Having a Vena Cava Filter Department of Radiology Information for Patients i Radiology Leaflet No. 30
Contents Page number Introduction 3 Referral and consent 3 Why do I need a vena cava filter inserted? 4 What is a vena cava filter? 4 Important information 5 How do I prepare for the procedure? 5 What happens during the procedure? 6 How long will the procedure take? 6 What happens after the procedure? 7 Are there any risks or complications? 8 Will I need to take anticoagulation afterwards? 10 Background radiation 10 Support for people with learning disabilities 11 Other sources of information 11 Additional hospital information 12 Any questions 15 2
Introduction This leaflet tells you about the procedure called insertion of a vena cava filter. It contains an explanation of how the procedure is carried out and what the possible risks are. This will help you to decide whether or not to go ahead with the procedure. Referral and consent The doctor who referred you should have discussed the reasons for this procedure and any alternatives with you. You should make sure that you understand these reasons, the procedure itself, any risks involved and the success rates. The consultant or the radiologist (a specialised x-ray doctor) who will be performing the procedure, will confirm that you understand why the procedure is being done, its potential risks and what the chances of success are. You will then be asked to sign a consent form. When you sign this it means you have agreed to have the procedure done and that you understand why it is needed. You will have a copy to take away. If after discussion with your hospital doctor or radiologist you do not want the procedure carried out, then you can decide against it. If you feel during the procedure that you do not want it to continue we will explain the consequences of not doing so, to help you fully decide. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary then he/ she will explain this to you, communicate with the referring doctor and ask that you return to your referring doctor for review. At all times the radiologist and referring doctor will be acting in your best interests. 3
Why do I need a vena cava filter inserted? Other tests that you have had done have shown that you have clots in the veins in your legs or pelvis, and that these may have passed upwards into your lungs and are causing significant problems. Generally, these problems can be treated effectively with blood thinning drugs, called anti-coagulants, but in your case it is felt that a further method of dealing with the blood clots is required. In some patients the filter is placed if anticoagulants (blood thinning medication) cannot be taken. What is a vena cava filter? A vena cava filter is a small, metal device about an inch (2 1/2 cm) long, shaped rather like the spokes of an umbrella or a basket. The filter is placed in the vena cava, which is the large vein in the abdomen which brings blood back from the legs and pelvis, towards the heart. If there are blood clots in the veins in the legs or pelvis, these could pass up the vena cava and into the lungs. The filter will trap these blood clots and prevent them entering the lungs and causing problems. Most filters can be taken out at a later date. Some filters are permanent and cannot be taken out. If this applies to you then your referring doctor will advise you. 4
Important information Please tell the doctor who is doing procedure if: You have any allergies, in particular to iodine. You have reacted previously to an intravenous contrast medium, the dye used for kidney x-rays and CT scanning. You are diabetic. There is any possibility that you may be pregnant. How do I prepare for the procedure? The test can be done as an inpatient or as a day-case. The radiologist will have selected the best for you depending on your health and home circumstances. No special preparation is required but you should continue to drink clear fluids (water or fruit juice) until 1 hour before the procedure. You may receive a sedative to relieve anxiety. You will be asked to put on a hospital gown. A needle may be put into a vein in your arm, either on the ward or when you arrive for your procedure. This is so that you can be given medication if necessary. 5
What happens during the procedure? The procedure will usually take place in the x-ray department. You will lie on the x-ray table flat on your back. You will be attached to a blood pressure monitoring machine and have a small monitoring device (peg) attached to your finger to monitor your heart rate. Everything will be kept sterile and the radiologist 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. The filter is usually inserted through the vein in your groin. Sometimes it may need to be inserted through the vein in your neck. If this is the case it will be explained to you. The skin and deeper tissues over the vein 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. If the procedure does become uncomfortable you should tell the member of staff who will be with you throughout the procedure. The filter is positioned in the vein using the x-ray equipment to guide it. A small amount of X-ray dye (a colourless liquid that shows up on x-rays) will be injected into the vena cava to confirm that the filter is positioned correctly. How long will the procedure take? Every patient's situation is different. It is not always easy to know how complex or how straightforward the procedure will be. Generally, the procedure will be over in about half an hour, but you may be in the x-ray department for about an hour altogether. 6
