MM Explaining Procedures Handbook

7/21/2019 MM Explaining Procedures Handbook

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EXPLAINING

PROCEDURES1. Bronchoscopy2. Endoscopy/Gastroscopy/

OGD - Oesophagogastroduodenoscopy3. Colonoscopy

4. Sigmoidoscopy5. Chest X-ray6. Abdominal X-ray7. Barium Swallow/Meal/Follow Through8. Barium Enema9. IV Urogram/Pyelogram10. CT scan Computed Tomography11. MRI scan- Magnetic Resonance Imaging12. Ultrasound Scan13. Echocardiography

14. Ultrasound Duplex Scan15. ERCP Endoscopic Retrograde Cholangiopancreatography

16. Isotope Scans (i.Lung, ii.Bone, iii.Thyroid)17. Cystoscopy

General points:

Intro

Define - draw a picture!

Before procedure

During procedure

After procedure

Risks

Results

Confirm patient knowledge to make sure Ive given you all the info you need, questions - length, pain, likelihood ofside effects.

ZG 1


2/21

Indications ?Bronchial CA Abnormalities on CXR e.g. shadowing Persistent cough Coughing up blood (haemoptysis)

Biopsy a mass Foreign body removal e.g. peanut

ZG 2

1. BRONCHOSCOPY

Introduction

1. Introduction (full name & role), state purpose.

2. Take consent; patients name and DOB.

3. Ask if theyve had a bronchoscopy before and what they already know.

4. Ask the patient what they would like to know and if they have any concerns.

5. Tell the patient briefly what the procedure is and why it is being doneThis is where an operator looks into your airways using a flexible fibre-optic telescope which is as thin as apencil, no wider than my little finger. It is passed through the nose, down the back of the throat and intothe windpipe. It has a bright light and a camera on the end which allows the operator to see down yourwind pipe and into your airways. The pictures will appear on a screen.May be passed through mouth if nasal passage is too narrow.You may want to ask the patient if they have nosebleeds.

Before the Procedure

1. Outpatient/day case. Patient should not eat 4-6 hours before the bronchoscopy; sips of water are okay up to2 hours before. Come in, change into a gown.

2. Doctor may need to review your medication- e.g. pts on warfarin and aspirin must stop. May do a blood testto check clotting - to make sure you arent likely to bleed after the procedure.

3. The operator will numb the inside of your nose and back of throat by spraying some anaesthetic bitter.4. You may be given a sedative to relax, which will be injected into the back of your hand (cannula)- it will makeyou drowsy, but not put you to sleep, might not remember much of the procedure. You will not be able todrive home - bring someone with you or arrange transport.

5. You may be connected to a monitor to check heart rate, blood pressure, oxygen content of the blood. Anurse will also be there to assist the doctor/bronchoscopist.You may have a soft plastic tube in your nostril togive you oxygen.

During the Procedure

1. You will be asked to sign a consent form to ensure you understand the procedure.

2. Bronchoscope is gently guided through your nose and down your wind pipe - it might make you cough andbe a bit uncomfortable.

3. It will not affect your breathing at all.

4. The operator may take a sample of tissue (biopsy) to send to the lab for testing, or to look under themicroscope, which is painless - you might feel a slight tugging.

5. Bronchoscope is then removed gently and painlessly.

6. The procedure lasts 20 30 minutes, need about 2 hours for the whole appointment.

After the Procedure

1. Allowed to rest for a short while and then can go home as soon as the procedure has finished, but need tobe accompanied due to the sedative.

2. You should not drive, operate machinery or drink alcohol 24 hours after having the sedative.?ask about work and taking time off if appropriate.

3. They can eat normally 2 hours after the procedure.

4. Risks/Complications:Sore nose or throat (1 day usually)

Tired after sedative.Slightly increased risk of throat or chest infection. If biopsy taken you may cough up a small amount of blood- if >1 tablespoon, go to GP, or

damage to lung.A collapsed lung may occur, but this is rare.

5. Will be followed up in clinic in a few weeks, where youll be able to find out about the results (take a fewdays to come back).

6. Ask the patient if they have anymore questions and tell them to let the nurse know if theyre coughing upblood (>1 tablespoon) immediately or to go to your doctor.

7. Ask the patient if they have anymore questions - anything you would like to clarify.

8. Ask the patient to repeat almost everything you have said.


3/21

Indications Peptic or duodenal ulcers ? Oesophageal or gastric CA Oesophagitis or gastritis Abnormalities seen in other investigations e.g.

barium swallow

Recurrent indigestion Upper abdominal pains Difficulty swallowing (dysphagia) Recurrent vomiting

ZG 3

2. ENDOSCOPY/GASTROSCOPY (OGD)

Introduction

1. Introduction (full name & role), state purpose

2. Take consent, patients name and DOB

3. Ask if theyve had a endoscopy before and what they already know

4. Ask the patient what they would like to know and if they have any concerns

5. Tell the patient briefly what the procedure is and why it is being doneThis is where an operator passes a flexible fibre-optic telescope called an endoscope, which is as thinas a pencil/no wider than my little finger, along the back of your throat to have a look at your foodpipe, stomach and a part of your small intestine. It has a bright light and a camera on the end whichallows the operator to see into your gut. The pictures will appear on a screen.


1. Outpatient/day case. Should not eat 4-6 hours before the gastroscopy because the stomach needs to beempty. Come in, change into a gown.

2. The operator will numb the back of the throat by spraying some anaesthetic bitter.

3. May be given a sedative to relax, by injecting it into the back of the hand (cannula).

4. Patient will be given a plastic mouth guard between their teeth to keep the airway open and to stop bitingthe endoscope.

5. May be connected to a monitor to check heart rate, blood pressure, oxygen content of the blood. Nurseswill be there to assist the doctor/operator and help you with anything if you need it.

6. You will be given advice about medication which may need to be stopped before the test. (e.g. Aspirin,Warfarin bleeding)



2. You will be lying on your side as the endoscope is gently passed through your mouth. The operator will askyou to swallow, which might be a little uncomfortable, after which it will continue down your food pipe,stomach and the first part of your intestine.

3. It will not affect your breathing.

4. Air is passed into the endoscope to make the stomach lining easier to see, and this may make the patientfeel full and want to burp - this is nothing to be embarrassed about.

5. The doctor/operator may take a sample of tissue (biopsy) to send to the lab for testing/look at under themicroscope, which is painless.

