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 Urinary procedure performed in the Radiology (X-ray) Department. The types of procedure includes Percutaneous Nephrostomy, Nephrostogram or Ureteric stents. 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 particular organ to be able to insert drains, stents or obtain more detailed images. 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 leaflet may not answer all your questions, so if you have any queries or concerns, please contact us using the telephone number on your appointment letter, or ask the ward staff.
What is a Percutaneous Nephrostomy?
A Percutaneous Nephrostomy is a special procedure, sometimes performed under sedation, to relieve the symptoms of an obstructed kidney. The urine from a normal kidney drains through a narrow tube, called the ureter, into the bladder. When the tube becomes blocked, for example by a stone, the kidney can become damaged if left untreated. It is possible to relieve the blockage by inserting a thin plastic drainage tube (nephrostomy) through the skin (percutaneous) into the kidney. This drainage tube then allows the urine to drain from the kidney into a collecting bag, outside the body.
If a Nephrostogram has been previously inserted it may require assessment by injecting contrast (X-ray dye) into the tube and take images under fluoroscopy (a nephrostogram).
It may be possible to use the Nephrostomy to position a thin wire into the ureter and bladder to pass any cause of the blockage and then feed another thin plastic tube (catheter or stent) to allow urine to drain into the bladder.
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.
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.
| 6 hours prior the procedure | 2 hours prior the procedure | |
| Light food | No Food | No food |
| Any drink | Clear Fluids | No fluids |
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 may need a cannula (small tube) inserted into a vein in your arm to allow access for fluids and for administering medication.
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.
The ultrasound will be used to decide on the most suitable place for inserting the needle.
Everything will be kept sterile and the radiologist will wear sterile gloves. Your skin will be cleaned with antiseptic solution and sterile drapes will be placed over this area. Then your skin will be numbed with local anaesthetic. When the local anaesthetic is injected, it will sting to start with, but this soon wears off, and the skin and deeper tissues should then feel numb The radiologist will insert the thin needle whilst looking at the images to ensure accuracy of positioning. You may be aware of a pushing sensation as the needle is positioned, but this is generally done so quickly that it does not cause much discomfort.
A needle followed by a wire and catheter (fine plastic tube) will be inserted into the kidney using ultrasound and x-ray guidance. A small amount of x-ray dye (contrast agent) is injected to allow images to be taken of the urinary collecting system. The procedure may finish at this stage or a stent or drainage catheter may be inserted, this will depend on what the radiologist finds.
If the procedure does become painful you should tell the radiologist performing the
procedure and they may give you more local anaesthetic or sedatives.
When the procedure is finished, a small dressing may be placed to cover the site of the drain attached to a collecting bag and you will be returned to the ward.
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 an external drainage catheter attached to a bag, it is important that you are aware of it. For example, you should try not to get up out of a chair without remembering about the bag, and making sure that it can move freely with you. However, you will be able to lead a normal like with the catheter in place. The bag needs to be emptied fairly frequently so that it does not become too heavy.
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
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. If you have been admitted specifically for this procedure as a day case patient, you should then be able to go home. In some cases you may be asked to stay overnight.
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 interventional procedure carries a small risk of bleeding. On rare occasions, this may become severe. There may be soreness around the injection or drain site and some bruising. On rare occasions, bleeding may be severe and require blood transfusion or another radiological procedure to stop it.
Infection: Occasionally there may be infection in the area surrounding the biopsy site. This can usually be treated with antibiotics. If the urine is infected, although you may be on antibiotics, there is a small risk that infection might be released into your bloodstream, making you unwell for a period
Urine leak: If there is a leak of urine for any reason into the abdomen from this procedure, it may require another radiology inserted drain through the skin as a temporary measure until the fluid has gone.
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.19
Approval date:
10 February 2024
Review date:
10 February 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.