Varicose Veins. Patient Information

Transcription

1 Varicose Veins Patient Information Author ID: JM Leaflet Number: Surg 037 Name of Leaflet: Varicose Veins Date Produced: November 2011 Review Date: November 2013 Varicose Veins Page 1 of 11

2 This leaflet aims to give you information about your operation and your stay in hospital and advice for when you go home. If you wish to speak to someone by phone please ring the following number: Langtree Ward What are Varicose Veins? Varicose literally means swollen or enlarged. As you probably know, varicose veins are superficial or surface veins which are enlarged and twisted. They are most often seen in the legs. They can be unsightly and painful. If left untreated they can bleed, clot or rarely cause ulcers. There can be different reasons why veins become like this. It can be due to deep veins not working properly. The deep veins cannot be seen because they lie deep inside the calf and thigh muscles but they are responsible for carrying most of the blood back from the legs to the heart. This leads to more work for the surface veins. These cannot cope so they stretch and twist. Sometimes it can be due to faults in the surface veins alone. What does the treatment consist of? Whatever the cause the surgeon will discuss the best way to treat this in your individual case. It can be a combination of the following: 1. Tying off the superficial vein at the groin. (High ligation). 2. Removing the superficial vein completely by stripping, endovenous laser Therapy (EVLT) or injecting foam into it foam sclerotherapy 3. Tying off or removing the surface veins. (Local ligation) 4. Injecting the surface veins to make them clot and disappear sclerotherapy. High ligation and stripping are performed under a general anaesthetic. Local ligation and endovenous laser therapy (EVLT) are performed under local anaesthetic and sclerotherapy is performed without any anaesthetic. Alternatives Alternative compression hosiery can often relieve the symptoms of discomfort from varicose veins. Varicose Veins Page 2 of 11

3 Pre-operative Assessment Clinic If due to have a general anaesthetic At the clinic you will be seen by a nurse who will complete a preoperative screening assessment. This will include taking a nursing history, anaesthetic history and organising blood tests, ECG s and obtaining the results of previous tests, e.g. angiograms, x-rays, etc. The nurse will advise you about your particular operation. He/she will explain to you about the pre and post operative care. It will be explained to you what to expect on the ward before your operation what will happen when you are transferred to theatre and what to expect, post operatively, e.g. intravenous infusion (drip), oxygen therapy, pain relief and when you will start fluids and diet. If you are a diabetic you may need an insulin infusion so that we can maintain your blood sugar levels until you are back on diet and fluids. You will be advised to leave your valuables at home. You may be seen by a doctor in the clinic, if this does not occur you will be assessed on the ward when you are admitted. The doctor will take a medical history, complete your consent to this operation with you. If you are taking any medication please bring these with you to the clinic and to the hospital when you are admitted. Admission to hospital You will need to book in at the admissions desk and then you will be transferred to the ward. You will be welcomed to the ward by a nurse or receptionist. The nurse will show you to your bed area and then she will check some details with you and give you a wristband with your Unit number, name, date of birth and ward. If you are allergic to any medication you will also be given a red wristband indicating what your allergy is. The nurse will check your notes to ensure all your tests and investigations are available. You will be seen by a doctor who works with your consultant. People who will see you The Anaesthetist This is the doctor who after talking to you and examining you can decide on the best type of anaesthetic. They will give you your anaesthetic and look after you during the operation. Details to help them do this best include any chest conditions you have, any anaesthetics you have had before, if anyone in your family has had problems with anaesthetics, or dental treatment you have had. If you smoke you will be advised not to. The Physiotherapist If you have any chest, breathing or circulation problems the physiotherapist may be asked to see you. They will help get your chest and breathing to its best before and after your operation. They may demonstrate some breathing exercises and give you advice. They may demonstrate some leg exercises to help your circulation. Varicose Veins Page 3 of 11