6. The procedure lasts 20-30 minutes, when finished the endoscope will be removed gently and painlessly.

After the Procedure

1. You can go home as soon as the procedure has finished, but need to be accompanied due to the sedative.

2. Should not drive, operate machinery or drink alcohol 24 hours after having the sedative.

3. Can eat normally after the procedure.

4. Risks/Complications:Sore throat (1 day).Tired due to sedative.Slight risk of throat or chest infection.Damage to the gut can rarely occur, but see a doctor if there is abdominal pain (worsening,

worse than normal heartburn), fever, SoB, vomiting blood or any other problems.A small number of elderly people have a heart attack or stroke during or soon after.Allergic reaction to sedative

5. They will be followed up in clinic in a few weeks, operator will send results to the dr.

6. Ask the patient if they have anymore questions - anything you would like me to clarify.

7. Ask the patient to repeat almost everything you have said


4/21

Indications Bleeding from the anus Lower abdominal pains Persistent diarrhoea

Abnormalities seen on other scans such as abarium enema

Colorectal cancer IBD Diverticular disease

Polyps

ZG 4

3. COLONOSCOPY

Introduction



3. Ask if theyve had a colonoscopy before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneThis is where an operator places a flexible fibre optic telescope, which is as thin as pencil, through theback passage to have a look at the large intestine. It has a bright light and a camera at the end so wecan see into you intestines/bowel. The pictures will appear on a screen.


1. Outpatient/day case. Common procedure, routinely done.

2. No food 6 hours before, but plenty of clear liquids. IDDM - find out to arrange when you can have theprocedure and arrange meals and insulin appropriately with your doctor.

3. Patient will be given powerful laxatives to clear the colon.

4. Patient may be given a sedative to relax (not asleep), by injecting it into the back of the hand (cannula).Arrange transport in order to get home as you will be drowsy after the procedure.



2. You will be given a hospital gown. You will be asked to lie on a bed on your side during the procedure withyour knees to your chest.

3. Monitored throughout - HR, BP, oxygen.

4. Doctor/nurse will insert a gloved, lubricated finger into your back passage to check for blockages.

5. Colonoscope gently passed into the back passage inside the colon liquid jelly used to make it easier-may feela bit cold. Process may be uncomfortable, but wont be painful.

6. May feel like passing faeces or wind, but this is natural so please dont feel embarrassed!

7. Air is passed into the colonoscope to make the colon lining easier to see, and this may make the patient feelfull and want to pass wind, have wind pains.

8. The doctor/operator may take a sample of tissue (biopsy) to send to the lab for testing/to look at under a

microscope, or remove polyps (small lumps of tissue which hang from the inside lining of the colon), which areboth painless.

9. The colonoscope is gently removed from your back passage.

10. The procedure lasts 20-30 minutes.

After the Procedure

1. They can go home as soon as the procedure has finished, but need to be accompanied due to the sedative.

2. They should not drive, operate machinery or drink alcohol 24hours after having the sedative

3. They can eat normally after the procedure

4. Risks/Complications:Tired due to the sedative.Damage to the bowel can rarely occur, but see a doctor if you experience abdominal pain, fever,

SOB, vomiting blood.

Feeling bloated and having wind-pains (usually passes quickly). After a biopsy a small amount of blood may be visible in the stool. Damage/perforation of bowel - rare. Seek help if lots of blood in stool. In a few cases the colonoscopy may have to be repeated.

5. They will be followed up in clinic in a few weeks - operator will send results to the dr.

6. Ask the patient if they have any more questions, anything to be clarified.



5/21

Indications Bleeding from back passage especially anus Pain from back passage Cancer or inflammation of rectum/sigmoid

Removal of polyps Lower abdominal pain Persistent diarrhoea Abnormalities seen on other scans e.g. Barium Enema

ZG 5

4. SIGMOIDOSCOPY

Introduction


2. Take consent, patients name and DOB.

3. Ask if theyve had a sigmoidoscopy before and what they already know.


5. Tell the patient briefly what the procedure is and why it is being doneThe operator will gently insert a thin, flexible telescope the size of a pencil into your back passage,which will allow the doctor to see around bends in the colon. It has a bright light and a camera at theend which is used to look into your rectum and lower colon. The pictures will appear on a screen.Samples of tissue may be taken if necessary. Not painful, but may be slightly uncomfortable.


1. Patient will be given powerful laxatives (e .g. Picolax) for 1-2 days before the procedure and/or enema onarrival so that the colon is empty and the operator can have a clear view.

2. For the 12 hours before the procedure have fluids only (no solids in diet), but you can eat a light breakfaston the morning just before the procedure.

During the Procedure1. You will be asked to sign a consent form to ensure you understand the procedure.

2. You will be given a hospital gown and asked to lie on your side with your knees to your chest.

3. Doctor/nurse will insert a gloved, lubricated finger into your back passage to check for blockages.

4. Sigmoidoscope is lubricated and gently passed through the rectum.

5. Air is blown into the back passage which may make you feel bloated or like you want to pass wind or moveyour bowels - this is completely normal, dont feel embarrassed!

6. The doctor/operator may take a sample of tissue (biopsy) to send to the lab for testing/to look at under amicroscope, or remove polyps (small lumps of tissue which hang from the inside lining of the colon), which areboth painless.

7. Sigmoidoscope is then gently pulled out and procedure is done.

8. The procedure lasts 20 30 minutes.

After the Procedure

1. You will be able to dress yourself and then rest until you are ready to go home.

2. No sedation given !no restrictions.

3. Can eat normally after the procedure.

4. Risks/Complications:BloatingWind/crampy pains and wind after the procedure.Small amount of blood in stoolDamage/perforation of lower part of bowel - severe abdominal pain, bloody bowel movements,

rectal bleeding, fever - contact a doctor immediately.May require colonoscopy or repeat sigmoidoscopy.

5. They will be followed up in clinic in a few weeks - operator will send results to the dr.

6. Ask the patient if they have any more questions, anything to be clarified.



6/21

Despite all the newer, more sophisticated forms of scanning, a plain X-ray is still one of the most sensitive ways ofdetecting many problems.

It may be all that is needed to diagnose or assess various problems or monitor treatment.

Indications Pneumonia, pneumothorax, lobar collapse, pleural

effusion, TB, pulmonary oedema, PE Congestive heart failure

Interstitial lung disease

Bone fractures Hiatus hernias

ZG 6

5. CHEST X-RAY

Introduction



3. Ask if theyve had an x-ray before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneAn x-ray machine produces short bursts of x-rays that pass easily through fluids and soft tissues ofthe body, but are blocked by dense tissues such as bone. A film, like a photographic film, is placedbehind and when the X-rays hit it, a picture is made, which will enable the doctors to have a look atthe structures inside your chest. Usually done erect and PA.


1. Ask the patient if there is a chance they are pregnant - (small risk the x-rays may cause harm to the unbornchild). She may be advised not to have the x-ray.

2. You wont need to do anything to prepare - just turn up for the appointment.

3. Explain that the patient will have to change into a gown.



2. Explain that the patient will be standing against part of a machine in the x-ray room and that theradiographer will be behind a screen - pt will be seen and heard at all times.

