Preparation for your short stay knee replacement

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This booklet has been written by the teams who will look after you during surgery. It aims to help you understand the surgery, guide you through the various phases of your operation, and inform you how you can best prepare and recover afterwards.

You may be given a paper copy of this information which you should bring with you on the day of your surgery. 

This page contains the following information:

  • Preparing for your operation
  • On the day of your operation
  • Going home
  • Physiotherapy advice
  • Therapy advic

A joint replacement operation is done to improve your quality of life. It will hopefully allow you to do some of the things that have become difficult with your joint arthritis.

From the day you are admitted to hospital, the staff involved in your care will work together to assess your needs in preparation for leaving hospital.

We ask you to provide us with all the necessary information that will help with planning your hospital care and timely discharge, as early as possible.

You will need to make the arrangements for your own transport home prior to your admission. If you or your relatives/carers have any concerns about your hospital discharge or transfer, do not hesitate to ask a member of the team.

Discharge Lounge 

Where possible, discharge arrangements will be made so you are able to vacate your hospital bed. This may include transfer to the Discharge Lounge; we will prepare you and keep you informed.

The Discharge Lounge is a safe area providing nursing care and regular refreshments and meals, including breakfast, where you can wait to be taken home.

Pathway for recovery

Returning home as soon as safely possible, even on the same day as your operation

As a result of expert surgery, anaesthetics, and a highly skilled team of doctors, nurses, and allied health professionals, many patients will not need to stay in hospital overnight and will be ready to go home the same day.

This is the usual pathway in many orthopaedic centres across the country, providing an excellent standard of care with very positive results and patient feedback.

However, some patients may not be ready to return safely home the same day and will need a little longer. If this is the case, we would expect you to be able to go home the day after your surgery, or as soon as all teams treating you are satisfied.

We will only discharge you once you are recovered and able to safely return home.

Managing and understanding the process

It is important for you to have realistic expectations of having joint replacement surgery. You should have a clear understanding of what to expect at each stage. You must prepare appropriately for your surgery and work with the clinical teams you meet during your care.

Preparing for your operation

Prepare ahead

The weeks leading up to your operation are as important as the operation day itself.

After your surgery, you will either return home on the same day, or stay in hospital for just one night. You should plan ahead before your surgery and think about how things might be for you when you return home. You must also attend all your appointments before your surgery date.

Arranging transport

You should arrange for a family member or a friend to collect you after your surgery. The hospital does not routinely provide transport for your return home.

Assistance for after your surgery

You have probably been living with joint pain for some time before your operation and will already have ways of adapting to certain situations at home. However, when you are recovering from your operation you may also need some extra help with general tasks at first, like cooking, shopping, and cleaning. You must organise this help before your operation date. 

To make sure that your return home is successful and safe, you will need to have someone to stay with you overnight after your discharge, and for a few days after returning home. This is essential if you are to go home on the day of surgery.

Care agency support

Very few people need professional care support at home. The NHS can only provide professional care based on specifically assessed needs and cannot arrange convalescent care. If you choose to have help, not based on assessed need, you must arrange this privately.

Prepare your home

Preparing your home environment in advance is really helpful for when you get discharged.

For example, you can:

  • Freeze some simple to cook meals or have some ‘ready meals’ on hand.
  • Move any regularly used items that are heavy, or out of reach, to more accessible places, such as moving the saucepans you use frequently up from any low shelves or cupboards.
  • Avoid potential trip hazards by removing any loose rugs or obstacles from the floor such as excess furniture or things that would be easy to trip over.
  • Make arrangements for someone to care for any pets, including walking dogs, after your surgery.

Keep fit and healthy

The fitter you are before your operation, the less likely you are to have complications during and after your surgery.

You should seek to make some lifestyle improvements, such as:

  • Reducing alcohol intake.
  • Stopping smoking.
  • Keeping as mobile as possible and exercising.
  • Losing weight.

You should aim to control any long-term health conditions as well as possible before your operation to help prevent any complications, and to avoid your operation being postponed.

Check your own blood pressure if you are able to or get it checked at your GP. If it is above 160/90 you are likely to require medication and the sooner this is started, the sooner we will be able to go ahead with your surgery.

Similarly, if you have diabetes and your HbA1c has not been checked for 6 months or was over 69mmol/mol the last time it was checked, please arrange to have this checked again, and work with your diabetic adviser to improve it.

It is very unlikely that your surgery will be done if your diabetes is not well controlled and your HbA1c is above this value.

The pre-operative assessment process is important as it helps the hospital plan your care.

You will be asked by the hospital to provide some information about your general health and current medications. You may be asked to provide this information via:

  • Computer or mobile app.
  • Phone consultation.
  • Video consultation.
  • Face-to-face appointment.

This allows us to inform and advise you about your procedure, for example, we can provide you with instructions about medications and fasting times before your operation.

What details will be checked? 

At your pre-operative assessment appointments we will check various medical details such as: 

  • Your general health status.
  • Your blood pressure.
  • Your blood count to see if you are anaemic.
  • Your kidney functions.
  • How well you are controlling your diabetes.

Medicines

We will also review your medicines. It is fine to continue taking most medicines and to take them on the day of your surgery. However, there are certain medications we may need you to stop taking for a few days before your operation, such as:

  • Blood thinning/anti-clotting medications.
  • Some blood pressure medications.

We will give you clear instructions if this is needed and tell you when you should start these medications again after your surgery.

