situation as soon as possible. At all times the radiologist and referring doctor will be acting in your best interests.
Procedure
You will need to wear a hospital gown. The Porters will collect you from the ward and bring you to the X-ray Department, on your bed, for the procedure.
The procedure will be explained to you by the radiologist. You will be able to ask any further questions that you may have.
You will be asked to lie on the examination table. It is important that you stay very still until the procedure is over. If you are uncomfortable please let the doctor know. You will need a cannula (small tube) inserted into a vein in your arm to allow access for fluids and for administering medication.
The radiologist will keep everything as sterile as possible, and will wear a theatre gown and operating gloves. The skin near the point of insertion, usually the groin, will be thoroughly cleaned with antiseptic, and then most of the rest of your body covered with a theatre towel.
The skin and deeper tissues over the artery in the groin will be anaesthetised with local anaesthetic, and then a needle will be inserted into this artery. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into the artery. Then the needle is withdrawn allowing a fine, plastic tube (a catheter) to be placed over the wire and into this artery.
The radiologist will use X-ray fluoroscopy to make sure that the catheter and the wire are then moved into the arteries which are feeding the uterus and fibroid(s). A special x-ray dye, called contrast medium, is injected down the catheter into these uterine arteries, and this may give you a warm feeling in the pelvis.
Once the fibroid blood supply has been identified, fluid containing thousands of tiny particles is injected through the catheter into these small arteries which supply blood to the fibroid which silts them up and blocks them.
Both the arteries on the left and right side of the uterus need to be blocked in this way and this can normally all be done from the right groin, but sometimes the anatomy means the process of inserting a needle and catheter may need to be inserted in the left groin too.
At the end of the procedure, the catheter is withdrawn and the radiologist then presses on the artery in the groin to stop any bleeding.
After the procedure
Once you have returned to your ward, nurses will carry out close and regular observations, such as taking your pulse, blood pressure and temperature, to make sure that there are no problems. You may be required to stay in bed for at least four hours. You should tell the nurses if you feel worsening pain or a rise in your body temperature. You should drink plenty of fluids and eat normally
If you have any problems after the procedure please speak to the staff on the ward or contact your GP or emergency doctor if problems occur when you have returned home
Will it hurt?
When the local anaesthetic is injected it will sting initially, but this soon passes off, and the area should then feel numb with only the sensation of pushing remaining.
The procedure itself may become painful as the blood supply is reduced to the uterus and fibroids. However, you will be connected to a Patient Controlled Anaesthesia (PCA) pump which will be controlled by you and by pressing a button will deliver drugs which are strong painkillers. This allows you to receive as much of the strong painkilling medication you need into a vein without any risk of excessive amount which can be dangerous.
How long does it take?
As an approximate guide, expect to be in the Radiology Department for about 45 minutes to one hour. However much of this time is taken up by preparation rather than the procedure itself. You will normally be expected to rest on the ward for at least four hours after the procedure and would normally expect to be in hospital for 1-2 days.
Risks
As with any procedure or operation, complications are possible. The possibility of these occurring will vary for each patient and the possibility of these happening to you will be discussed with you, before you sign the consent form.
- Bleeding: Any intervention on a blood vessel carries a risk of bleeding. There may be a small bruise around the site where the needle has been inserted and this is quite normal. There is a chance that the bruise may become very large and uncomfortable, but this does not happen very often.
- Pain. Most patients feel some pain afterwards. This ranges from very mild pain to severe crampy, period-like pain which is generally worst in the first 12 hours. While you are in hospital this can be controlled by powerful pain killers. You will be given further tablets to take home with you.
- Temperatures. Most patients get a slight fever after the procedure. This is a good sign as it means that the fibroid is breaking down. The pain killers you will be given will help control this fever.
- Vaginal discharge. A few patients get a vaginal discharge afterwards, which may be bloody due to the fibroid breaking down or the effect of the procedure on the lining of the uterus. Usually the discharge persists for approximately two weeks from when it starts, although occasionally it can persist intermittently for several months. This is normal but you may need to wear sanitary protection. However, if the discharge becomes offensive (strong smell or colour) and if it is associated with a high fever and feeling unwell, there is the possibility of infection and you should contact your gynaecologist urgently.
- X-rays used in the procedure are a type of radiation. We are all exposed to natural background radiation every day from the sun, food we eat, and the ground. Exposure to medical X-rays carries a small additional risk, but your doctor feels that this risk is outweighed by the benefits of having the procedure and the amount of radiation you will receive is kept to as low as reasonably possible.
Contact us
If you have any queries relating to this information, please contact the Radiology service.
About this information
Service:
Radiology
Reference:
PILS-IR.15
Approval date:
2 October 2024
Review date:
2 October 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.