3. i.You have to place your hands on your hips and move your elbows forward, so your shoulder blades dontobscure your lungs.ii. A lead apron will be worn to protect the lower part of your body.iii. You will be asked to stay still to prevent blurring the images.iv. Then you take a deep breath and hold while the radiographer presses a button, that passes the X-raysthrough you for a fraction of a second.v. You might hear a slight whirring noise as the machine becomes fully running, but you will be unaware of thefraction of a second when the X-ray source is active.

4. Completely painless. You cannot see or feel the x-rays.

5. The process of taking the film will last only a few minutes, but the radiographer may need to take further X-rays at different exposures or positions. This usually takes no more than 5 - 10 minutes.

After the Procedure

1. You are free to leave once the procedure is complete, you can go home on the same day and resume allnormal activity.

2. X-ray pictures are then analysed and a report is sent from the x-ray doctor to whoever requested the x-ray.This may take some time to reach your referring doctor, but is normally available in less than 14 days. Youcould ask the radiographer or radiologist for some indication of time.

3. Risks/Complications:explain to the patient that there is a very small chance the x-ray damage may cause cancer - risk is

comparable to one days worth of exposure to sun.

may cause harm to the unborn child of pregnant women

4. Tell the patient that they will be followed up in clinic in a few weeks.

5. Ask the patient if they have any more questions anything needing clarification?



7/21

Indications

Diagnostic purposes e.g. for acute abdominal pain Progression of an illness or after treatment

Renal colic: KUB Intestinal obstruction: erect and supine films may be used; may also see fluid levels Perforated bowel: erect film will show gas under the diaphragm Appendicitis: ltd value at point of management Intussusceptions: characteristic gas patterns; USS is better

Detection of foreign bodies

ZG 7

6. ABDOMINAL X-RAY

Introduction



3. Ask if theyve had an x-ray before and what they already know.


5. Tell the patient briefly what the procedure is and why it is being done.An x-ray machine produces short bursts of x-rays that pass easily through fluids and soft tissues ofthe body, but are blocked by dense tissues such as bone. A film, like a photographic film, is placedbehind and when the X-rays hit it, a picture is made, which will enable the doctors to have a look atthe structures inside your tummy. Usually done supine and AP.


1. Ask the patient if there is a chance they are pregnant - (small risk the x-rays may cause harm to the unbornchild). She may be advised not to have the x-ray.

2. You wont need to do anything to prepare - just turn up for the appointment.

3. Explain that the patient will have to change into a gown.



2. Explain that the patient will be standing against part of a machine in the x-ray room and that theradiographer will be behind a screen- pt will be seen and heard at all times.

3. i. You will be asked to stay still to prevent blurring the image.ii. Will be asked to take a deep breath in and hold it for a few seconds.iii. hen you take a deep breath and hold while the radiographer presses a button, that passes the X-raysthrough you for a fraction of a second.iv. You might hear a slight whirring noise as the machine becomes fully running, but you will be unaware of thefraction of a second when the X-ray source is active.

4. Completely painless. You cannot see or feel the x-rays.

5. The process of taking the film will last only a few minutes, but the radiographer may need to take further X-rays at different exposures or positions. This usually takes no more than 5 - 10 minutes.

After the Procedure

1. You are free to leave once the procedure is complete, you can go home on the same day and resume allnormal activity.

2. X-ray pictures are then analysed and a report is sent from the x-ray doctor to whoever requested the x-ray.This may take some time to reach your referring doctor, but is normally available in less than 14 days. Youcould ask the radiographer or radiologist for some indication of time.

3. Risks/Complications:explain to the patient that there is a very small chance the x-ray damage may cause cancer - risk is

comparable to one days worth of exposure to sun.may cause harm to the unborn child of pregnant women

4. Tell the patient that they will be followed up in clinic in a few weeks.

5. Ask the patient if they have any more questions anything needing clarification?



8/21

ZG 8

7. BARIUM SWALLOW/MEAL/FOLLOW THROUGH

Introduction



3. Ask if theyve had a barium swallow before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneX-rays are taken of your oesophagus, stomach and small intestine as you drink a white liquid thatcontains some barium sulphate. The barium meal helps the stomach and intestine to show up moreclearly. You will then be asked to lie on a couch. You may be asked to swallow some bicarbonatepowder and citric acid before swallowing the barium- these fizz in the stomach and make gas. The gasexpands the stomach and duodenum. The gut doesnt show up too well on a normal X-ray, so we canuse a white liquid drink to help show the organs up.


1. Tell the patient that they will be asked not to eat or drink for 4-6 hours before the test.

2. Ask the patient if they are allergic to any medication and that they are able to continue with their own meds.

3. Tell your doctor if you have IDDM so that they can arrange the best time for you to stop eating and for thetest to be done.

4. Ask the patient if there is a chance they are pregnant - (small risk the x-rays may cause harm to the unbornchild). She may be advised not to have the procedure.

5. Tell the patient they will need to change into a gown and their obs will be taken.



2. Explain that the patient will have to swallow some fruit-flavoured barium liquid, which is safe.

3. May be given an injection to relax the muscles in your gut.

4. i.Barium swallow:explain that the patient will then have to stand in front of an x-ray machine whilst x-rays are takenii. Barium meal: you lie on a couch (similar to barium enema). May be given bicarbonate powder and citricacid before swallowing barium- these fizz up when they mix in the stomach and make some gas. You may beasked to move around in different positions. You may also be given an injection of a drug that makes themuscles in the stomach and gut relax.iii. Barium follow through: they look at the small intestine so you wait 10-15 minutes before x-rays aretaken

5. Explain that x-rays are then taken, which are quite small dose and safe

6. Explain that the procedure lasts 15-30 minutes.

After the Procedure

1. They can eat normally.

2. May feel a bit sickly and constipated afterwards. Drink lots of fluid and eat plenty of fruit for a day or so. Goto your GP if you havent passed any stools for 3-4 days.

3. They will be able to go home on the same day, but they may want to stay by a toilet for an hour

4. They should be escorted home and not operate any heavy machinery or drive

5. Risks/Complications:Some people get sick for a few hoursBarium might make them constipated so see a doctor if they havent passed stool for 3 daysTheir stool may be white/pale due to the barium, and that this will last for about 1 dayThe injection to relax their muscles may cause some vision blurring so do not drive

6. They will be followed up in clinic in a few weeks

7. Ask the patient if they have anymore questions.



9/21

Indications Assess stomach problems that cannot be seen

on a normal x-ray Vomiting a lot

Vomiting blood Difficulty swallowing (dysphagia)

Barium Swallow

Drink barium liquid - often pleasant to taste (fruity)! Stand in front of X-ray whilst pictures taken as you swallow. Test aims to look for problems in the oesophagus (gullet), such as a stricture (narrowing), hiatus hernias, tumours,

reflux from the stomach, disorders of swallowing, etc. You will usually be asked not to eat or drink for a few hours before this test. A barium swallow test takes about 10 minutes.

