Financial and social care advice  

The Bristol M.E. Service recognises the impact that ME/CFS and Long Covid can have on people’s ability to work and therefore on their finances.  We cannot advise you directly about finances and accessing benefits as this is a specialised area, but we can help you with:   

• confirmation of diagnosis and that you are being helped by a specialist team.   
• an outline of your functional ability and how that varies due to post exertional malaise.   

These two key areas can both be included in our standard clinic letters.  However, if you need to appeal a decision regarding your benefits and there is a request for further information, we can write a letter for you to add this appeal. This can include more information about the condition, the therapy approach that we offer and an outline of your functional ability.  

People we support might apply for: 

Personal Independence Payment (PIP) https://www.gov.uk/pip

Employment and Support Allowance (ESA) https://www.gov.uk/employment-support-allowance

Universal Credit (UC) https://www.gov.uk/health-conditions-disability-universal-credit

Carer's Allowance https://www.gov.uk/carers-allowance

Specialist support

We advise that you contact specialist support to establish which benefits you can apply for, and have some help in completing the application forms.  Here are some of the places that can offer this:

Citizens Advice Bureau https://www.citizensadvice.org.uk/

North Bristol Advice Centre https://northbristoladvice.org.uk/

Bristol Law Centre  https://www.bristollawcentre.org.uk/

Bristol Law Centre provides skilled assessment, triage & signposting for social welfare legal issues. They may be able to offer free legal advice & casework, depending on capacity, funding and your circumstances.  If they can’t help you, they will always give you information on your options. For free legal advice if you live in Bristol and beyond. The Centre can help with housing issues, welfare benefits, discrimination and other disputes at work, mental health tribunals and Court of Protection, immigration and asylum, family disputes and tribunal appeals. 

Charities: Action for M.E. and the M.E. Association  

The M.E. charities also support people with Long Covid and provide up-to-date information on benefits and advice on how to complete the forms. 

The M.E. Association guides to benefits: https://meassociation.org.uk/free-literature-downloads/

Action for M.E. guide to welfare benefits: https://www.actionforme.org.uk/get-information/care-and-support/welfare-benefits/

Social care and adaptive equipment   

You will need to contact the social services department you live in, which is provided by the council that you pay your council tax to.  There will be a number you can call or a weblink to apply for help. 

Bristol City Council https://www.bristol.gov.uk/residents/social-care-and-health

North Somerset Council https://n-somerset.gov.uk/my-services/adult-social-care-health

South Gloucestershire Council https://beta.southglos.gov.uk/health-and-social-care/

Gloucestershire County Council https://www.gloucestershire.gov.uk/health-and-social-care/adults-and-older-people/

Other help can be provided by the Red Cross, who are able to offer short-term support https://www.redcross.org.uk/get-help/get-support-at-home

Mobility aids and wheelchairs

We can offer advice about the potential benefits of mobility aids. Please ask your clinician if you would like to discuss this. The NHS web pages about mobility aids are a helpful guide: https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care-homes/walking-aids-wheelchairs-and-mobility-scooters/

If you want a short-term wheelchair loan, the Red Cross offer a rental or hire service. 

Rent or hire a wheelchair: https://www.redcross.org.uk/get-help/hire-a-wheelchair

To access an NHS wheelchair for regular use please ask your GP for a referral. 

You could also search the Internet for mobility centres as there are a number in the area, for example:

The Bristol Mobility Centre https://www.bristolsmobilitycentre.co.uk/

Ableworld Gloucester https://gloucester.ableworld.co.uk/

Members of the public and staff are able to attend our Trust Board meetings in public. If you would like to attend, please let us know by emailing trust.secretary@nbt.nhs.uk and we can provide details of the location, and print papers if required. If you wish, you can ask a question to the Trust Board.

The Trust Board meets in public at 10am.

•  Thursday 30 May 2024
•  Thursday 25 July 2024
•  Thursday 26 September 2024
•  Thursday 28 November 2024
•  Thursday 30 January 2025
•  Thursday 27 March 2025

Download Integrated Performance Reports (IPR):

Download Meeting Papers:

This information is for patients who have been referred to receive regular replacement antibody therapy using immunoglobulin (IgG). This page tells you about the treatment, including risks and benefits, and where you can obtain further information.

What is immunoglobulin?

