Having an angiogram/angioplasty Department of Radiology Information for Patients i Radiology Leaflet No. 1
Contents Page number Introduction 3 Referral 3 What is an angiogram/angioplasty? 4 Are there any risks or complications? 5 Preparing for the procedure 6 On the day of the procedure 8 What happens during an angiogram/angioplasty? 9 How long does the procedure take? 11 What happens after the procedure? 11 Discharge information after the procedure 11 Important information after the procedure 12 What if I need to talk to someone? 13 Important guidance following angioplasty 13 Background radiation 14 Support for people with learning disabilities 14 Other sources of information 14 Additional hospital information 15 Any questions 19 2
Introduction Please read all of this leaflet. It provides information about two procedures called Angiogram and Angioplasty. It explains how to prepare for the procedure, what is involved and what the possible risks are. It also tells you about your admission into hospital and your discharge home. Please read your appointment letter carefully. It will explain which hospital you should attend. Referral and Consent Your specialist has referred you to the Radiology Department to have a diagnostic angiogram and / or angioplasty. This is performed by a Consultant Radiologist within the Radiology Department (a doctor specialised in performing these procedures). Your specialist should have discussed the reasons for this procedure with you in the clinic. Before the procedure takes place you will be asked to sign a consent form. This form says that you need to know what risks are involved with the procedure. This is a legal requirement and makes sure that you are fully informed about your procedure. If after discussion with your specialist or radiologist you do not want the procedure carried out then you can decide against it. 3
What is an angiogram / angioplasty? An angiogram is an X-ray examination which will show if there are any narrowings or blockages in your blood vessels (arteries). Normally, blood vessels do not show up on ordinary X-rays. However by injecting a special X-ray dye into the blood vessel, and taking X-rays, detailed images of arteries can be produced. If there is a narrowing or blockage, the Radiologist will decide if angioplasty treatment is necessary. Angioplasty involves passing a wire and balloon through the narrowing or blockage and inflating the balloon to stretch the artery open. This will improve blood flow. In some cases, a small mesh tube called a stent may be inserted which keeps the blocked or narrowed artery open. The stent remains in your artery and becomes part of your artery wall. 4
Are there any risks or complications? Angiography is a very safe and well established procedure. However, complications do occur on rare occasions and your hospital doctor will discuss this with you when you are asked to sign the consent form. The most common risks are:- Bruising this is common and may take some weeks to fade. Very rarely, the bruising is severe and an operation may be needed. Bleeding at the skin entry point There is a small risk that, on rare occasions, the procedure may damage the blood vessel and an operation may be needed to repair it. A small tear of your artery (called rupture or dissection) - this is also a small risk and if this happens treatment may be needed to repair this. If it is not possible to repair the damage then there is a risk to the limb (amputation) but this is very rare. Embolus - some of the blockage can break away and may block the artery lower down the leg which may make your symptoms worse. This might be dealt with at the time of having the procedure or there may be a need for an operation. There is a risk of 1-2% of worse blockage or rupture of the artery / vessel. An allergic reaction to the X-ray dye please tell staff if you have any allergies to minimise this risk. Sometimes it is not possible for the doctors to stretch the artery open. If this is the case with your artery, alternative treatments will be discussed with you. 5
Preparing for the procedure Most patients will have their procedure as a day case. This means they will go home the same day. Under certain circumstances an overnight stay may be required. You will receive a phone call from a Radiology Nurse to discuss your condition, medication and home circumstances. During this call the Nurse will explain the procedure, your admission and any preparation that you may need to do this includes doing an MRSA swab test and making sure that all of your blood tests are up-to-date. The Nurse will also answer any questions that you may have (there is space at the end of this leaflet for you to write any questions that you may wish to ask so you don t forget). If you are normally on any type of blood thinning medication (see list on page 7) you will receive specific instructions about stopping your medication before the procedure. Please follow these instructions given to you. Please arrange for someone to collect you and take you home because you must not drive for 48 hours after the procedure. You will also need to arrange for someone to stay with you for at least 12 hours or overnight. 6
Preparing for the procedure (continued) Please tell the Nurse if any of the following apply to you: if you have any allergies. if you are taking any medication particularly any medicines that thin your blood (these drugs include Rivaroxaban, warfarin, clopidogrel (Plavix) or Dalteparin / Heparin injections, Aspirin, Apixaban) or any medicines that treat diabetes. if you have diabetes. if you are on renal dialysis or have any problems with your kidneys. if there is a possibility that you may be pregnant. During this phone call, the Nurse will also ask you the following:- Are you able to provide your own transport home (you are not allowed to drive yourself)? Do you have anyone to stay with you after your procedure? Do you have any mobility problems? This allows us to assess whether you are able to have the procedure as a day case patient. Have a bath/shower in the morning or the night before. Please be prepared to spend the whole day in hospital and bring an overnight bag with you in case you need to stay in hospital (toiletries, dressing gown, slippers and something to occupy your time). Please take your normal medication unless you have been told not to (e.g. stopping warfarin). 7