Barium Meal Aims to look for problems in the stomach and duodenum such as ulcers, polyps, tumours, etc. You drink some barium liquid, but you then lie on a couch whilst X-ray pictures are taken over your abdomen. It

may take a little longer to do than a barium swallow. So that the barium coats all around the lining of the stomach, the doctor doing the test (radiologist) may do one

or more of the following:o

Ask you to swallow some bicarbonate powder and citric acid before swallowing the barium. These 'fizzup' when they mix in the stomach and make some gas. (You may have to resist the urge to burp.) The gasexpands the stomach and duodenum and also pushes the barium to coat the lining of the stomach andduodenum. This makes the X-ray pictures much clearer, as it is the shape and contours of the lining of thestomach and duodenum which need to be seen most clearly on the pictures.

o Ask you to turn over on to your stomach on the couch. Various X-ray pictures may be taken whilst youare in different positions.

o Give you an injection of a drug that makes the muscles in the stomach and gut relax. You will usually be asked not to eat anything for several hours before this test. (Food particles in the gut can make

it difficult to interpret the X-rays.) However, you may be allowed sips of water up to two hours before the test.

Barium Follow Through This test is similar to a barium meal but aims to look for problems in the small intestine. You drink the barium liquid but then need to wait 10-15 minutes before any X-rays are taken. This allows time for

the barium to reach the small intestine. You may then have an X-ray every 30 minutes or so until the barium is seen to have gone through all the small

intestine and reached the large intestine (colon).

ZG 9


10/21

ZG 10

8. BARIUM ENEMA

Introduction



3. Ask if theyve had a barium enema before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneX-rays are taken of your large intestine, and to make the images much clearer we will place what wecall an enema into the back passage which contains a liquid that makes x-rays come up very clearly this contains barium, and we need to do this to find out why you have your symptoms.


1. Explain that the patient must take powerful laxatives (e.g. Picolax) to clear the stool from the gut.

2. i.Ask the patient if they are allergic to any medication and tell them that they are able to continue with theirown meds.ii. If youre taking iron tablets, please stop taking them a day before the test.iii. You will also be advised on the kind of food to eat 24 hours before the test. You will most likely be advised

to eat light food.iv. Tell your doctor if you have IDDM, so that you can arrange for the best time for you to stop eating and forthe test to be done.v. Ask the patient if there is a chance she is pregnant - (small risk the x-rays may cause harm to the unbornchild). She may be advised not to have the procedure.

3. Tell the patient they will need to change into a gown and their obs will be taken



2. You will lie on their side a small tube will be put up the back passage by a few centimetres.

3. Barium liquid and some air (to push contrast towards the walls) are passed into the large intestine - trappedwind (wind pains).

4. May have to move around to help the barium reach the caecum.

5. May be given an injection to relax the bowel muscles.

6. Explain that x-rays are then taken with you in different positions, which are quite small dose and safe. Allowslooking at the bowel from different angles.

7. Explain that the procedure only lasts 20 minutes.

After the Procedure

1. Risks/Complications:Some people feel sickly for a few hoursBarium might make them constipated drink lots, eat fruits. See a doctor if they havent passed stool

for 3 daysStools are white/pale due to the barium, and that this will last for about 1 day

The injection to relax their muscles may cause some vision blurring so do not driveTell the patient that very rare complications include perforation of the colon and an allergic reactionto the injection.

2. Tell the patient they will be able to go home on the same day, but they may want to stay by a toilet for anhour due to trapped air and stomach cramps. Can eat normally straight afterwards.

3. Tell the patient that they should be escorted home and not operate any heavymachinery or drive

4. Tell the patient that they will be followed up in clinic in a few weeks

5. Ask the patient if they have any more questions.


Indications

Continuousdiarrhoea

Anal bleeding Lower abdominal

pains

Polyps Inflammation Narrowing of colon Tumours Diverticular disease


11/21

Indications Stones - kidneys, ureters. Recurrent infections of the bladder or kidney. Haematuria - blood in urine. Any obstruction or damage to any part of the urinary tract can often be seen on an IVU. Renal cell carcinoma Hydronephrosis

ZG 11

Introduction



3. Ask if theyve had an IVU before and what they already know.


5. Tell the patient briefly what the procedure is and why it is being doneThe urinary system does not show up well on ordinary x-ray pictures, but with intravenous urographya contrast dye is injected into a vein. The dye travels in the bloodstream, concentrates in the kidneysand then a series of x-ray pictures are taken. The dye blocks the x-rays coming through onto the film,helping to make a picture. The dye is then passed out into the bladder with urine made by thekidneys.


1. The patient may have a blood test to check that they are not in renal failure, because kidneys need to work.Let the doctors know if you have any kidney problems.

2. Tell your doctor if you have any allergies, especially allergy to contrast dyes such as iodine.

3. You cannot eat for several hours before the test to make sure the pictures come out as clear as possible.(discuss with doctor if youre IDDM, so we can arrange a schedule that suits you).

4. You may be given laxatives for a day or so before the procedure to clear the bowel to make pictures clearer.

5. Patients should stop Metformin for 2 days before the procedure because of the interaction with iodine inthe dye affects the kidneys.

6. Pregnant women, if possible, should not have an x-ray as there is a small risk that it may cause harm to theunborn child.



2. Will change into a gown. The patient will have a contrast dye injected into a vein, which may sting slightly.

3. Lie down on a couch and stay in that position for each x-ray. X-rays are taken every 5-10 minutes, and they

may be asked to empty their bladder before the final picture.3. The procedure lasts 30-60 minutes.

After the Procedure

1. They can go home as soon as the procedure has finished.

2. They can eat normally after the procedure.

3. Risks/ Complications:The dye may cause a warm feeling and metallic taste in the mouth (short term).A small number of people get an allergic reaction to the dye: may get itchy skin rash, mild lip

swelling, breathing difficulties, collapse (anaphylaxis) VERY RARE, treated immediately.A rare complication can be kidney failure.

4. They will be followed up in clinic in a few weeks with the results.

5. Ask the patient if they have anymore questions or if anything needs clarifying


9. INTRAVENOUS UROGRAM/PYELOGRAM


12/21

IndicationsA CT scan can be done on any section of the head or body to give clear images of bones, muscles, organs.

Detect suspected abnormalities in the body. To give a surgeon a clear picture of an area of your body before certain types of surgery.

To pinpoint the exact site of tumours prior to radiotherapy.

Study brain and CSF- including after strokes.

ZG 12

10. COMPUTED TOMOGRAPHY (CT) SCAN

Introduction



3. Ask if theyve had a CT scan before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneA CT scan is a special x-ray test which can give extremely good pictures of the inside of your bodywhich do not show up on normal x-ray pictures. The scanner is like a polo mint which you have to liein - you will be asked to lie on a bed and keep still as a ring rotates around your body, taking pictureswith x-rays as it does so. The pictures are more detailed than a normal x-ray.