Ward staff will inform you of the pain relief that your surgical team have prescribed for you when you leave hospital. This discussion will also include advice about paracetamol. We advise patients to source their own supply if they are able to do so, in line with North Bristol NHS Trust Policy.

Do your physiotherapy exercises

The exercises on page 18 of this booklet should be completed both before and after your surgery. Doing these exercises before your operation will strengthen your muscles and will help you to recover more quickly after surgery.

On the day of your operation

You will be given a specific time to arrive, depending on the time of your operation.

Eating and drinking before your operation

You must follow the instructions about fasting times. It is important that you follow the fasting instructions correctly or your operation may be cancelled on the day. You must not have any food or milky drinks for 6 hours before your surgery. Please do not suck sweets or chew any sort of gum.

We encourage you to continue to drink plain water until you arrive at hospital and after your admission this will be provided according to your anaesthetist’s instructions.

What to bring with you to the hospital

  • All your current medication in original packaging.
  • Wear loose, comfortable day clothes to get dressed back into after your operation. Your leg may be swollen after surgery so make sure this is an appropriate size.
  • Flat, sturdy footwear with a back on it. No mules or sliders.
  • Overnight bag in case you are not ready to return home on the same day.
  • Glasses, hearing aids, walking aids that you might have.
  • Phone, charger, headphones, music devices, if you would like to listen to music during your operation.
  • It is also a good idea to bring something to read to keep you occupied in case you have a wait. Wi-Fi coverage can be variable.
  • Contact details of the person who will be picking you up.
  • Any letters you receive from the hospital giving you arrival instructions for the day of surgery.

Please try to avoid bringing in a large number of items with you and minimise items of high value or cash.

Arriving at the hospital

When you arrive, you will be greeted by a member of the reception team. They will book you in and confirm some details with you. You will then be seen by one of the nursing team who will run through some additional questions.

Confirming your consent form

The surgical team will confirm with you the operation they are planning to do and check your consent form. They will use a pen to draw an arrow on the leg that is going to be operated on.

They will be able to answer any last-minute questions you may have.

Meeting your anaesthetist

Before your operation, you will meet your anaesthetist. They will explain the type of anaesthetic that is going to be used and answer any questions you may have about the anaesthetic.

Getting ready for your operation

When it is time for your operation, you will be asked to change into a theatre gown. You will then walk to the operating theatre with one of the team. There, you will be greeted by your anaesthetist, and you will also meet the operating department practitioner, who works with the anaesthetist to look after you.

Routine checks

Some routine checks will be carried out to confirm your identity and to check if you have any allergies. We will confirm again your operation, and what side you are having it on.

Attaching monitoring equipment and a drip

One of the team will attach some standard equipment to monitor your heart, blood pressure, and oxygen levels while you are having your anaesthetic and operation.

Your anaesthetist will also be giving you various medicines through a drip in the back of one of your hands. These include antibiotics, anti-sickness medicines, and fluids.

Spinal anaesthetic

In some cases, your anaesthetist will give you a spinal anaesthetic. This is very safe, and avoids the need for having a general anaesthetic, which may cause unpleasant side effects.

Spinal anaesthetic also helps you to recover quickly and receive the best post-operative pain relief.

Local anaesthetic is placed around some of the nerves in your lower back. This numbs your pain nerves so that you do not feel pain during the operation.

The operation

Once you are in the operating theatre, your leg will be painted with some cleaning fluid and then covered with drapes. You will not be able to see the surgery and the local anaesthetic block will prevent you from feeling any of the operation.

Some people find listening to music through their headphones to be a good distraction. It helps them to relax, and this will be offered to you. You may wish to bring your own music on your phone or portable music device, and your own headphones.

Some people prefer to have a small amount of sedation so that they have a light sleep through their surgery. Your anaesthetist will discuss and agree with you a plan depending on your medical history, and your wishes.

The operation typically takes about 1.5 hours. During this time, your observations will be continually monitored by your anaesthetist.

After the operation

At the end of your operation, you will be transferred to the recovery area where the nurses will monitor your observations. You will be encouraged to eat and drink.

Once your anaesthetic has mostly worn off, you will be assessed by our nursing and therapy teams. They will help you get up, stand, and practice walking with walking aids. The team will practice with you getting on and off the bed, chair, and toilet. You will be encouraged to get dressed in home “day clothes” with supportive footwear (no mules or sliders). You will also be taught how to safely use the stairs.

To return home, the team needs to be happy that you can manage these activities at home with walking aids if required. If you require any equipment to assist you, this will be assessed and provided before your discharge. Please bear this in mind when organising your transport home.

Going home after your operation

Returning home

Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or if you need to stay overnight with us at the hospital.

Arrange for someone to collect you

When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital.

Arrange for support at home

If you live alone you will need to arrange for a friend or relative to stay with you overnight after discharge and for a few days after returning home. You should arrange this before you come in to have your surgery.

Wound dressing

Your wound is covered by a shower proof dressing so you can shower as soon as you feel able but do not aim water directly at the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound checked. Please leave any dressings in place and keep as dry as possible until this appointment. Seek advice if the dressing is wet or peeling off the wound.

Keep active after your operation

The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle.

Pain control

Joint replacement surgery is painful – just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild to moderate pain when moving. It is not going to be 100% pain free.

Arrows in a circle, the cycle of moving, reducing stiffness and swelling, less pain, and less medication and side effects.