What happens after the procedure? You will be taken back to your ward. Nurses will carry out routine observations, such as taking your pulse and blood pressure, to make sure that there are no problems. They will also look at the skin entry point to make sure there is no bleeding from it. You will stay in bed for a few hours until you have recovered. You may be allowed home on the same day, or kept in hospital overnight. If you have any problems after the procedure please speak to the staff on the ward or your radiology nurses. If you have any problems after the procedure when you have gone home please see your GP. You will need someone to drive you home. 7
Are there any risks or complications? 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 complications occurring will vary for each patient and the possibility of these complications happening to you will be discussed with you before you sign the consent form. Bruising - there may occasionally be a small bruise, called a haematoma, around the site where the needle has been inserted. This is quite normal. If this becomes a large bruise, then there is a risk of it getting infected and this would then require treatment with antibiotics. This does not happen very often. Circulatory problems - very rarely some damage can be caused to the vein by the catheter, and this may need to be treated by surgery or another x-ray procedure. There is a possibility that the filter will actually cause blockage of the vena cava, the large vein that brings blood back from the legs to the heart. If this was to happen you might get some swelling of the legs. This is rare and usually happens because the filter has worked and done the job for which it was intended. This can cause the valves in the veins to not work properly and this can lead to painful venous leg ulcers in later life. The risk of this happening is less than 1 in 50 patients. As with any mechanical device, there is also the possibility that the filter will eventually fail to work properly. The risk of a complication from the filter is less than 5 patients in 100. There are some complications if the filter needs to be removed or changed to a permanent filter if a large volume of clot is trapped by the filter. 8
Are there any risks or complications? (continued) Infection - With any surgical procedure there is a risk of an infection happening. To keep this risk as small as possible the procedure is done under sterile conditions with sterile gloves, gowns and equipment. The risk of this is less than 1 in 50 patients. Perforation of the vein wall - This is rare. The risk of this happening is less than 1 in 60 patients. Sometimes the filter can move. This is rare. The risk of this is less than 1 in 300 patients. Contrast medium - You may get a warm feeling and / or a metallic taste when the injection of the contrast medium (x-ray dye) is given and sometimes can feel sick. If you do get these feelings they usually last about 1 minute. Some patients may be allergic to the contrast medium (the clear liquid that shows up on x-rays). You will asked a series of questions about your health before the test starts to see if you might be allergic to the x-ray dye. Filters are good but not perfect and there is a risk that you may still have blood clots passing into your lungs even though you have a filter fitted. The risk of this happening is less than 1.3 patients in 100. The overall risk of any complication including minor ones is 5-8 per cent (between 5 and 8 patients in 100). Despite these possible complications, the procedure is normally very safe, and is carried out with no significant side effects at all. 9
Will I need to take anticoagulation afterwards? Yes, unless there is a reason why you cannot take anticoagulation (blood thinning) medication. Background radiation The risk of having x-rays is very small indeed. We are all exposed to natural background radiation every day of our lives. This comes from the sun, food we eat, and the ground. Each examination gives a dose on top of this natural background radiation. The risks of radiation are slightly higher for the unborn child so we must ask female patients aged 10 to 55 years about their menstrual history. The radiation from the x-rays during a vena cava filter is equivalent to receiving approximately 14 months of natural background radiation. The benefits of this examination outweigh any potential risk and the risk from not having the examination could be greater. We will take all safeguards to minimise the amount of x-rays you receive. 10
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) 258 4382 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 Please note that the views expressed in these websites, do not necessarily reflect the views of UHL or the NHS. University Hospitals of Leicester website: www.leicestershospitals.nhs.uk NHS Direct: For health advice or information you can call NHS on: 111. 11
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 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. 12
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. 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. www.leicestershospitals.nhs.uk/patients/getting-to-hospital/bustravel/hospital-hopper-bus/ 13
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. This leaflet has been produced with reference to guidelines from the Royal College of Radiologists. 14
Any questions? If you have any questions write them down here to remind you what to ask when you speak to your consultant, radiologist or nurse specialist. 15
Produced by: Imaging Patient Information Group. Edition 5. Leaflet Produced : October 2015 Next Review: October 2020 IMA086-1015 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