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 transjugular procedure performed in the Radiology (X-ray) Department. This information tells you about the procedure, what is involved, and what the possible risks are.
This leaflet may not answer all your questions and it is not meant to replace informed discussion between you and your doctor, but can act as a starting point for such discussions.
If you have any questions about the procedure, please ask the doctor who has referred you or the department that will be performing it.
What is a biopsy?
A biopsy is a way of taking a small piece of tissue out of your body using only a tiny cut in the skin and a thin needle. In most cases, a liver biopsy is taken through the skin by passing a fine needle through into the liver. A transjugular liver biopsy is an alternative way of obtaining the liver specimen by passing the needle through the vein in the neck (jugular vein). This method is used in patients who have abnormal clotting of the blood or fluid collecting within the abdomen. This technique is used to reduce the risk of bleeding after the biopsy. The biopsy will then be examined under a microscope by a pathologist (an expert in making a diagnosis from tissue samples). We will use one or more types of radiology method to guide the needle into the correct place in the body.
The transjugular access may also be used to place a transducer in the vein to measure the blood pressure within the liver. This can be done only or combined with the biopsy.
The biopsy will be performed by a radiologist (doctor specialising in medical imaging) who will be assisted by a radiographer and / or a radiology nurse.
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.
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.
What to bring with you
You will usually be admitted for the procedure as a day case. The location where you should attend for the procedure will be on the first page of this appointment or you will be given the location by telephone. 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
Eating and Drinking
You can have a light breakfast on the day of the procedure. Please only drink clear fluids (eg water) in the 2 hours prior to the procedure.
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 biopsy is 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 be asked to lie on the x-ray examination table, generally flat on your back. During your procedure, the nurse will monitor your blood pressure, pulse, oxygen levels and heart rate. It is important that you stay very still until the procedure is over. If you are uncomfortable please let the doctor know.
The skin near the point of insertion in the neck will be cleaned with antiseptic and then the rest of your body will be covered with a sterile theatre drape.
The skin and deeper tissues over the vein will be anaesthetised with local anaesthetic and then a needle will be inserted into the vessel. Once the radiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle and into the vein. The needle is then withdrawn, allowing a fine plastic tube called a catheter to be placed over the wire and into the vein.
The radiologist uses the x-ray equipment to make sure that the catheter and the wire are moved into the correct position and then the wire is withdrawn. A special dye (contrast medium), is then injected through the catheter and x-rays are taken.
Once the radiologist is satisfied that the catheter is in the correct position the pressure measurements will be taken and/or the biopsy device will be inserted and a sample of the liver obtained. You will not feel anything when these are done. The catheter will be removed and pressure applied to the neck until there is no evidence of bleeding.
Will it hurt?
Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic.
You may feel the doctor changing and moving catheters in and out of your neck area.
Although this is sometimes slightly uncomfortable, it should not be painful.
As the dye, or contrast medium, passes around your body, you may get a warm feeling, which some people can find a little unpleasant.
How long will it take?
Every patient’s situation is different and it is not always easy to predict how complex or how straightforward the procedure will be. Generally the procedure takes between 30 and 45 minutes. As a guide expect to be in the x-ray room for two hours altogether.
After the procedure
Afterwards 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
The Results
The results of your test will be made available to the requesting doctor and will usually take about 10 working days. You will receive an outpatient appointment to obtain the results.
Risks
As with any procedure or operation, complications are possible. We have included the most common risks and complications in this leaflet. 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 vascular procedure carries a small risk of bleeding. On rare occasions, this may become severe. There may be soreness around the biopsy site and some bruising.
Infection: Occasionally there may be infection in the area surrounding the skin site. This can usually be treated with antibiotics.
Damage to underlying tissues: Rarely, as the biopsy needle passes through the body to the target area, surrounding tissues may be damaged.
Unfortunately, not all biopsies are successful. This may be because, in spite of taking every possible care, the piece of tissue which has been taken may not contain enough abnormal cells for the pathologist to make a definite diagnosis. If you need any further investigations, they will be discussed with you in clinic
X-rays 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 test 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.27
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.