The pain relief package you receive has been specially designed to try and control your pain as well as possible. It starts from the day of your surgery and continues after your discharge home. We will give you the same pain relief tablets whether you stay in hospital overnight or return home on the same day as your operation.

The pain relief package requires you to take your medicines at specific times.

Ward staff will inform you of the pain relief that your surgical team have prescribed for you, when leaving hospital. This discussion will also include advice regarding paracetamol, where we advise patients to source their own supplies if they are able to do so, in line with North Bristol NHS Trust Policy.

Additional medications

We will ask you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses.

What to expect when you get home:

Swelling: it is common to have some generalised swelling of the leg. Swelling will often get worse if you sit for a long time, so we encourage you to remain gently active. To help reduce lower limb swelling you may need to rest for at least 20 minutes in the morning and/or afternoon on the bed initially. If you have increasing swelling and pain, please seek medical advice.

Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain relief package. However, please make sure you take these as prescribed, along with drinking plenty of water. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP.

Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises. In the first couple of weeks it is vital to balance ice treatment with pain management and careful limited physiotherapy. Please make sure that you follow the pain management program you were discharged with to help control your pain.

Ice therapy can be very helpful in reducing swelling and pain after your operation. If you are given an ice band please make sure you take it home with you. If not, you can use a bag of frozen peas or similar at home. An ice band can be applied but if using frozen peas etc, wrap them in a damp tea towel/ pillowcase before applying to your leg.

Ice therapy can be used for up to 20 minutes. You should leave at least one hour after each ice therapy application to give your circulation time to recover. Make sure your wound dressing does not become wet.

If you have any of these conditions you should discuss this with your Physiotherapist before using any ice therapy:

  • Problems with your circulation.
  • Fragile skin.
  • Loss of skin sensation.

Difficulty sleeping: it is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. You can sleep in any position including lying on either side.

What to look out for

Deep vein thrombosis (or DVT) blood clots in the leg can happen after joint replacement surgery. If your leg becomes hard, swollen, hot, and painful, especially in the calf area then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms.

Infection is very rare. However, if your joint replacement or scar becomes hot, red and/or increasingly swollen, or if you feel unwell, then please seek medical assistance.

Support after discharge

The ward team will let you know what arrangements have been made for your follow-up appointments.

Following your discharge from hospital there is always someone you can contact for advice

If you would like more information before your operation or have any questions after you have been discharged home, or concerns about your wound, contact your Consultant’s Secretary in the first instance unless you have been given an alternative contact such as a Specialist Nurse/Practitioner.

For therapy related queries, please contact Physiotherapy admin 0117 414 4412 or Occupational Therapy admin 0117 414 1272.

Physiotherapy advice

Completing the exercises below will benefit your recovery, improve movement in the knee joint and develop the strength of muscles around it.

These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery. We recommend you continue these exercises for a minimum of 6 weeks after surgery. Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.

Total knee replacement exercises

Ankle pumps

Lying on your back, quickly point your toes up and down 10 times. 

Repeat every hour you are awake.

This exercise improves the circulation in the lower limbs, helps to prevent the formation of deep vein thrombosis (blood clots), and reduces swelling.

Ankle with toes pointed

Knee bracing (static quadriceps) exercises

Lying down or slightly reclined with legs straight. Pull your ankle up and push your knee down firmly against the bed. Hold 5 seconds- relax.

Repeat 10 times.

This exercise helps you to regain control of your knee ready for standing and walking. It also helps you to achieve a straight knee.

Leg lying on flat surface with toes pointed to the ceiling

Knee bending (flexion) on a sliding sheet

Lying down or slightly reclined with a sliding sheet under your heel. Bend and straighten your knee by sliding your foot up and down the sheet.

Repeat 10 times.

This exercise will improve your knee bend which is important for getting into a car and sitting. Your hamstring muscles will become stronger.

Knee bent with foot on bed

Straight leg raising

Lying down or slightly reclined. Lock your knee straight. Lift your whole leg 10cm (4 inches) off the bed. Aim to keep your leg absolutely straight. Hold for 5 seconds. Repeat 10 times.

This exercise challenges your thigh muscles and tests their ability to support you when you are standing.

Person lying on bed with straight leg raised

Knee stretch (posterior capsular) exercise

Lying with leg straight out in front of you, place a folded-up towel underneath your heel. Allow knee to straighten so you feel a stretch behind your knee. Hold for 30 seconds.

This exercise helps to stretch tight muscles at the back of your leg (hamstrings and calf muscles). If they are significantly preventing your knee from straightening, the Physiotherapist will advise you how often to repeat this exercise.

Person lying on bed with leg straight and ankle rested on a rolled up towel

Exercises in the sitting position

By the second day after your operation, you will begin to notice improvements in your knee bend, muscle power and walking.

The flexibility and bend of your knee is best achieved as soon as possible.

You may have an increase in knee stiffness when you wake up in the morning. This is because your knee is less active at night.

You will need to work hard in the morning to achieve the same range of movements you had the previous evening. Aim to improve range throughout the day.

Your physiotherapist will advise you when to progress to the next set of exercises.

Knee bending (flexion) in sitting

Sit on a chair with your feet on the floor. Bend your knee as much as possible.

Repeat 10 times.

This exercise helps your knee to bend. Your goal is to sit comfortably in a chair with your knee at a right angle as soon as possible. A good bend will be needed in the future for stairs and getting up from a chair.