On the day of the procedure Eating and drinking. Unless you have been told otherwise by the angiography team. If you have a morning appointment If you have an afternoon appointment Have a light breakfast. (cereal or toast with a drink). Have a light lunch with a drink. It is important that you continue to drink until one hour before your appointment time. Please follow any instructions advised by your Pre-assessment Nurse and bring any medication into hospital with you in their original boxes. When you arrive at the Angiography Suite you will be asked to change into a hospital gown and paper pants. A nurse will confirm your details and you will be asked to wear a wristband which confirms your details please do not remove this wristband whilst you are a patient in the hospital. Your blood pressure and pulse will be taken and you will be asked some questions. A special tube (called a cannula) will be inserted into a vein in your hand or arm which allows us to give any medication or a drip if required during your procedure. You will be asked for your consent for the procedure to go ahead. A Doctor will answer any questions that you may have. The Angiography department provides an emergency service and these patients will take priority. Some procedures may take longer than expected. Staff will keep you informed of any delay. Please bring something occupy your time. Your patience is appreciated. 8
What happens during an angiogram / angioplasty? In the X-ray room you will be looked after by a team of nursing and radiographic staff. You will lie flat on your back on the X-ray table and you will be connected to a blood pressure machine. The Radiologist and Nurse will wear a theatre gown and sterile gloves. Your skin will be cleaned with antiseptic and you will have some of your body covered with sterile sheets. You will have an injection of local anaesthetic in the groin which may sting a little for a few seconds until the area becomes numb. The Radiologist will then place a catheter (a thin flexible tube about the size of a piece of spaghetti) in the artery. A contrast agent (a colourless liquid which shows up on x-rays) will be injected though the catheter into your blood vessels. A series of x-rays (called screening) will then be used to take pictures of your blood vessels. The Radiologist will look for any narrowed or blocked arteries. 9
What happens during an angiogram / angioplasty? (continued) If you have narrowed or blocked arteries, they may be treated at this time with Angioplasty. Angioplasty involves the inflation of a balloon within the blocked artery to stretch it open. When the balloon is inflated you may experience some discomfort and a sensation of pressure but this will pass when the balloon is deflated. Before During angioplasty After Artery Catheter Widened artery and increased blood flow Blockage Inflated balloon When the procedure is over, the Doctor will remove all equipment and either press firmly on the skin entry point, for around 20 minutes, to prevent any bleeding and bruising, or insert a plug device to seal the artery. The Doctor will explain the procedure that has just been performed for you. If a plug device is used, further information about this will be given to you about at the time. 10
How long does the procedure take? Please note that all procedures are different and some procedures will take longer than others. Usually you will be in the examination room for one to two hours. What happens after the procedure? You will be taken to the Recovery Ward and Nurses will carry out routine observations of your pulse, blood pressure and wound site. You will rest in bed for several hours to ensure your wound is healed. When you are able to sit up in bed, you will be offered food (a sandwich) and a drink. Discharge information after the procedure When you have completed your bed rest and you do not have any complications, you may be able to go home with your carer, friend or relative. You may do normal light activity but avoid heavy lifting for 48 hours after the procedure. See information on page 12. Do not drive for 48 hours from the end of the procedure. Please arrange for someone to collect you and take you home. You will need to arrange for someone to stay with you for at least 12 hours or overnight. 11
Important information after the procedure Important advice: If your legs or feet become cold, pale, painful or numb please contact Ward 23 at the Glenfield Hospital urgently for advice on 0116 258 3700. If you had your procedure at Leicester General or Leicester Royal Infirmary phone the ward you were on. Leicester Hospitals switch board number is 0300 303 1573. It is important that you look out for the following: Bleeding: It is normal to see a spot of blood on your plaster. If you notice a slight bleed, please press firmly on the plaster for 10 minutes. If the bleeding continues, seek medical advice urgently. If you begin to bleed a lot from your wound site, this is an emergency and you need to dial 999. Please lie flat and get someone to apply firm pressure to the wound. Bruising: This is normal. However, if a lump or a swelling occurs, please apply pressure and phone 0116 258 3700. You may have a shower or a warm bath 24 hours after your procedure. A shower is preferable. For the next 48 hours do not lift, stretch or do any strenuous activity, for example, heavy housework, gardening, sex or walking long distances. Work: It may be wise to take a week off work depending on the job you do. Please ask the Doctor or one of the Nurses if you are unsure. Do not drive for 2 days. 12