4 Acute pain nurse Before your operation you may be seen by an acute pain nurse, he/she will explain to you about different methods of analgesia, such as tablets, patient controlled analgesia and epidurals. He/she will also visit you after the operation to monitor your pain control. Preparing for the day Here are some of the things that will happen the day of your operation: The previous evening the area to be operated on will be shaved. You may be given a small enema to help clear your bowel. You will be asked not to eat or drink anything 6 to 8 hours before your operation. This is very important as it will help prevent you vomiting under anaesthesia. Mouthwash is available to help your mouth feel fresher. Some time in the morning of your operation day you will be asked to take a shower or a bath and to put on a theatre gown. You will be visited by one of the specially trained nurses from the recovery department. They will care for you for a short while immediately after your operation before you return to the ward. You will be asked to remove any jewellery except wedding ring (tape will be placed over this). Other jewellery can be safely stored for you and returned later. It is preferred though if you do not bring excessive jewellery into hospital. We ask you not to wear make-up or nail varnish and to remove hair grips or slides. If necessary you will be assisted to remove any false prosthesis. If you have a hearing aid or wear glasses, they may be worn until you get to theatre; if it helps you. Then they will be stored safely and returned immediately after your operation. A nurse will check that you have a wristband on with your name, ward, and Unit Number. The Unit Number is your unique personal number. It is a safety feature. A nurse will make sure all your documentation and test results are in order and ready. A special checklist is used to ensure nothing is overlooked. You will be asked the same questions by several staff en route to theatre. These are all safety measures to double check all is in order. An hour or so before your operation you may be given a small tablet or injection to help you relax. It is referred to as a pre-med. It is difficult to give an exact time for an operation to be performed. Many factors are involved. The staff on the ward may be able to indicate roughly when your operation will be, but this may alter. Please be assured every effort is made to reduce the time you have to wait on the ward once you are ready. Varicose Veins Page 4 of 11

5 Some find listening to music or reading relaxing. Others feel better talking to staff or patients. If you give some thought to how you may feel on this day, it may help you feel less nervous. When the time for your operation arrives you will be assisted onto a trolley. A nurse and porter will escort you to the operation suite. Here you will be met by anaesthetic staff. Your details will be checked yet again. The anaesthetic will then be administered in the anaesthetic room. Following this you will awaken in the recovery suite and your operation will be over. After the operation You will wake up in the recovery suite where you will remain probably for an hour or so. Here specially trained nurses will monitor closely how you feel. They will take readings like blood pressure and pulse, about every 15 minutes. This is quite normal, we do this with everyone. You may at first have a small oxygen mask in place. This will help the anaesthetic wear off, but you will still feel drowsy. When doctors and nurses are happy with your condition you will be taken back to your ward and gently transferred to bed. Here you will be made comfortable and can rest. Back on the ward Here the nurses will at first continue to monitor your progress very closely. They will regularly check your blood pressure, pulse and dressing. This is normal practice. They will check less and less as you improve.a nurse will check to see if you have passed urine by 6 to 12 hours after your operation. Will I be in pain? Most people fear this. The amount of discomfort people feel varies quite a lot. The doctors and nurses will ensure it is kept to a minimum. Any medication you need to control pain is already on the ward. It will be given promptly according to how you feel. Injections are more usual at first, then tablets later on. Please say if you are in pain. Some feel methods of relaxation like listening to quiet music or controlled breathing also gives assistance. How long will I be kept in bed? The morning after your operation a nurse will remove the bandages from your leg(s). They will clean your leg(s), replace any dressings as necessary, and will ensure you are correctly fitted with elasticated stockings to help your circulation. Regular gentle exercise will prevent stiffness, soreness, and help your circulation. At first moving may be painful but this will lessen with time. When can I eat and drink? You should be able to drink small amounts of water a few hours after your operation. If you do not feel sick these will increase. After this you can try a light meal. Varicose Veins Page 5 of 11