Immunoglobulin (IgG) is a fluid containing antibodies, (proteins produced by the immune system), that help protect against infection. It has been available for the treatment of antibody deficiency syndromes for more than 30 years. It has been proven to be a very effective and well tolerated treatment. IgG is extracted from blood derived from donor pools of at least 10,000 individual blood donors.

How safe is it?

There is an extremely small risk that some bloodborne infections may be passed on through the use of  immunoglobulin.

Immunoglobulin products have been prepared from fully tested blood and have also been treated during manufacture to destroy blood-borne agents known to cause infection. However the risk of blood-borne infection cannot be completely eliminated. No recipients of IgG have contracted HIV or CJD (the human form of mad cow disease). No proven cases of hepatitis C have been identified since the mid 1990s, when the manufacturing process was altered to include elimination of this virus.

What are the benefits?

There is very strong clinical evidence that if you are not treated with IgG you are likely to have recurrent infections, which may lead to tissue damage, including long-term chest complications. 

Are there any side effects? 

As with all medicines there is a small chance of side effects. However, immunoglobulin has a good safety record. Adverse reactions may be categorised as mild, moderate or severe.

• Mild reactions usually occur within 30 minutes of the start of the infusion and include headache, flushing, chills, backpain, or muscular aches.
  Reactions are experienced by up to 10 in 100 patients, typically lasting a few hours. These reactions can often be prevented by the use of simple medicines, paracetamol and/or anti-histamine before starting your infusion and ensuring that the infusion speed is not too rapid.
• Severe allergic reactions are very rare and typically happen within seconds or minutes of beginning the infusion. Symptoms may include itchy skin rash, swelling of the face and throat, difficulty in breathing, dizziness or fainting and even collapse. This will be discussed with you before you start treatment.

How do I receive it? 

• Your medication can be transfused into a vein like a blood transfusion over 1-3 hours, and then repeated every 2-4 weeks.
• It can also be given subcutaneously (under the skin), on a more frequent basis, usually weekly.
• Your therapy will initially be given in hospital, after which time you may choose to be trained to give your own treatment at home. This will be discussed with you on an individual basis. 

Your treatment will probably be life-long. 

Will I need any blood tests?

You will be asked to have regular blood tests to monitor your IgG levels. The dosage and frequency of treatment may then be adjusted as necessary. Failure to achieve acceptable IgG levels can lead to recurrent infections. 

It is also normal practice to store small samples of your blood at the start of your treatment and before any change of product. Should any blood-borne infections occur this will enable us to determine whether it is related to your infusion.

Where to get further information and advice

Further information is available from the manufacturers of the individual IgG product. (The name of the manufacturer can be obtained from your clinician).

Safety and adverse reactions information

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT002304.

This page contains information for patients who have been referred for an induced laryngeal obstruction test.

Why do I need this test?

This test is required if your doctor thinks that you may have inducible laryngeal obstruction.  This means the vocal cords and/or structures

 around them become narrowed as a response to triggers, such as perfumes, dust, cleaning products or exercise.  

Symptoms that may suggest you have this condition can include breathlessness, noisy breathing, wheeze, cough, or changes in your voice.

Before the appointment

Phone the Respiratory Physiology team before your appointment if you have experienced any of the following:

• Head, eye, mouth, chest, or abdominal surgery in the last 2 months. 
• A chest infection, diagnosed by a medical professional, in the last 2 months.
• A heart attack/stroke that occurred in the last 2 months.
• A blood clot in your lung.
• Coughing up blood in the last 2 weeks

What do I need to do on the day?

• Do not drink any alcohol before testing.
• Eat only a small meal.
• Do not complete any strenuous exercise at least 30 minutes before your appointment.
• Avoid potential triggers related to your symptoms.
• Do not apply body lotions before the test.
• Take all of your usual medications as prescribed before the test.

What do I need to bring?

You should bring your appointment letter.

If possible, you should bring the trigger/s of your symptoms. If they cannot be brought, then just phone our department on the number provided at the end of this leaflet. 

If you are being tested for exercise induced symptoms then exercise equipment will be provided – please bring clothes suitable to exercise in.

What happens during my appointment?

When you arrive in the Brunel building, please go to Gate 12 and check yourself in at the reception desk. When your name appears on the television screen, go to the Respiratory Physiology waiting room.

You will be invited into the testing room where you will have the chance to ask any questions and the details of the test will be explained to you. 

A simple breathing test will then be performed, and your oxygen levels measured by an oximeter being placed on one of your fingers. 