What if I need to talk to someone? Contact numbers: In office hours (Monday to Friday 9am 5pm): Please ring The Angiography Department at Glenfield on 0116 250 2318. Or, if you had your procedure at Leicester General Hospital phone the Radiology Department at Leicester General Hospital on 0116 258 4541. Out of Hours: Please ring Ward 23 at the Glenfield Hospital on 0116 258 3700. If you had your treatment at the Leicester General or Leicester Royal Infirmary phone the ward you were on. Leicester Hospitals switch board number is 0300 303 1573. Important Guidance after angioplasty Smoking If you are a smoker please be aware that smoking can affect the success of the procedure. Patients who continue to smoke have a greater risk of their treated arteries re-blocking and of having a stroke or heart attack. The Nurse will be able to give you information about the help that is available to NHS patients to support and encourage stopping smoking. If you would like help to give up smoking, please telephone the NHS Smoking Helpline on 0800 022 4332. Exercise People who have cramping in one or both legs when walking can improve their walking distance by taking regular exercise. We would encourage gentle exercise after one week. Walking, cycling and swimming can be of benefit. Please check with your doctor before starting an exercise programme. 13
Background radiation We are all exposed to natural background radiation every day of our lives, for example, the sun and the food that we eat. Each examination gives a dose of this natural background radiation. The radiation from the X-rays during an angiogram/angioplasty examination is equivalent to receiving approximately 1-2 years of natural background radiation. Support for people with learning disabilities There is support available in our hospitals for patients with learning disabilities. Please contact the learning disability specialist nursing team on (0116) 250 2809 telling them when the appointment is and what examination has been booked. Other sources of information Websites: For general information about radiology departments visit the Royal College of Radiologists website: www.goingfora.com For information about the effects of x-rays read the NRPB publication: X-rays how safe are they, on the Health Protection Agency website: www.hpa.org.uk University Hospitals of Leicester website: www.leicestershospitals.nhs.uk NHS Direct: For health advice or information you can call NHS on: 111. 14
Additional hospital information How was it for you? If you wish to make any comments or suggestions regarding your visit to the Radiology Department please fill in a suggestion form or speak to a member of staff. Suggestion forms and/or message to matron cards are located in all waiting areas within the department. University Hospitals of Leicester NHS Trust also has a Patient Information and Liaison Service (PILS), and you are welcome to contact them on: Freephone: 08081 788337 email: pils.complaints.compliments@uhl-tr.nhs.uk We review our information leaflets on a regular basis. If you have any comments about how we can improve these leaflets please speak to a member of staff. 15
Additional hospital information (continued) Directions and parking For information about getting to the hospital please see the hospitals website: www.leicestershospitals.nhs.uk/patients/getting-to-hospital Hospital car parking is available to all hospital patients and visitors. Spaces are limited so please allow plenty of time to find a car parking space. Parking charges are payable, please check tariff boards or the hospital website for full details. As well as the hourly rates there are a range of saver tickets available for patients and prime carers. Dedicated disabled parking bays are also available. Marked disabled bays exist outside of the public car parks for which there is no charge. If you park in the car parks the fee will apply. Drop off bays exist at the main entrances, these bays have a 20 minutes maximum stay. Certain qualifying benefits as notified by the Department of Social Security entitle the patient to free or reduced parking. For more information contact the Cashiers office. 16
Additional hospital information (continued) Bus services to the hospital Our aim is to ensure that there are car parking spaces available for those who really need to use them. We encourage you to use public transport or walk to the hospital if you are fit and well. For information on bus routes and times contact Traveline on 0871 200 2233. The hospital Hopper service runs from Monday to Friday, every 30 min from 06:30 hours until 18:00 hours and every hour from 18:00 hours until 21:00 hours. The Hopper stops at our three hospital sites, as well as other key locations such as Leicester train station, Beaumont Leys centre and Hamilton centre and also St Nicholas circle. For information about bus services to the hospital and the hospital hopper please see the hospitals website. www.leicestershospitals.nhs.uk/patients/getting-to-hospital/bustravel/hospital-hopper-bus/ 17
Additional hospital information (continued) Relatives and escorts You may wish to bring a friend or relative to accompany you to and from the Radiology Department when you have your examination although they may not always be allowed into the examination room. This may be useful if you do not understand English very well or if you have any special needs. Children Baby changing facilities are available. Please ask to be shown to them if you wish to use them. We are unable to offer childcare facilities. If you need to bring your children with you, please bring along an adult who can supervise them whilst your examination is being carried out. Radiology staff are not able to supervise your children. Facilities available: Refreshments: Refreshments including hot and cold drinks are available in the hospital. Please ask a member of staff for directions. Shops: Each hospital contains a shop selling magazines, newspapers, sweets and drinks. Please ask a member of staff for directions. 18
Any questions? If you have any questions, write them down here to remind you what to ask when you speak to your nurse/consultant. 19
Edition 6. Leaflet Produced: September 2017. Next Review: September 2022. Imaging Patient Information Group - CMG CSI (Mear)IMA059-1117 Today s research is tomorrow s care We all benefit from research. Leicester s Hospitals is a research active Trust so you may find that research is happening when you visit the hospital or your clinic. If you are interested in finding out how you can become involved in a clinical trial or to find out more about taking part in research, please speak to your clinician or GP. If you would like this information in another language or format, please contact the service equality manager on 0116 250 2959