Person sitting in chair with leg bent

Self-assisted knee bend exercises

Sitting, cross your legs at the ankles with your good leg on top of the operated leg. Use the good leg to help bend the operated leg backwards.

Repeat 10 times.

Person sitting in chair with one ankle on pushing the other back

Seated lunge exercises

Sitting, bend your operated leg, back as far as you can. Keep your foot flat on the floor and do not allow it to move forwards. Slide your bottom forwards on the chair.

Repeat 10 times.

This will help to bend your knee further.

Person in chair doing seated lunge

Knee bends/squats

Standing whilst holding onto a stable surface (as shown in the photo). Slowly bend your knees. Keep your heels on the floor. Slowly return to standing by straightening your knees.

Repeat 10 times.

This exercise encourages the muscles around the knee to work together in a smooth and coordinated fashion. It prepares your knee for getting up and down off low chairs and toilets.

Person standing with knees bent, holding onto support rail

Using a walking frame

For the first day after your operation, you will probably find that you feel more confident using a walking frame especially when walking unsupervised.

Follow this order of movements:

  1. Move the frame forward.
  2. Take one small step forward with your operated leg.
  3. Brace the knee of the operated leg.
  4. Step through with your other leg whilst using the frame for support.

Tip: do not walk too close to the front of the walking frame. 

Using sticks or crutches

Once you are confident with the walking frame you will progress to using sticks/crutches (whichever you and your therapist feel is most appropriate).

Advice for walking with sticks/crutches:

  1. Move sticks/crutches forward together.
  2. Step forward so the operated leg is level with the sticks/crutches.
  3. Place weight as necessary, through your arms onto sticks/crutches.
  4. Brace the thigh of the operated knee.
  5. Step your other leg forwards past your operated leg.
  6. When you feel confident enough to use only one stick/crutch, hold it in the opposite hand to your operated leg.

Walking

Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis, and to steadily increase the distance as you recover. It is normal to put full weight through your operated leg.

As soon as possible, try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking, continue to use your walking aids.

Stairs

The therapist will practice with you how to safely use the stairs before going home. To go up and down the stairs, use a banister rail if there is one.

Going down, put the crutch/stick on the step below then step down with the operated leg, followed by the unoperated leg.

Person going stairs with 2 walking sticks
Going down stairs with 2 walking sticks

Go up leading with the unoperated leg first, followed by the operated leg and then the crutch/stick.

Person going up stairs holding 2 walking sticks
Person going up stairs holding 2 walking sticks

 

 

 

Therapy advice

Sleeping

You may sleep in any position including lying on either side. It is essential that you do not sleep with your knee bent over a pillow. 

Getting dressed

We encourage you to get dressed into your own comfortable day clothes as soon as possible after your surgery rather than staying in pyjamas or a hospital gown.

Driving and car travel

You can travel as a passenger in a car immediately following your operation.

  • It is best to sit in the front seat, have someone move it well back.
  • If possible, get into the car directly from the drive or road rather than the kerb or pavement.
  • Use your arms to lower yourself onto the edge of the car seat.
  • Slide back into the seat.
  • Lift both legs in as your body turns to sit in the seat.
Getting out of a car
Getting out of a car

Stop regularly on longer journeys so you can get out of the car to change position and move around.

You should not drive until you are able to perform an emergency stop safely.

We recommend you inform your insurance company before you start driving.

Returning to full activities

At first you will need help with household tasks which involve carrying items or kneeling. Kneeling may be uncomfortable for the first few months. Sometimes the scar remains sensitive and not everyone finds it possible to kneel after a knee replacement.

You should be able to start your normal activities such as gardening or bowling as soon as you no longer need walking aids. This is normally 6 weeks after surgery.

You should not swim before your wound is fully healed.

Discuss your lifestyle and activities with your consultant at your clinic review at 6-12 weeks. They will be happy to advise you on returning to your normal activities.

The time of your return to work will depend on your job. Your consultant will advise you on this.

Equipment

The walking aids and any equipment prescribed to you after your surgery are provided by an equipment company. Please ring the number on the sticker on the equipment, to discuss its return.

© North Bristol NHS Trust. This edition published November 2024. Review due November 2027. NBT003722.

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Clinical Nurse Specialist Neuro Oncology (Surgery)

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Neuro-Oncology Clinical Nurse Specialist Team

The Neuro-Oncology Clinical Nurse Specialists are experts in cancer care; we work as part of the Cancer Support Team. We can answer your questions and give you information about your diagnosis, treatment, and the support available during and after your care.

Cancer Support Worker (CSW) 

The Cancer Support Team also has Support Workers. They are trained to provide support and provide information about physical, emotional, and practical concerns to help you self-manage your recovery and return to a healthy a lifestyle as soon as possible.

Personalised Care and Support Planning (PCSP)

Personalised Care and Support Planning is a conversation and assessment offered with your Clinical Nurse Specialist and/or Cancer Support Worker to help discuss your health and wellbeing in relation to your cancer. It will assess your individual needs and concerns, to understand what matters to you.

Personalised Care and Support Planning includes sharing information with you about diet, physical activity, fatigue, and other practical information relevant to you. This could include anything from emotional support to directing you to local support services, such as benefits advice.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare. When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual   preferences beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that might be helpful to ask:

  • What are my options?
  • What are the possible benefits and risks of those options?
  • What support and information is available to help me make my decision?

Shared decision making matters to us. Tell us what matters to you. 

