Day case cerebral or spinal angiogram

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1 Day case cerebral or spinal angiogram Information for patients This leaflet answers some of the questions you may have about having a cerebral or spinal angiogram. It explains the risks and the benefits of the procedure and what you can expect when you come to hospital for this procedure. If you have any questions or concerns, please do not hesitate to speak to the doctors or nurses caring for you. What is a cerebral or spinal angiogram? It is a type of x-ray that gives us detailed information about the blood vessels arteries and veins in your head, neck or spine. We cannot usually see blood vessels on an x-ray. But by injecting a clear liquid dye, called a contrast agent, into an artery in your groin or leg, through a thin plastic tube (catheter), we can make the arteries show up on x-ray images. What are the benefits? Because an angiogram gives us lots of information about your blood vessels, it is often very useful in helping us to diagnose your condition and plan your treatment. What are the risks? This is the only test that we can use to decide whether you need certain treatments, such as surgery or embolisation. There are some risks and side effects, which we list below. The procedure is normally very safe and most patients have no major problems. Minor, common side effects and risks You may feel warm, see lights, hear buzzing noises or have a strange taste in your mouth as we inject the dye. These symptoms should only last for a few seconds and are completely normal. If you have any symptoms that are very unpleasant, tell the radiologist or nurse and they may be able to ease them. You may have bleeding from where the needle was put into your groin. You can usually stop this if you press on the wound. You may get a small bruise (haematoma) around where the needle is put in. This is quite common.

2 Serious but rare risks The small bruise at the place where the needle is put in may become large and uncomfortable and you may need more treatment. Very rarely, the catheter can damage an artery in your groin and you may need more treatment. You have a less than 1 in 500 chance of having an allergic reaction to the dye. This is more likely if you suffer from a lot of allergies or have severe asthma. The reaction may vary from very mild to very severe. It is important that you contact the neuroimaging assessment nurse as soon as possible before your procedure if you have reacted to an x-ray contrast agent before, or have severe asthma and have been admitted to hospital with an asthma attack in the past year. We only use non-ionic dye, which is much less likely to cause a reaction. The most serious but very rare (1 in 500) risk of cerebral angiography is damage to your nervous system (a stroke). When we put a catheter into an artery that supplies blood to the brain, there is a small risk of damaging or blocking the artery. This can damage the nervous system and may be temporary or permanent. We do not know how severe it will be or who it will affect. If you are in the early stages of pregnancy there is a very small risk of x-rays harming your unborn child. If you think you may be pregnant, or you are trying to get pregnant, please tell us before your appointment. Are there any alternatives? You have been referred for an angiogram because your consultant thinks it is the best investigation for your condition. If you do not have it, the risk to your health may be greater than the risk of having the angiogram. Sometimes we can do other types of investigation such as an ultrasound scan or magnetic resonance imaging (MRI) to diagnose your condition. Talk to your radiologist about whether these are suitable for you. Consent We must by law obtain your written consent to any operation and some other procedures beforehand. Staff will explain the risks, benefits and alternatives before they ask you to sign the consent form. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to speak with a senior member of staff again. Pre-assessment One of our neuroimaging assessment nurses will phone you before your appointment to do a pre-assessment check. They will explain the procedure and answer any queries you may have. If they have not contacted you within two days of your appointment, please phone them on If they cannot take your call, leave your name and contact details so they can call you back. Do I need to prepare for my angiogram? Medications Medication that thins your blood: if you are taking any blood-thinning medications, such as warfarin or clopidogrel, you must phone us on and ask to speak to the senior nurse as soon as you receive your appointment letter. Medication for diabetes: if you are a non-insulin dependent diabetic taking Metformin, do not take it on the day of your angiogram and for 48 hours after. Check with your diabetes doctor that it is ok for you to stop. You can keep taking most other prescribed medicines as normal.