6 When can I have a bath? To help you feel clean and fresh, you may gently wash and dry your legs and feet each day, but avoid getting any dressings wet or changing them unnecessarily. As soon as this is done you must put the elasticated stockings back on. When the cuts have healed fully, and when you have been told you do not need to wear elasticated stockings, then you can bathe as you wish. What about my dressings and stitches? The leg(s) treated will be covered with crepe bandage from toe to groin. This will help circulation and reduce oozing. The bandage may show some blood-staining. A nurse will remove the bandage and clean any marks or remains of the brown antiseptic paint used by the surgeon. The leg(s) may appear quite bruised in places. These will fade and disappear in time. There will be some plasters on the leg(s) to cover the small cuts. Sometimes a large plaster is used to cover more than one small cut, so do not be alarmed at this. The plasters can be changed as necessary. If a cut has been made in the groin, 'high ligation', there will be a dressing over this. The nurses will check this and replace it as necessary. If the plasters are left on it will help prevent the stitches from catching on the stockings. Any stitches will be removed by the District Nurse. Sometimes the smaller cuts are closed with thin strips of sticky tape instead of stitches. General care and advice It is a good idea to become familiar with some simple aspects of your care before you leave hospital. This will prevent complications and aid your recovery. Here are some Do's and Don'ts Do wear the stockings, as instructed. This is important. Do regular exercise. Aim to increase your walking by about 50 yards each day, until you are back to normal. There is no strict rule as to how little or how much you should walk. It is better to have several shorter walks than one long one. If you are quite active at home this may adequately cover your exercise needs. Walking makes the calf muscles work to pump the blood round. This helps prevent formation of blood clots, which can be a complication after this type of surgery. Do elevate your legs or use a footstool when resting. This will help the blood flow up the legs and back to the heart. Don't let your feet hang over the end of a footstool. This causes pressure on the calves, and can affect the circulation. Do exercise your calf muscles even if you are standing or sitting. Do this by tensing and un-tensing them every few minutes. Varicose Veins Page 6 of 11

7 Do wear your elasticated stockings day and night for as long as the doctor has instructed, usually one to two weeks. If needed they can easily be washed and quickly dried while you are resting. But you must put them back on after. Do keep them pulled up properly, and resist the urge to turn the ends over. If the elasticity wears off, ladies, try a suspender belt! Gents, may just have to persevere! Call the hospital or your local doctor if you notice any of the following: 1. Increased redness, swelling, pain or tenderness in the calf region. 2. Shortness of breath associated with chest pain or tightness in the chest. Don'ts Don't sit with your legs crossed at any time. Don't stand in one position too long without moving your legs, even when you are back to normal. Remember to continue to tense and un-tense your calves. Don't wear clothing which is too tight or restrictive around the legs. Something else to think about These days many people are trying to give up smoking. Smoking has a tendency to make the blood more prone to forming clots and these can cause complications. You will already have been advised to stop smoking for a while prior to your anaesthetic, so why not keep up the good work! If you would like to try, ask the nurses for some helpful advice. Going home When can I go home? Varicose vein procedures are usually day cases, so you will go home shortly after the procedure is finished. We will arrange for a District Nurse to call at your home 10 to 14 days after your operation to remove stitches and check how you feel. Coming in as a Day Case You may have the operation performed as a day case. This means you will come into hospital on the morning of the operation. You should not eat or drink from the preceding evening. Your varicose vein operation will be performed in the morning and providing you have made a satisfactory recovery you will be discharged in the afternoon. It is most important that someone will be at home to take care of you. Arrangements will be made to ensure a District Nurse will visit you in the evening to check on your recovery. She will remove your bandages. The next day you will be able to get up and should then put on the elasticated stockings that will have been given to you before you have left the ward. Varicose Veins Page 7 of 11