NGS Macmillan Wellbeing Centre 

We give help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have any concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop ins’ for coffee and a chat, or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15

Phone number: 0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at or soon after the time of a cancer diagnosis.

The session provides:

  • Information about cancer and related topics that help you participate in your care and recovery.
  • The opportunity to meet other people with similar experiences.
  • Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

Useful contact information

Contact numbers

Please do not hesitate to contact any of the following numbers if you have any further questions or concerns about any aspect of your care not covered here. We are here to help:

In an emergency

Call 999 and go to your nearest accident and emergency department.

Clinical Nurse Specialists

  • Bea Coghlan (Lead CNS)
  • Kirsty Reeve (CNS)
  • Kat Russell (CNS)
  • Eleanor Shone (CNS)
  • Garry Pearce (Support Worker)

0117 414 7352

Monday to Friday, 08:00 to 15:30 (excluding bank holidays)

Use this number for questions about your condition, to report changes in symptoms, and advice on medication.

Consultant Secretaries

Use this number for clinic appointments, administrative questions including copy clinic letters, DVLA queries, and insurance queries etc.

Waiting list coordinators

Use these numbers for querying dates for surgery, pre-op appointments, and MRI scans. 

0117 414 8014 or 0117 414 6712
Monday to Friday, 08:00 to 16:00.

Wards

Medi-Rooms level 2: 0117 414 8025/0117 414 8026/0117 414 8027/0117 414 8028

Brain Tumour Support Charity 

0145 442 2701

They can help with: 

  • Emotional support.
  • Family support and guidance.
  • Practical support and next steps.
  • Counselling for you and loved ones.
  • DVLA/blue badge information
  • Support groups.
  • Employment support.
  • Finance and benefits guidance.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003712

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Macmillan Wellbeing Centre

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The NGS Macmillan Wellbeing Centre, at Southmead Hospital, offers support and information to anyone affected by cancer. Whether you are someone who has just been diagnosed; in the middle of, or finished treatment, or a friend, family member or carer of someone with cancer. 

Sarcoma Clinical Nurse Specialist and Support Team

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Who are we? 

The Sarcoma Clinical Nurse Specialist (CNS) is a registered nurse with specialist education and experience in sarcoma. We are your key worker, which means we are your main point of contact. We can answer questions, provide support during and after your care, and act as a patient representative in the sarcoma multi-disciplinary team (MDT) meetings.

What support and information will be offered? 

  • Support during your investigations and at diagnosis.
  • Verbal and written information on diagnosis and treatment options.
  • Answers to any questions about diagnosis, treatment, and end of treatment plan.
  • Directing you to other support such as a physiotherapist, dietician, finance and welfare services, and cancer information and support services.

Cancer Support Worker (CSW) 

The Cancer Support Worker is a non-clinical member of the sarcoma support team. They have received training to provide support and information about physical, emotional, and practical concerns to help you self-manage your recovery and return to as healthy a lifestyle as possible. 

Personalised Care and Support Planning (PCSP) 

Being diagnosed with sarcoma can be a frightening and unsettling time. It can affect many areas of your life.

The sarcoma service offers each patient a PCSP at diagnosis and after finishing treatment. This involves completing a simple questionnaire that allows you to highlight your concerns and to prioritise what matters most to you.

We offer you this assessment to ensure that wherever possible, your concerns and needs are being addressed. We can discuss additional support to help you manage your diagnosis, treatment, and beyond.

Our Sarcoma Cancer Support Worker, Hannah, will contact you two weeks after your diagnosis.

Areas covered by the PCSP may include:

  • Physical concerns: tiredness or fatigue, weight change, sleep, appetite.
  • Practical concerns: finances, transport or parking, housing.
  • Emotional concerns: uncertainty, sadness or depression, worries about the future, feeling a lack of control.
  • Family or relationship concerns: partner, children, person you care for.
  • Spiritual concerns: faith and spirituality.
  • General information and support: exercise and activity, diet and nutrition, health and welling.

This is personal to you, it might be that now is not the right time. The option to create a care and support plan is available to you at any stage of your diagnosis and treatment pathway. We encourage you to ask for one at any time you feel you need one. 

The Sarcoma Multi-Disciplinary Team 

The MDT is a team of specialists with experience in the diagnosis and management of sarcoma. The MDT is made up of: 

  • Clinical Nurse Specialists (CNS).
  • Plastic surgeons.
  • Oncologists.
  • Radiologists.
  • Histopathologists.
  • Thoracic surgeons.
  • Retroperitoneal surgeons.
  • The MDT coordinator.
  • Patient Pathway Coordinators.
  • Sarcoma Cancer Support Worker (CSW).

Making decisions about your healthcare

At NBT we encourage shared decision making. This is when patients work with healthcare professionals to make decisions about their healthcare plan and treatment. This makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments base on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments. You are always welcome to bring someone with you such as a family member or friend to your appointments.

Some questions that might be helpful to ask:

  • What are my options?
  • What are the possible benefits and risks of those options?
  • What support and information is available to help me make my decisions?

Shared decision-making matters to us. Tell us what matters you you. 

If you would like a PCSP or a supportive conversation sooner, please contact Hannah on 0117 414 7417.

The Sarcoma Clinical Nurse Specialist can be contacted on 0117 414 7453.

NGS Macmillan Wellbeing Centre 

We offer help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15
Phone: 0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at, or soon after the time of a cancer diagnosis.