1. Ask female patients if there is a chance she is pregnant - (small risk the x-rays may cause abnormalities in theunborn child). She may be advised not to have the CT scan.

2. If you are diabetic - speak to your doctor about fasting for a few hours.

3. Asked to remove all metal objects from their body. Do not to wear clothes with metal zips, studs.

4. Patient will not be allowed to eat or drink for a few hours before the procedure.

5. i. Abdominal & Pelvic scans: 1 hour before test, you may be asked to drink a special contrast this

will help show your gut better.ii. Pelvic scans: you may have contrast enema given before the procedure where fluid is pushed into yourback passage through a tube that is gently placed into your bottom. Women may be asked to insert a tamponin their vagina.ii. Urinary scans: IV line placed into your arm and contrast dye injected through it - may sting, cause warmfeeling or leave a metallic taste temporarily.


1. You will be asked to sign a consent form to ensure you understand the procedure. Change into a gown.

2. May have contrast dye injected into a vein - may sting slightly, warm feeling, metallic taste.

3. Some patients feel anxious or claustrophobic, so are given a sedative to help them relax.

4. Asked to stay as still as possible on the bed as otherwise the scan pictures may be blurred.

5. The x-ray machine and x-ray detector both rotate around your body, always being opposite each other. Thisallows various images from different angles to be taken

6. Completely painless - may be uncomfortable keeping still for so long.

7. The procedure lasts 20 60 minutes.

After the Procedure

1. They can go home as soon as the procedure has finished, but need to be escorted if they were given asedative may be unable to drive.


3. Should not drive, operate machinery or drink alcohol until 24 hours after the procedure.

4. Risks/Complications:X-ray dose is generally quite low in CT so risk of harm is small.Drowsy - sedative.

Warm feeling and metallic taste in the mouth (short term).A small number of people get an allergic reaction to the dye: may get itchy skin rash, mild lipswelling, breathing difficulties, collapse (anaphylaxis) VERY RARE, treated immediately.

A rare complication can be kidney failure due to the dye.

5. They will be followed up in clinic in a few weeks, with the results.

6. Ask the patient if they have any more questions.



13/21

Indications Whether other tests e.g. X-rays do not give enough information. Detailed pictures of brain and spinal cord, slipped discs, brain tumours, blood flow in BVs, kidney transplants Torn ligaments around joints (used a lot in sports injuries). Diagnosis and planning for treatment of CA

ZG 13

Introduction



3. Ask if theyve had an MRI scan before and what they already know.

4. Ask the patient what they would like to know and if they have any concerns.5. Tell the patient briefly what the procedure is and why it is being done:

An MRI scan is a special scan that is safe and painless and provides detailed pictures of the structuresinside your body. You lie on a bed/couch that moves you through a small 1.5m tunnel and the MRImachine takes pictures around you. It may be a bit noisy - given headphones/music.


1. Patient will not be able to eat and drink normally and take your medication before the procedure - IDDM.

2. You may be asked to fill a safety questionnaire before the scan asking about any metal within your body. Tellthe doctor if you have any allergies.

3. Patient will be asked to remove all metal objects from their body- let the operator know if you have anymetal in your body (pacemakers/defibrillators, hearing aids, surgical clips, artificial heart valves, metal limbs/joint, pins, screws, staples, fragments in eyes, etc.) or if you have any tattoos that have metal inside.

4. In some cases you may need to have an X-ray before the MRI to identify metal.

5. Ask the patient if there is a chance they are pregnant - it is advised not to perform MRIs on pregnantwomen as the effects of strong magnetic fields on a developing baby are not yet known.



2. The patient may have a contrast dye injected into a vein in their arm (may sting slightly) - gives betterpictures.

3. You will have to lie down on a couch and keep completely still - this may be a bit uncomfortable. The couchwill then gently slide into the scanner, which looks like a tunnel surrounded by a large circular magnet.

4. The scan itself is painless.

5. Operator will be in next room observing through a window- you can talk to them.6. Monitoring your heart rate, blood pressure and oxygen levels.

7. Some patients feel anxious so may be given a sedative to help them relax.

8. Scanner is quite noisy so you may be given headphones to protect your ears - music.


After the Procedure

1. Can go home immediately after procedure, but need to be escorted if they were given a sedative.

2. They can eat normally and carry on as normal after the procedure.

3. Risks/ Complications:

MRIs are painless. Unlike other scans, MRIs do not use radiation.The dye may cause a warm feeling and metallic taste in the mouth (short term).A small number of people get an allergic reaction to the dye (anaphylaxis).A rare complication can be kidney failure.Pregnant women may be advised not to have the scan, as the effects of strong magnetic fields on a

developing baby are not yet known.

4. They will be followed up in clinic in a few weeks with the results.

5.. Ask the patient if they have anymore questions, clarification.


11. MAGNETIC RESONANCE IMAGING (MRI) SCAN


14/21

Indications Size, shape and consistency of organs, structures and abnormalities. During an operation, if the surgeon needs to inspect a structure or monitor. Monitor the growth of an unborn child, and check for abnormalities- ultrasound scans are routine in pregnancy. Appendicitis Gynaecological symptoms Gallstones Cysts Free fluid around the kidney Pancreatitis Abscess- especially liver

Breast Pathology Aneurysms Infections Blocks in blood vessels (see Doppler)

ZG 14

Introduction



3. Ask if theyve had an ultrasound before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneThis is a painless test that uses sound waves to create images of organs and structures insideyour body. It is a harmless test because there is no radiation. A small hand-held sensor, which

is pressed carefully against the skin surface, both generates sound waves and detects anyechoes reflected back from solid structures creating a picture of your internal organs. The

sensor can be moved over the skin to view the organ from different angles, the picturesbeing displayed on a screen.


1. The patient should eat and drink normally before the test, or may be asked not to eat for a few

hours if certain parts of abdomen being scanned:May be asked to eat a low fibre diet 2-3 days before ultrasound to decrease gas in gut.Gallbladder/ Pancreas: do not eat for 12 hours before scan- drink only clear fluids.Liver/ Kidneys: avoid fizzy drinks and beans for 1-2 days before test (wind/gas in bowel may

obstruct view).Bowel: need to eat a low fibre diet and may be given enema.Bladder/Pelvis: may need to have a full bladder - drink 1-2 pints of water before test.

2. You may be asked to change into a hospital gown, let us know if you have any allergies. Only alubricating jelly will be used, but its helpful to know.



2. Lubricating jelly is put onto your skin - can be slightly cold.

3. A probe (like a thick, blunt pen) is then put over the jelly and onto your skin.

4. The probe is connected to a monitor. It is moved around at different angles and you may also be

asked to move around to help get the best image, which will come up on the monitor.