3 Eating and drinking Drink plenty of fluids the day before your angiogram so you do not get dehydrated. On the day of your angiogram you are fine to drink fluids and have a light breakfast, unless we have told you not to. Wash cloths If we have sent you a pack of wash cloths, it is important that you wash with them on the morning of your appointment as they reduce the risk of spreading skin bacteria between patients. Follow the instructions that come with the pack. If you do not use the wash cloths then we may have to cancel your angiogram. What happens before the angiogram? It is important that you arrive on time so we can get you ready for your procedure. You do not usually need to stay in hospital overnight, but we will admit you to a ward after the procedure. This is so you can recover and we can monitor you and make sure you are ok. We will care for you on the ward until you are discharged later the same day. Sometimes, the results of your pre-assessment checks may mean we decide to admit you overnight after you have had your angiogram. If this is the case, we will tell you before your procedure and explain what you need to do to prepare. When you arrive we will ask you to take off all your clothes and put on a hospital gown. You will need to take off any hair clips or jewellery but not rings so we advise you to leave your jewellery at home. The radiologist (x-ray doctor) who is going to do your procedure will explain why you are having the angiogram, its benefits and risks, and ask you to sign a consent form if you agree to go ahead. What happens during the angiogram? You will have a local anaesthetic for the procedure, so you will be awake. In the x-ray room, we will ask you to lie on your back on the table with your head on a pad. We will attach you to a monitor, which will record your heart rate, oxygen level and blood pressure during the procedure. A nurse will shave and clean your groin and then cover you in sterile sheets from your neck down, with only your groin showing. The radiologist will then inject local anaesthetic into your groin to numb the area. They then put a catheter (thin tube) into the artery in your groin which they thread into your body until it reaches the main blood vessels that supply your head, neck or spine. You will not be able to feel this tube inside you. They will check the position of the tube on a video monitor. When it is in the right place, they inject a contrast agent and take some x-ray images. The equipment will come very close to your head but it will not touch you. The contrast agent passes out of your blood quickly, in your urine. You will not aware of this at all. When the radiologist is taking the x-ray images, they sometimes ask you to hold your breath and to keep very still for a few seconds. They will give you clear instructions before they take each set of images and they may do this several times. Will it hurt? It will sting for a few seconds when the radiologist gives you the local anaesthetic injection. The anaesthetic numbs your groin area to make the procedure more comfortable.

4 How long does an angiogram take? It usually takes about minutes. What happens after the angiogram? After we have finished taking images, we will take the catheter out of your groin. The radiologist will press firmly on the area where the needle was put in for about 10 minutes, to prevent any bleeding. The radiologist will study the images and send the results to the doctor who referred you for the procedure. The radiologist may not be able to discuss the results with you straight away as the images may need more processing. When you arrive on the ward you will need to stay in bed for four hours to recover: two hours lying flat and two hours sitting up. During this time, the ward nurse will check you regularly, including looking at the site where you had the catheter put into your groin, to make sure there is no bleeding. If you do have bleeding, we will ask you to stay in bed resting a bit longer, but this does not usually happen. You may have some bruising around your groin, which can be sore, but most people have little or no after effects. If you feel any pain or see a big bruise forming, tell one of the nurses as soon as possible. If you have not had any problems, you can go home at the end of your recovery period. Although the risk of bleeding after the procedure is small, it is important to arrange for a responsible adult to collect you and stay with you for the first 24 hours. Walking and climbing stairs should be kept to a minimum as they can increase the risk of bleeding from your groin so, if possible, you should travel home by car or taxi. What happens when I go home? It is normal for your groin to be tender for a few days and for you to get a bruise that can sometimes extend down your leg. To reduce your risk of complications, it is important that you follow these instructions after you are discharged, unless we tell you otherwise. For the first 24 hours: Make sure that a responsible adult stays with you. Make sure that they can get to you at all times. For example, do not lock the bathroom or toilet door. Do not take a hot bath or shower as this may make you more likely to bleed. Drink plenty of water to help flush the contrast agent out of your body. If your groin starts to bleed, lie down, keep your leg as straight as possible and get the person with you to press firmly on the wound. If it does not stop after 10 minutes or if the bleeding is severe, call an ambulance and keep pressing on the wound until they arrive. For the first 48 hours: Do not bend over, strain yourself or lift anything heavy (more than 5kg). Do not drive. If you do it for a living, do not drive for 72 hours. Do not do any work. Contact your GP (home doctor) if you notice any of the following: a hard tender lump under your skin at the place where the needle was put in your groin (a very tiny lump is normal) any increased pain, swelling, redness and/or discharge in this area a cold foot on the same side as the catheter was put in a raised temperature/fever.

5 What should I do if I cannot come to my appointment? Contact us as soon as possible. Tel: /4899/ Who do I contact with queries and concerns? If you have any queries or concerns about your procedure, contact the neuroimaging assessment nurse. Tel: , 9am - 4pm, Monday to Thursday If you have any concerns after your procedure, contact the neuroradiology department. Tel: /4899/1796 9am - 5pm, Monday to Friday Outside of these hours, contact an out of hours GP service or Emergency Department/A&E Acknowledgement: we wish to thank the Royal College of Radiologists for allowing us to reproduce some of their copyright material in this leaflet. Care provided by students We provide clinical training where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision. PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. PALS at King s College Hospital, Denmark Hill, London SE5 9RS: Tel: You can also contact us by using our online form at PALS at Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND Tel: If you would like the information in this leaflet in a different language or format, please contact PALS on Corporate Comms: 0835 PL631.2 May 2016 Review date May 2019

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