The session provides:

  • Information about cancer and related topics that help you participate in your care and recovery.
  • The opportunity to meet other people with similar experiences.
  • Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

Further useful information

Sarcoma UK

The only cancer charity in the UK focusing on all types of sarcoma.

Home | Sarcoma UK

Cancer Research UK

Information about symptoms, causes, tests, scans, treatments, and current research.

Soft Tissue Sarcoma | Cancer Research UK

Macmillan Cancer Support

Information about diagnosis, treatment, side effects, and how to get further support.

Sarcoma | Macmillan Cancer Support

NHS

Soft tissue sarcoma information.

Soft tissue sarcoma - NHS (www.nhs.uk)

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003719

Support your local hospital charity

Southmead Hospital Charity logo

See the impact we make across our hospitals and how you can be a part of it. 

Macmillan Wellbeing Centre

MWBC Sign with Cherry Blossom

The NGS Macmillan Wellbeing Centre, at Southmead Hospital, offers support and information to anyone affected by cancer. Whether you are someone who has just been diagnosed; in the middle of, or finished treatment, or a friend, family member or carer of someone with cancer. 

Contact Sarcoma Cancer Nurse Specialists

Gynaecological Cancer Nurse Specialists

Regular Off Off

The Gynaecological Cancer Nurses

We are Clinical Nurse Specialists experienced in the care of individuals who are undergoing investigations for suspected gynaecological cancers or those who have been diagnosed.

We understand that waiting for test results and appointments can be a worrying time and we are available to help support you from the moment of referral, until you are either discharged from our service or your care has been taken over by the Gynaecological Cancer Team at St Michael’s Hospital, UHBW.

We are here to answer queries or concerns, and provide support and information to you, your family, and carers. We are part of a multidisciplinary team and there will be several different people involved in your care. We act as a ‘link’ to improve communication between them, you, and the wider cancer team.

We aim to: 

  • Meet you and your family during hospital appointments when possible, and provide advice and support.
  • Visit you on the ward if you are an inpatient.
  • Answer any questions you have about your illness, the tests you may need, and discuss treatment plans for you.
  • Provide phone, email, and face-to-face support.
  • Refer you to other services for support.
  • Liaise with community healthcare teams away from the hospital, such as district nurses, GPs, etc.
  • Make sure you understand what is happening at each stage of the investigation and/or treatment pathway.
  • Support you with concerns about cancer and treatment, symptoms and side effects.

Service availability

Monday to Friday (excluding bank holidays): 08:00 - 17:00

07899 011805

GynaeoncCNS@nbt.nhs.uk

If there is no answer, please leave us a message with your full name and hospital number if available. If we are in clinic or meetings, there may be a delay in returning your call. We aim to call you back as soon as possible. We do not have a weekend or bank holiday service.

Please note: this is not an emergency line. If your enquiry is urgent, you can contact 111 or your GP. If your enquiry is an emergency you should call 999.

Out of hours

If you are a patient already know to Southmead Gynaecology Department and are under investigation or have a confirmed cancer and are concerned about your symptoms, please call Cotswold Ward on 0117 414 6785.

If you have already had treatment at St Michael’s or are already known to the team please call UHBW CNS Team on 0117 342 5177 or Ward 78 on 0117 342 5278.

If you are currently having chemotherapy/radiotherapy treatment at BHOC please call the 24 hour Acute Oncology line on 0117 342 2011.

Personalised Care and Support Planning (PCSP)

This helps people living with cancer to have a say in how their care is planned and given. This means making sure the care matches what’s important to them.

This includes:

  • Having conversations to identify your concerns.
  • Developing a Personalised Care and Support Plan.
  • Sharing information about diet, physical activity, fatigue, practical information, emotional support, etc.
  • Directing you to local support services such as benefits.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare.

When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that may be helpful to ask:

  • What are my options?
  • What are the possible benefits and risks of those options?
  • What support and information is available to help me make my decisions?

Shared decisions making matters to us. Tell us what matters to you. 

NGS Macmillan Wellbeing Centre 

We give help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have any concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop ins’ for coffee and a chat, or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15

Phone number: 0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at or soon after the time of a cancer diagnosis.

The session provides:

  • Information about cancer and related topics that help you participate in your care and recovery.
  • The opportunity to meet other people with similar experiences.
  • Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

© North Bristol NHS Trust. This edition published September 2024. Review due September 2027. NBT003677

Support your local hospital charity

Southmead Hospital Charity logo

See the impact we make across our hospitals and how you can be a part of it. 

Macmillan Wellbeing Centre Useful Links

Useful links to partner websites such as Macmillan Cancer Support, Cancer Research UK, and Penny Brohn.

Macmillan Wellbeing Centre

MWBC Sign with Cherry Blossom

The NGS Macmillan Wellbeing Centre, at Southmead Hospital, offers support and information to anyone affected by cancer. Whether you are someone who has just been diagnosed; in the middle of, or finished treatment, or a friend, family member or carer of someone with cancer. 