A thin tube with a small camera will be gently placed in and through your nose so your throat can be observed. A helmet will be placed on your head to hold the camera in place. If you are being tested for exercise-induced laryngeal obstruction, then stickers will also be placed on yourchest to look at your heart rhythm throughout the test.

The physiologist and doctor will then safely expose you to the symptom trigger in a controlled manner, while observing your vocal cords via the camera. 

What happens after my appointment?

After the test, we will inform you of the results and discuss a plan. This will be communicated to your GP via a letter, and you will receive a copy. 

Who can I contact for any queries or concerns?

If you have any problems or concerns about coming for this test or are going to be late, please do not hesitate to contact us:

Respiratory physiology team
Phone: 0117 414 5400

We are happy to talk to you about any issues or concerns you have about your appointment.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003263. 

This page contains information for patients who have/may have a lung nodule.

I’ve been told I have a lung nodule, what does this mean?

A lung nodule is a very small area of round shadowing, like a “spot” or “blob”, seen on a CT scan. Nodules are 3cm (1 inch)or less and do not cause any symptoms.

You may have several nodules. This is not always more serious than just having one.

How common are lung nodules? 

• About 1 in 4 (25%) older people who smoke or who have smoked have nodules.
• About 1 in 10 (10%) people who have never smoked may have nodules.
• Nodules may be caused by scarring from lung infections.
• They are common in people who have had TB in the past.

Are lung nodules cancerous? 

Most nodules are benign (non-cancerous). In a very small number of people the nodule could be an early lung cancer.

How can we find the cause? 

It is not always easy to know the cause of a nodule from just one CT scan. Because they are very small, doing a biopsy on them (taking a piece of the nodule out and examining it) can be difficult or risky.

Do all nodules grow? 

No. Benign (non-cancerous) nodules usually do not grow but cancerous ones will eventually get bigger. The best way to assess them is to repeat the CT scan after a period of time.

Even if your nodule does grow, monitoring them with repeat CT scans will allow your doctor to pick up any changes early and arrange further tests before the nodule causes symptoms or problems.

How will I get my results? 

Your CT result will be sent to your hospital consultant, usually within 4 weeks of your scan. Your consultant will then get in touch with you to let you know the result, either via a phone call, a letter, or a clinic appointment.

What happens next? 

Nodules are usually followed up for between 2 and 4 years, with CT scans every 3, 9, or 12 months. 

• If your nodule is stable over several years, you will be discharged.
• If your nodule grows or changes at all, your consultant may arrange for you to have more tests. This could include a special scan called a PET scan, or a biopsy.
• If you develop any symptoms in your chest, please contact your GP. It is very unlikely that these symptoms will be caused by your nodule, but it is important to let your GP know anyway 

If I have any questions, who do I ask? 

Your GP will be kept fully informed of your progress and scan results. You should also receive a copy of all letters from your consultant. If you have any questions in the meantime, please contact the Lung Navigator at North Bristol NHS Trust.

NBT Lung Navigator
Phone: 0117 424 0654

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT003679.

A pleural vent is a medical device that is used to treat a pneumothorax. This page will explain what a pleural vent is, why it is used and how it is inserted.

Why do I need a pleural vent?

A pneumothorax occurs when air gets trapped in the space between the lung and the chest wall (the pleural space). The air gets there either from a defect on the surface of lung or through the chest wall. The air can squash the underlying lung and cause it to collapse. 

You may experience some or all of the following symptoms; breathlessness, cough, or a sharp, stabbing pain on one side of the chest, which may be worse when breathing in. 

There are different ways to treat a pneumothorax depending on the cause, how large it is and how severe your symptoms are. This includes conservative management (observation only), pleural aspiration and an intercostal chest drain. Your doctor will explain the benefits and risks of these options to you in more detail. 

Sometimes, we can use a pleural vent instead of an aspiration or a chest drain.

What is a pleural vent?

A pleural vent is a small medical device. It consists of a small tube connected to a one-way valve inside a chamber. The tube sits inside the chest and the chamber sits on the front of the chest. 

The pleural vent allows air to escape from the pleural space through the device to help the lung reinflate. 

Unlike a chest drain, you can usually go home with a pleural vent in place and do not have to stay in hospital. The pleural vent stays in for a few days until the pneumothorax has healed.

How will the pleural vent be put in?

The pleural vent is inserted in hospital by a doctor who will talk to you about the benefits and risks of the procedure and ask you to sign a consent form.