8 When will I be back to normal? Do not under estimate your operation. Even a short stay in hospital can put you out of routine and make you feel generally tired. Try to plan periods of rest and activity during the day to allow for this. At first it may feel lumpy under the skin where the veins have been removed. This will settle down. It may take six months or more for the results of the operation to reach their best. Sometimes there is a swelling around the ankle which can last a week or two. This is usually controlled by wearing the elasticated stocking, as directed. Can varicose veins re-occur? Sometimes new veins appear, or veins which were not noticed before the operation become more obvious afterwards. So it is important that you make sure that all the veins which trouble you are discussed with the surgeon. What about work? Depending on your treatment you may be able to return to work anything between one and three weeks after your operation. Please ask the doctor about your circumstances. After Endo Venous Laser Therapy (EVLT) or Foam sclerotherapy you can return to work the next day. Sick notes If you require a medical certificate, please ask the nurses on the ward. Your G.P. will give you sick notes after discharge from hospital. Driving If you have had general anaesthetic, you may resume driving once you can do an emergency stop without discomfort in the wound, e.g. after about 10 days. Lifting The discomfort in the wound(s) will probably prevent you from lifting too much and harming yourself. Coming back to clinic A follow-up appointment will be arranged for about four to six weeks after you leave hospital. This can be at Wigan or Leigh. What are the complications? Varicose vein surgery is a common operation and complications are rare. However, there is a possibility of a clot forming in the deep veins (DVT), particularly if taking an oral contraceptive. An injury to a nerve may cause a loss of sensation or, rarely, foot drop. There is also a risk of a wound infection. Varicose Veins Page 8 of 11

9 After Endo Venous Laser Therapy (EVLT), or foam sclerotherapy, there maybe an inflammatory reaction along the course of the vein. This may be hard, red, tender and lumpy before gradually settling over a period of three to four months. There may also be some brown staining at the site of the treatment that may persist for up to 18 months. Conclusion These notes do not cover everything. We hope you will find them useful however, and that they will help towards making your stay in hospital less worrying. Remember, try and read these notes a few times before you come in, and bring them with you on admission. Don t forget... if you have any questions, write them down. Varicose Veins Page 9 of 11

10 Research Research is undertaken to add to the existing scientific knowledge on a particular subject. There are a number of staff within the Trust who conduct Research studies. It is possible that during the course of your treatment you may be asked to take part in a research study, however, you do have the right to refuse, and this will not affect the care that you receive. Your NHS Number, Keep it Safe Every person registered with the NHS in England and Wales has their own unique NHS Number. It is made up of 10 digits for example Everyone needs to use the NHS Number to identify you correctly. It is an important step towards improving the safety of your healthcare. Always bring your NHS number with you to all hospital appointments or quote it if you need to telephone the hospital for any enquires. This will allow staff to check that they have the right patient details by checking this against your NHS number. To improve safety always check your NHS Number on correspondence the NHS sends to you. Ways of finding out your NHS Number If you do not know your NHS number, contact your GP or local Primary Care Trust. You may be asked for proof of your identity, for example a passport or other form of identity this is to protect your privacy. Once you have obtained your NHS Number write it down and Keep it Safe. My NHS Number Data Protection The Trust will endeavour to ensure that your information remains secure and confidential at all times. The Data Protection Act 1998 explains how personal information should be processed and this applies to all information whether held on paper or electronically on computer systems. We must ensure that all personal information is processed fairly, lawfully and as transparently as possible so that you: Understand the reasons for us processing your personal information Give your consent for the disclosure and use of information where necessary Gain trust in the way we handle your information Understand your rights regarding the right to request access about the information we hold about you. The Caldicott Guardian, who is a senior health clinician, has the role to ensure we meet the highest standards for handling personal information at the Trust. For further information regarding data protection, please read our leaflet called Protecting Your Data - How we use your health records or visit the Information Governance pages on the Trust website. Varicose Veins Page 10 of 11

11 Patient Relations The Patient Relations Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. We will do our best to help you to resolve any concerns you may have about the care you received. We can also give you information on the services provided by the Trust. If you have a concern or there is a problem, the best way to get it resolved is usually to tell someone there and then. On a ward, talk to the sister or charge nurse on duty. In a clinic, talk to the receptionist or one of the nursing staff. If you want to talk to a senior manager or to someone who has not been directly involved in your care and treatment, we can usually arrange this during office hours. You can also ask to speak to a member of the Patient Relations Department. Staff in any ward or department will be able to contact a member of the team for you or you can telephone The Patient Relations Department is open Monday to Friday between 9:00 am and 4:00 pm. Outside of these hours there is an answer-phone service. If you wish to make a formal complaint you can telephone or write to: The Patient Relations Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Telephone: This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Varicose Veins Page 11 of 11