5. When enough images are taken, probe will be removed from your chest and the jelly wiped off.

6. Completely painless - only discomfort is if the operator needs to press the probe firmly.

7. The scan takes 15-45 minutes.

After the Procedure

1. They can go home as soon as the procedure has finished.


3. There are no complications - no radiation.

4. They will be followed up in clinic in a few weeks

5. Ask the patient if they have anymore questions, if anything needs clarification.


12. ULTRASOUND SCAN


15/21

Indications Valve function (stenosis or regurgitation) Heart failure Pericardial effusion Post-MI looking at function and damage Hypertrophic cardiomyopathy LV hypertrophy

Coronary Artery Disease & Ischaemic Heart Disease Congenital heart disease Aortic aneurysm/ aortic dissection Masses within heart

Doppler echocardiographyThis can measure variations in blood flow in different parts of the heart (e.g. it can detect turbulent flow next to a

damaged valve) and can assess how well the heart valves are working.Stress echocardiogramThis test is done to see how the heart responds to 'stress' such as exercise. In this test your doctor may do an ECHO as described above during or soon after exercise. Or you may be given a

medication that causes the heart to beat harder and faster.Transoesophageal echocardiography In this test you swallow a probe that is attached to a thin tube connecting it to the ultrasound machine. This views

the heart from within the oesophagus (gullet) which lies just behind the heart. Imager clearer than normalechocardiogram. Done when a very detailed picture is needed. For example, to assess valves before surgery is doneto repair damaged valves, or to assess the extent of infection of a heart valve.

ZG 15

13. ECHOCARDIOGRAM

Introduction



3. Ask if theyve had an echo before and what they already know.


5. Tell the patient briefly what the procedure is and why it is being doneThis is a painless test that uses sound waves to create images of the heart. It is a harmless testbecause there is no radiation. A small hand-held sensor, which is pressed carefully against the skinsurface, both generates sound waves and detects any echoes reflected back creating a picture of yourheart. The sensor can be moved over the skin to view the heart from different angles, the picturesbeing displayed on a screen.


1. You can eat and drink normally and take your medication.

2. Tell your doctor if you have any allergies, even though this test will only involve a cool jelly being rubbedonto your chest.

3. You will be asked to change into a hospital gown and/or prepare to undress down to your waist.



2. Your chest will need to be exposed.

3. The operator will spread some lubricating jelly (cool) over your skin and then move the probe (which lookslike a thick, blunt pen) over your skin to get a clear picture. The probe is connected by a wire to a monitor,which displays the picture.4. You may hear a whooshing noise as the probe detects your blood flowing if the volume is on.

5. The probe is moved around at different angles and you may also be asked to move around.


7. Completely painless - only discomfort is if the operator needs to press the probe firmly.


After the Procedure

1. They can go home as soon as the procedure has finished

2. They can eat normally and continue medication normally after the procedure.

3. Risks/Complications Very safe procedure. No significant risks other than perhaps an allergic reaction to the jelly.

4. They will be followed up in clinic in a few weeks where your doctor will discuss your results with you.

5. Ask the patient if they have any more questions or if anything needs clarifying?



16/21

Doppler is just the sound - no image of vasculature is produced.

Indications Abdominal aneurysm Arterial occlusion Carotid occlusive disease Renal vascular disease Varicose veins Venous insufficiency Blood flow in arteries and veins To diagnose Stenosis Used regularly in Obstetrics

ZG 16

14. ULTRASOUND DUPLEX SCAN

Introduction



3. Ask if theyve had a Doppler before and what they already know


5. Tell the patient briefly what the procedure is and why it is being doneThis is a painless test that uses sound waves to measure the blood flow in your blood vessels. It is aharmless test because there is no radiation. A small hand-held sensor is pressed carefully against theskin surface after lubricating jelly has been spread over it. The sensor both generates sound waves anddetects any echoes reflected back information on your blood vessels. The sensor can be moved overthe skin to get a clear picture. You may hear a whooshing sound if the volume is on.


1. Outpatient test. You can eat and drink normally before the test and continue to take your usual medication.

2. You may be asked to change into a hospital gown. It is better to wear a top with short or loose sleeves andbottoms that can be rolled up.

3. You may be asked to remove socks/tights and shoes.


1. You may be asked to sign a consent form to ensure you understand the procedure.

2. You lie on a couch. Your abdomen/legs will need to be exposed.

3. The operator will spread some lubricating jelly (cool) over your skin and then move the probe (which lookslike a thick, blunt pen) over your skin to get a clear picture. The probe is connected by a wire to theultrasound machine and monitor, which displays the picture.

4. You may hear a whooshing noise as the probe detects your blood flowing if the volume is on.

5. The probe is moved around to get different views of the blood vessel.


7. Completely painless- only discomfort is if the operator needs to press the probe firmly.8. Usually takes about 30 minutes, but you may need to allow 1 hour for time to rest before your bloodpressure is recorded (ABPI may be conducted).

After the Procedure

1. Can go home straight away.

2. Can eat and drink normally. Take your medication normally.

3. Risks/Complications: Dopplers are very safe - no radiation.

4. They will be followed up in clinic in a few weeks.

5. Ask the patient if they have anymore questions or if anything needs clarifying?



17/21

ZG 17

15. ERCP (Endoscopic Retrograde Cholangiopancreatography)

Introduction



3. Ask if theyve had an ERCP before and what they already know


5. Tell the patient briefly what the procedure is and why it is being done

ERCP stands for Endoscopic Retrograde Cholangiopancreatography.This is where an operator passes a flexible fibre optic telescope, called an endoscope, which is as thinas a pencil/no wider than my little finger, along the back of your throat to have a look at your bileducts, pancreas, gallbladder and liver. It has a bright light and a camera on the end which is connectedto a screen showing the pictures and allows the operator to get a good view. They may take samplesof tissue (biopsy) if needed. X-rays will also be taken - also painless.


1. Explain that the patient must not eat for at least 6 hours before the procedure, but can have small sips ofwater up until 2 hours before the procedure. Ask pt if they are IDDM - discuss with doctor to arrange thebest schedule for yourself.

2. Ask the patient if there is a chance they are pregnant - (small risk the x-rays may cause harm to the unbornchild). She may be advised not to have the procedure.

3. You may need a blood test to check how well your blood clots a day or two before the ERCP; may be

required to stop medications such as blood-thinners (Aspirin, Warfarin). Ask the patient if they are allergic toany medication.

4. You will be given a gown to change into and their obs (blood pressure, HR, RR, temperature) will be taken.



2. Local anaesthetic (numbs) sprayed into back of throat - bitter, or a lozenge to suck.

4. Usually given a mild sedative (drowsy, not asleep) to help you relax through a line in the back of your hand(cannula) - arrange for someone to drive you home.