You must tell the doctor if you take any medications that thin your blood, such as warfarin, apixaban, rivaroxaban or clopidogrel. These medications can increase the risk of bleeding and may need to be stopped before the procedure. 

The procedure takes about 15 minutes, and you will be placed into a comfortable position on your back on a couch. Then:

• The insertion area is cleaned with an antiseptic to kill any bacteria on your skin. This may feel cold.
• Local anaesthetic is injected into the area with a small needle to numb the skin. This will feel sharp and you may feel a stinging sensation when the anaesthetic is injected.
• When the area is numb, a small cut is made and the pleural vent is inserted. This should not be painful but you may feel some pushing or pressure.
• The pleural vent is held in place on the front of your chest with a sticky dressing, and sometimes a stitch if needed.
• The blue disk at the top of the pleural vent will move up and down when you breath in and out, showing that it is working correctly.

What are the benefits of a pleural vent?

A pleural vent is simple and quick to insert with local anaesthetic, it allows continuous drainage of air from the pleural space, unlike an aspiration, and you can walk around as normal. If you feel comfortable, you may be able to go home with the pleural vent in place.

What are the risks of a pleural vent? 

Inserting a Pleural Vent is a routine and safe procedure. However, as with any medical procedure, there are potential risks:

• Pressure or discomfort when the tube is inserted (common). The use of local anaesthetic reduces this discomfort. As the anaesthetic wears off you may notice the Pleural Vent more.
• Significant bleeding (very rare, around 1 in 500 for a chest drain). Inserting the tube may cause bleeding outside the skin or into the pleural space. If it is significant, you may need a further procedure to stop the bleeding or a blood transfusion.
• Damage to the lung or other nearby organs (very rare). This risk is reduced by checking a chest x-ray or sometimes using an ultrasound machine to confirm the position of the pneumothorax before the device is inserted.
• Re-expansion pulmonary oedema (very rare). This happens when a collapsed lung re-opens too quickly and fills with fluid. This can make patients feel more breathless and unwell. If this happens you may need to stay in hospital and be given oxygen.
• Discomfort whilst the pleural vent stays in (common). This is usually mild and can be relieved with simple painkillers such as paracetamol or ibuprofen.
• Skin reaction to the dressing. You should tell the doctor if you have had problems with dressings before.
• Infection around the skin or in the pleural space (rare, around 1 in 50 for chest drains). This is minimised by cleaning the skin effectively before device insertion and ensuring the Pleural Vent is kept clean and dry while it is in place.
• Tube becomes kinked or blocked and stops working. If this occurs, you may notice worsening breathlessness or chest pain.
• Swelling around the device. If air from the pleural space drains under the skin instead of through the device (because the device is blocked or no longer sitting in the right place), a problem called subcutaneous emphysema can develop. If you press on the swelling it feels crackly or crunchy, or like bubble-wrap. If it is mild and not worsening, it may not require any further action. However, if it spreads or worsens, you should arrange to be seen quickly (see below).

How do I look after the pleural vent at home?

Call 999 or attend the Accident and Emergency Department immediately if:

• The pleural vent comes out for any reason.
• You experience severe or worsening pain or breathlessness.
• You notice swelling around the device that is spreading rapidly.

Do check that the blue disk at the top of the Pleural Vent moves up and down when you breathe.

Do tell the nurses or doctors, using the contacts below, if the disk stops moving. This may mean the pneumothorax has resolved. 

Do avoid heavy lifting, straining or vigorous exercise as this may displace the device or make the pneumothorax worse. 

Do not take a bath, go swimming, or immerse the device in water. This can damage the device or dressing and increases the risk of infection.

Do not remove the device yourself.

Fluid collection chamber

Sometimes, fluid can come out of the chest in addition to air. The Pleural Vent can collect a small amount of this fluid in the chamber but may need to be drained periodically. If you notice the fluid collection chamber is full, please contact us using the numbers below.

How is the pleural vent removed?

The pleural vent must only be removed by a trained healthcare professional. Any dressings or stitches will be removed and then the device is pulled out. A simple dressing is placed over the area. This only takes a couple of seconds and is not painful. After it is removed, a chest X-ray will be repeated. 
We will remove the pleural vent in the Pleural Clinic when the pneumothorax is resolved.

Who do I contact for more advice or help?