Contact Haematology

Regular Off Off

Blood Transfusion

Telephone: 0117 4148350
On-Call Haematology BMS via bleep 9433

Autolab heldesk

Telephone: 0117 4148383
On-Call Haematology BMS via bleep 9433

Medical Staff

Dr A Whiteway
Consultant Haematologist
Head of Clinical and Laboratory Haematology
Via Haematology secretaries - Telephone: 0117 4148401

Dr Michelle Melly
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr M Kmonicek
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Samreen Siddiq
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Sophie Otton
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Jaroslaw Sokolowski
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Surenthini Salmon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Kiri Dixon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Laboratory Staff

Mrs Allison Brixey
Blood Sciences Manager
Telephone: 0117 4148416

Mrs Joanne Skingley
Blood Sciences Operations Manager
Telephone: 0117 4148498

Mr Tim Wreford-Bush
Lead BMS Blood Transfusion
Telephone: 0117 4148363

Dr Karen Mead
Specialist Practitioner of Transfusion
Telephone: 0117 4148358

Mrs Grace VanDerMee
Lead BMS Haematology
Telephone: 0117 4148356

Mrs Halina Collingbourne
Quality Manager
Telephone: 0117 4148354

Anticoagulation Monitoring Service

Please note that this service has moved to Pharmacy.

Llinos Jones
AMS@nbt.nhs.uk
Telephone 0117 4148405
Contactable from Mon-Fri 09:00 - 17:00

Secretaries Office

Telephone: 0117 4148401
Email: HaematologySecretaries@nbt.nhs.uk

Contact Haematology

Haematology Clinics

Regular Off Off

All clinics are held at Gate 5, Brunel building, Southmead Hospital, Bristol, BS10 5NB.

Referrals should be made to the Consultant Haematologists.

Monday am
General Haematology Clinic
Dr S Otton, Dr J Sokolowski Dr S Siddiq and Dr K Dixon

Tuesday am
General Haematology Clinic
Dr A Whiteway
Lymphoma Clinic
Dr K Dixon

Tuesday pm
Lymphoma Clinic, 
Dr S Otton week 1,3,5, Dr J Sokolowski- every week
Thrombosis Clinic
Dr M Melly

Wednesday am
Myeloma Clinic
Drs M Kmonicek and Dr A Whiteway
General Haematology Clinic
Dr S Salmon

Friday am
General Haematology Clinic
Dr M Kmonicek and Dr M Melly
Lymphoma Clinic
Dr S Salmon, Dr S Siddiq and Dr J Sokolowski

Haematology Clinics

Neuropathology Service

Regular Off Off

The Department of Neuropathology is based in the Pathology Sciences Building on the Southmead site of North Bristol NHS Trust.

The Head of Department is Professor Kathreena Kurian.

The department provides a UKAS accredited diagnostic neuropathology service (including nerve and muscle biopsies), for the Bristol area and regional hospitals, including those from the private sector.  It also provides a referral service both nationally and internationally.

The following services are provided by the department:

  • Clinical neuropathology support for neuroscience specialities.
  • Neurosurgical biopsy histology, including fully integrated reports with molecular biology.
  • Diagnostic pathology of muscle and nerve, including in-house biopsy facilities.
  • Neuropathology autopsies.
  • Macroscopic assessment of fixed brain and spinal cord specimens.
  • Post-mortem neurohistology including work for H.M. Coroner and forensic service.
  • Cerebrospinal fluid cytology.

Neuropathology Requesting

Neuropathology request forms are available from the Neuropathology Department and should be completed in full.

Each request received by the laboratory is considered an agreement between the requestor and laboratory for provision of Neuropathology Services.

Refer to the Neuropathology Department User Manual (below) for further details on requesting tests.

Neuropathology Reports

Reports are currently available on ICE and will be sent by secure email to the requesting Clinician. A hard copy of reports can be obtained by telephoning the departmental secretarial team.

For further information, download the User Manual

Contact Neuropathology

Interventional Neuroradiology (INR)

Regular Off Off

The Tertiary Neurovascular Interventional Neuroradiology Unit at North Bristol NHS Trust (NBT) is a leading centre of excellence, specialising in advanced neurovascular interventions to diagnose and treat both adult and paediatric complex conditions of the brain and spine. Our mission is to deliver cutting-edge, patient-centred care through innovative neurovascular interventions. We strive to be at the forefront of medical advancements, improving patient outcomes and quality of life.

The Neurovascular Interventional Radiology (INR) service provides the largest 24/7 Mechanical Stroke Thrombectomy service in the UK, performing over 430 Mechanical Thrombectomy's (MT) for South West England and South Wales between 2023 and 2024. 

The unit offers a comprehensive range of services, including the treatment of cerebral aneurysms, arteriovenous malformations, and acute stroke interventions. NBT was awarded neurovascular (level 5) gamma knife commission for South West England in June 2024. Our INR department covers all paediatric neurovascular intervention at Bristol Children’s Hospital. Our team is proficient in minimally invasive endovascular procedures, ensuring the highest standards of care. Our team comprises highly skilled interventional neuroradiologists, neuro intensive care and neuro anaesthesia, neurosurgeons, and specialized nursing staff, all dedicated to providing exceptional care. Each team member brings extensive experience and expertise in neurovascular interventions.

Other procedures such as cerebral angiography, myelography, carotid stenting, lumbar punctures, spinal biopsies and cement augmentation procedures are also performed. We monitor closely international developments in the published scientific literature and adopt new techniques where appropriate; one such example being the emergence of middle meningeal artery embolization for chronic subdural haemorrhage, in carefully selected patients and in collaboration with our neurosurgical colleagues. There is an increasing demand for spinal injections and other related interventions. 