5. You will be asked to lie down on your side on a bed/couch.

6. Endoscope passed gently through mouth - operator will ask you to swallow. Then it will be gently passedinto your stomach and duodenum and air will passed through to make the structures easier to see. This maymake you feel full and as if you need to burp - this is completely normal and nothing to be embarrassed about.

3. You may be given a dye (may sting) through a side channel in the endoscope to help the operator see the

ducts better - these dont should up very well on an ordinary x-ray otherwise.4. X-rays will then be taken with a dye to visualise the organs.

5. Explain the possibility of stent insertion to widen the area if narrowing is found.

6. Explain that if gallstones are found stuck in a duct, the doctor may remove them. If they are too large, wemay use a diathermy.

7. A small sample of tissue (biopsy) may be taken to be tested in the lab/looked at under a microscope.

8.. Painless, but may be uncomfortable.

9. 30 minutes- >1 hour (depending on what is done)

After the Procedure

1. Allowed to rest for a short while and then can go home as soon as the procedure has finished, but need tobe accompanied due to the sedative.

2. If had interventional ERCP (stone removed, stent inserted) may have to stay in hospital overnight.

3. You should not drive, operate machinery or drink alcohol 24 hours after having the sedative.

4. Risks/Complications: most ERCPs are done without any problemsSore throat (mild, only a day or so).Tired due to sedative. No driving, operating machinery or drinking alcohol for 24 hours.Slight risk of chest infection.Damage to gut, bile duct or pancreatic duct- may cause bleeding, infection, perforation. See a doctor if

you have any of the following within 48 hours post-ERCP: abdominal pain (worse than usual, notnormal heartburn), fever, difficulty breathing, vomiting blood (haematemesis).

PancreatitisRisk is higher if you are already in poor general health - benefits of procedure need to be weghed up

against the small risk of complications.

5. Tell the patient that they will be followed up in clinic in a few weeks where your doctor will discuss yourresults with you.

6. Ask the patient if they have anymore questions or if anything needs clarification.


Indications Choledocholithiasis (gallstones in CBD) Acute/chronic pancreatitis Dx of pancreatic or biliary malignancy

(endoscopic USS may be better)

Pancreatic divisum Dilatation of benign structures Manometry measures in sphincter of Oddi

dysfunction


18/21

Indications Lung perfusion scan (also called a 'VQ scan') can detect blood clots in the lungs (pulmonary embolus).

ZG 18

16. i. ISOTOPE LUNG SCAN (V/Q SCAN)

Introduction



3. Ask if theyve had an isotope scan before and what they already know.


5. Tell the patient briefly what the procedure is and why it is being doneA very small amount of radioisotope - a chemical which emits rays (thought to be relatively harmless)is put into the body, usually by an injection into a vein. Sometimes you may be asked to breathe it in/swallow, instead of or along with the injection - if required. You will have to wait a few hours for theradioisotope to travel to the lungs. Cells which are most 'active' in the target tissue or organ will takeup more of the radioisotope. This emits gamma rays which are detected by a gamma camera and apicture is generated. Hot spots = where a lot of rays are taken up; cold spots= less uptake.The term radioactive might seem alarming - please do not worry, the substances we use are safe.


1. Ask the patient if there is a chance they are pregnant or breastfeeding- she may be advised not to have theprocedure. If you have contact with children or pregnant women - let your doctor know.

2. You may eat and drink normally and take medication.

3. A chest x-ray may be taken before the isotope lung scan - very small risk of radiation. Pregnant?

4. No need to undress but must remove metal objects and jewellery.5. Any allergies - allergic to iodine?



2. Will have an injection in the vein of a small quantity of radioisotope, which is held up in lungs.

3. It then takes some time - sometimes several hours (depending on what is being scanned) - for theradioisotope to travel to the target organ. You may want to bring something to read.

4. You may be asked to have lots to drink to help to flush the radionuclide from your body.

5. You may be asked to empty your bladder of urine before the scanning begins.

6. You may have to breathe in special gas to give an image of the air supply to the lungs, which is deliveredthrough a mask.

7. You will be asked to lie still on the couch whilst each picture is taken (prevent blurring)- you may sometimesbe asked to sit up.

8. Completely painless procedure - other than sharp scratch when injection given.

9. The procedure lasts 20-30 minutes- depends on how many pictures are taken.

After the Procedure

1. They can go home as soon as the procedure has finished - generally no after effects; okay to drive.


3. Radioisotope will be passed out through your urine/faeces (colourless and rid in about 3 days) - you may beadvised to flush the toilet twice and wash your hands rigorously for a few days.

4. If you feel something is not right then please contact the GP immediately.

5. Risks/Complications:There is a small risk that the gamma rays may harm an unborn child. Women who are pregnant or

breastfeeding may be advised not to have the scans.Very slight increase in the risk of cancer due to the radiation - similar with X-rays.

If iodine is injected, it can cause an allergic reaction. (rare)Theoretically, you can receive an overdose when the chemical is injected - very very rare!6. They will be followed up as soon as possible with the results.

7. Ask the patient if they have anymore questions, anything to clarify,



19/21

IndicationsA radioisotope is used which collects in areas where there is a lot of bone activity (where bone cells are breakingdown or repairing parts of the bone). So a bone scan is used to detect areas of bone where there is cancer, infection,or damage. These areas of activity are seen as 'hot spots' on the scan picture.

ZG 19

16. ii. ISOTOPE BONE SCAN

Introduction





5. Tell the patient briefly what the procedure is and why it is being doneA very small amount of radioisotope - a chemical which emits rays (thought to be relativelyharmless) is put into the body, usually by an injection into a vein. Sometimes you may be asked tobreathe it in/swallow, instead of or along with the injection - if required. You will have to wait a fewhours for the radioisotope to travel to the bone. Cells which are most 'active' in the target tissue ororgan will take up more of the radioisotope. This emits gamma rays which are detected by a gammacamera and a picture is generated. Hot spots = where a lot of rays are taken up; cold spots = lessuptake. The term radioactive might seem alarming - please do not worry, the substances we use aresafe.


1. Ask the patient if there is a chance they are pregnant or breastfeeding - she may be advised not to have theprocedure. If you have contact with children or pregnant women - let your doctor know.

2. You may eat and drink normally and take medication.


4. No need to undress but must remove metal objects and jewellery.

5. Check for allergies - especially to iodine.




3. It then takes some time - sometimes several hours (depending on what is being scanned) - for theradioisotope to travel to the target organ. You may want to bring something to read or you may be able to goout and come back to the scanning room later in the day.


5. You may be asked to empty your bladder of urine before the scanning begins.6. You may have to breathe in special gas through a mask.