The unit is actively involved in groundbreaking research and clinical trials, contributing to the advancement of neurovascular medicine. Our commitment to innovation ensures that we employ the latest techniques and technologies in patient care. There is an active academic department with close link with Bristol University Medical school. The INRs teach undergraduate medical students from Bristol Medical School, Severn Deanery radiology registrars, has pioneered an INR FY2 program and is involved in neuroscience clinical research programs. The group has collaborated on several published studies in recent years. NBT INR also trains international INR fellows, credentialing from allied specialities (neurosurgery and neurology) from USA and Australia. 

Contact the INR Department

Gate 19, Level 2
Brunel building
Southmead Hospital
Southmead Road
Westbury-on-Trym
Bristol
BS10 5NB

To contact the INR Department, please contact Alexandra Bessant, INR Secretary

alexandra.bessant@nbt.nhs.uk

0117 414 9007

Obstetric Anal Sphincter Injury (OASI) Clinic

Regular Off Off

What is an OASI? 

OASI stands for obstetric anal sphincter injury, which can happen after childbirth. It is an injury to the anal sphincter that is relatively common in people who have had a vaginal delivery (it affects 1 in 5).

What is the OASI clinic? 

This is one-stop clinic where the specialist, multi-disciplinary team aims to review all patients with an OASI.

Why do I need to attend an OASI clinic?

It is not mandatory for you to attend the clinic, however it is considered best practice to make sure you receive the best possible care. It is recommended by the the Royal College of Obstetricians and Gynaecologists. By assessing your symptoms, how you are healing, and giving you advice, this will help minimise your future risk of anal incontinence (not being able to control bowel movements).

When and where will my appointment be?

It will be at Southmead Hospital, Cotswold outpatients, on a Wednesday afternoon. It will usually be 12 weeks after giving birth.

Who will I see in the clinic? 

You will see Consultant Gynaecologist Miss Sen, and Consultant Colorectal Surgeon Miss McCarthy. You may also see a physiotherapist, specialist nurses, and clinical scientists. There may be trainee doctors in clinic who are there to observe. 

What happens at my appointment? 

You will have your first consultation with the specialists. You will be asked direct questions about your recovery including wound healing, bladder and bowel function (going to the toilet), and sexual activity.

We will then ask for consent to do an intimate vaginal and rectal examination, and there will be a chaperone in the room. The two tests will take about 10 minutes.

Endo anal ultrasound scan

This is an ultrasound test which uses sound waves to create images of structures in your body. This scan checks the integrity of your anal sphincters. A probe is inserted 5cm into your back passage (anal canal). It lets us see your sphincter repair and gives us valuable information about how it is healing. It is not painful but might be slightly uncomfortable. It is similar to a trans vaginal ultrasound which you may have had before.

Anorectal manometry

This test will feel similar to the ultrasound. A small catheter (18mm) will be passed a short distance into your lower rectum. It is not usually painful.

We will take some pressure measurements from your anal canal when you are resting, and you will be asked to squeeze for around 10 seconds. You will do this twice. It might feel uncomfortable if have had difficulty doing pelvic floor exercises after giving birth. 

The final part of the test involves blowing up a balloon at the tip of the catheter inside the rectum. It is usually inflated with 60ml of air and most patients will be aware of the sensation of needing to evacuate (go to the toilet). We will ask you to expel the balloon if you are able to.

These measurements give us a good idea about the function of your anal sphincters. It will help us decide if you may benefit from a course of pelvic floor physiotherapy. 

Will the examination and tests hurt? 

They may be uncomfortable but should not be painful. We won’t do the tests if it would be painful. All tests and examinations will be done with consent, and a chaperone present, and we will be guided by you. 

What will happen after the examinations and tests?

You will return to the consultation room where we will discuss the results of the tests, and the function and anatomy of your anal sphincter. We will talk about any future plans for pregnancy, and you will have plenty of opportunity to ask and questions you have.

It can be worrying for you to come to the clinic. You may have had difficulties in birth that you haven’t had a chance to process. In clinic you may also find it worrying to hear words such as anal sphincter, injury, and OASI. If there is anything you don’t understand or are concerned about, we would be happy to see you again. 

You don’t need to do any preparation before the tests. There is a small risk of injury to the rectum, and we advise you to look out for rectal bleeding after the procedure. If this happens you can phone the number on the back of this leaflet, or out of hours phone 111. 

How long will my appointment be? 

Your appointment will take around 30 minutes, and we will try to get all your tests done in one visit. Sometimes you may have to return on another day for the tests, particularly if you are in pain at the time of your appointment.

The tests in the OASI clinic are considered ‘mobile’ and are generally quick. Some patients may benefit from more thorough assessments so you may be referred for further tests either at Southmead Hospital or Bristol Royal Infirmary. These will be done on another day, and we will see you again in the clinic for a follow-up appointment after the tests. Sometimes we will offer you a follow-up in the Colorectal Clinic with Miss McCarthy if you have ongoing bowel issues.

Where can I find more information? 

MASIC Foundation 
Home - Aiming to change the lives of women injured during childbirth. (masic.org.uk)

Royal College of Obstetricians and Gynaecologists
Perineal tears and episiotomies in childbirth | RCOG 

© North Bristol NHS Trust. This edition published September 2024. Review due September 2027. NBT003413

Contact the Gynaecology Secretaries

Emma-Rose Thompson/Gynaecology Secretaries
Women and Children's Division
The Chilterns

0117 414 6749

Support your local hospital charity

Southmead Hospital Charity logo

See the impact we make across our hospitals and how you can be a part of it.