7. You will be asked to lie still on the couch whilst each picture is taken (prevent blurring) - you maysometimes be asked to sit up. More than one picture may be needed, can be several hours between eachpicture, will need the whole day. Make arrangements with work.


9. The procedure lasts 20- 30 minutes - depends on how many pictures are taken.

After the Procedure

1. They can go home as soon as the procedure has finished- generally no after effects; okay to drive.


3. Radioisotope will be passed out through your urine/faeces (colourless and rid in about 3 days)- you may beadvised to flush the toilet twice and wash your hands rigorously for a few days.


5. Risks/Complications:There is a small risk that the gamma rays may harm an unborn child. Women who are pregnant

or breastfeeding may be advised not to have the scans.Very slight increase in the risk of cancer due to the radiation - similar with X-rays. If iodine is injected, it can cause an allergic reaction (rare)Theoretically, you can receive an overdose when the chemical is injected - very very rare!

6.They will be followed up in clinic in a few weeks with the results.

7. Ask the patient if they have anymore questions or things to clarify.



20/21

IndicationsAreas of overactivity will show as 'hot spots' on the picture;areas which emit low levels of gamma rays may be shown as blue ('cold spots).

Check gland function Dx: hyperthyroidism, CA, other growths Assess nature of a nodule/lump

Detect abnormality- nodules/lumps, inflammation Spread of thyroid CA Evaluate changes after surgery, radiotherapy, chemotherapy

ZG 20

16. iii. ISOTOPE THYROID SCAN

Introduction






A very small amount of radioisotope - a chemical which emits rays (thought to be relatively harmless)is put into the body, usually by an injection into a vein. Sometimes you may be asked to breathe it in/swallow, instead of or along with the injection - if required. You will have to wait a few hours for theradioisotope to travel to the thyroid. Cells which are most 'active' in the target tissue or organ willtake up more of the radioisotope. This emits gamma rays which are detected by a computer and apicture is generated. Hot spots = where a lot of rays are taken up; cold spots = less uptake.The term radioactive might seem alarming - please do not worry, the substances we use are safe.


1. Ask the patient if there is a chance they are pregnant or breastfeeding - she may be advised not to have theprocedure. If you have contact with children or pregnant women, let your doctor know.

2. You may eat and drink normally. Doctor may ask that you stop certain medications before the test. May needto have thyroid function blood tests.


4. No need to undress but must remove metal objects and jewellery.5. Ask about allergies - especially to iodine. Taking any supplements?




3. It then takes some time - sometimes several hours (depending on what is being scanned) - for theradioisotope to travel to the target organ. You may want to bring something to read, may be able to leave andcome back.


5. You may be asked to empty your bladder of urine before the scanning begins.

6. You may have to breathe in special gas through a mask.

7. You will be asked to lie still on the couch whilst each picture is taken (prevent blurring) - you maysometimes be asked to sit up.


9. The procedure lasts 20-30 minutes - depends on how many pictures are taken. Scan may be repeated anumber of times over 24 hours.

After the Procedure

1. They can go home as soon as the procedure has finished - generally no after effects; okay to drive.


3. Radioisotope will be passed out through your urine/faeces (colourless and rid in about 3 days) - you may beadvised to flush the toilet twice and wash your hands rigorously for a few days.


5. Risks/Complications:There is a small risk that the gamma rays may harm an unborn child. Women who are pregnant or

breastfeeding may be advised not to have the scans.

Very slight increase in the risk of cancer due to the radiation - similar with X-rays. If iodine is injected, it can cause an allergic reaction (rare)Theoretically, you can receive an overdose when the chemical is injected - very very rare!

6. They will be followed up in clinic in a few weeks where your doctor will discuss your results with you.

7. Ask the patient if they have anymore questions, anything to clarify.



21/21

17. CYSTOSCOPY

Introduction



3. Ask if theyve had a cystoscopy before and what they already know.



This is a procedure where a doctor looks into your bladder with a special flexible, fibre-optictelescope called a cystoscope. This is about as thick as a pencil and the doctor can see around bendswith it. The cystoscope has a light and a camera on the end of it, which allows us to see pictures on amonitor which it is connected to. Itll be passed into the bladder through the tube which takes urinefrom the bladder to the outside of the body.


1. Usually done as an outpatient or a day case.

2. Ask the patient if there is a chance they are pregnant or breastfeeding - she may be advised not to have theprocedure if x-rays need to be taken. let your doctor know.

3. You may eat and drink normally, continue with normal medications - are you taking any blood thinners? Maybe given antibiotic injection.

4. Need to empty your bladder before the procedure - go to the loo.

5. You will need to wear a hospital gown.

6. Ask about allergies.During the Procedure


2. You may be given a sedative through a small line in the back of your hand (cannula) to help to relax. It wontput you to sleep. If this is done, you will need someone else to take you home.

3. You will lie back on a couch and the area at the end of the penis/outside the vagina will be cleaned. Theoperator will then apply some jelly into the opening to your bladder tube, which will help numb the area tomake it more comfortable for you as the cystoscope is passed through.

4. The doctor will then pass the cystoscope up into the bladder, where they will look at the inside of thebladder. Sterile water is passed down a side channel in the cystoscope to fill the bladder slowly which makes iteasier for the doctor to see the bladder. As the bladder fills, you will feel the need to pass urine, which may beuncomfortable.

5. Depending on why you need this investigation - the doctors may decide they need to remove a stone from

the bladder or a ureter (connection from kidneys which drains urine to the bladder. They may decide theyneed to obtain a urine sample from each of the ureters so they can check for infection, remove small growthsfrom the lining of the bladder (called a polyp), insert a stent, which is a small tube to help open out a narrowedureter, carry out a special x-ray test.

6. The doctor may decide that a small sample of tissue is needed to send to the lab/to look at under amicroscope. This isnt painful.

7. The cystoscope it then gently pulled out.

8.. The procedure lasts 5-10 minutes usually, may take longer if a sample is taken.

After the Procedure

1. Allowed to rest for a short while and then can go home as soon as the sedative has worn off, but need to beaccompanied due to the sedative.

2. You should not drive, operate machinery or drink alcohol 24 hours after having the sedative.?ask about work and taking time off if appropriate.

3. They can eat normally after the procedure.4. Risks/Complications:

Mild burning when passing urine for 24 hoursUrge to go more often than usualUrine may look pink due to mild bleeding, particularly if a biopsy was taken.Occasionally, a urine infection may develop - fever, pain on passing urine - seek medical help.Rarely, perforation of the bladder. Seek help if pain or bleeding is severe, lasts longer than 2

days.

5. Will be followed up in clinic in a few weeks, where youll be able to find out more details about the results.

7. Ask the patient if they have anymore questions - anything to clarify.


Indications Recurrent UTIs

Haematuria Incontinence Abnormal cells in urine sample Pain when urinating Difficulties in passing urine

Documents

MM Explaining Procedures Handbook