If you are an NBT patient and have queries or problems with your pleural vent device Monday to Friday 8am to 4pm, please contact: 

Pleural Clinical Nurse Specialist Anna Morley 0117 414 1900 

Respiratory Secretary Louise Brennan 0117 414 6451 

In an emergency, please go directly to the Emergency Department. 

© North Bristol NHS Trust. This edition published June 2022. Review due June 2025. NBT003482. 

What is a pleural aspiration? 

A pleural aspiration (also known as a thoracocentesis, pronounced “tho-rac-oh-sen-tee-sis”) is a simple procedure which involves passing a small needle through your chest wall, to remove fluid or air from the space between your lung and the rib cage (the pleural space).

Why do I need a pleural aspiration? 

We have recommended you have a pleural aspiration because fluid or air has collected in your pleural space. This is called a pleural effusion (collection of fluid) or pneumothorax (collection of air). These can both cause problems with breathing. 

Laboratory analysis of any fluid taken from your pleural space can help us to find out the cause for the fluid build up and help us decide how best to treat it. 

Removal of fluid or air from the pleural space can also help to relieve breathlessness.

Is there an alternative test that I can have instead of the pleural aspiration?

Your doctor can do ultrasound, X-rays and CT scans of your lungs, which will give additional information about the cause of the pleural effusion or pneumothorax. However, there may not be an alternative way of getting the specific information we obtain from pleural fluid samples.

Breathlessness caused by the fluid or air in the pleural space can be managed with other supportive measures, but often removing the air or fluid is the most effective way of managing these symptoms.

How should I prepare for my pleural aspiration?

If you are having the procedure done as an outpatient, please ensure we have the correct contact details for you and that you know when and where you need to come. 

Please bring a list of all your current medication, allergies and other medical conditions with you to the appointment.

It is important that you let us know in advance if you take blood thinning medications and why you are taking them as we will need to temporarily stop these before your procedure (the usual advice is given in the table below, although this may vary depending on why you need these medications, so please ensure you discuss it directly with the doctor or nurse). You should continue with all other medications as usual.

What happens before and during the pleural aspiration procedure?

Before the procedure is performed, a member of the team will take your blood pressure, heart rate and oxygen saturation. They will also ask you questions about your medical history, medications and allergies

• You will have an opportunity to ask questions and you will be asked to confirm you are happy for the procedure to be performed. You may be asked to sign a consent form.
• You will either sit with your head and arms resting on a pillow on a table or lie on your bed in a comfortable position.
• An ultrasound scan may be performed to choose the best place to insert the tube. Ultrasound is painless and involves a cool gel being to be applied to the skin.
• You may be offered painkillers to take before the procedure starts.
• Your skin will be cleaned with an alcohol-based liquid to kill any bacteria. If a large volume of fluid is to be removed, local anaesthetic is injected into the skin to numb the area, which can ‘sting’ temporarily but the pain will disappear quickly. Local anaesthetic may not be used if only a small sample is needed for diagnostic purposes.
• A small tube will be passed through your numb skin into the pleural space to allow the fluid or air to be removed. This should not be painful, but you may feel some pressure
• The length of time it takes to do the procedure depends on the volume of fluid or air that is removed. It usually takes between 10 and 30 minutes.

Are there any risks with pleural aspiration?

Pleural aspiration is generally a very safe procedure. However, as with all medical procedures, there are certain risks, although serious complications are very rare.

• Pain: The local anaesthetic will sting briefly, but the aspiration procedure itself should not cause pain.
• Infection: Very rarely (less than 1 in 100 patients) an infection in the skin or the pleural space may develop. If this occurs it can usually be treated with antibiotics, but in some cases a further drainage of fluid might be required. In the days following your procedure, if you feel feverish or notice any increase in pain or redness, inform your nurse or doctor.
• Bleeding: A bruise at the site of insertion occurs commonly. Rarely (less than 1 in 250 patients) the pleural aspiration may accidentally damage a blood vessel and cause bleeding into the pleural cavity. Often it stops by itself but occasionally this might require an operation, blood transfusion, or other intervention to stop the bleeding
• Discomfort during the procedure: As the lung stretches to fill the gap where the fluid or air was, it may cause cough, chest tightness or worsening breathlessness (1 in 10 patients). If the lung re-expands quickly, there is a small risk of fluid collecting in the lung itself (re-expansion pulmonary oedema) (less than 1 in 200 patients). If you experience these symptoms during the procedure, please let the nursing or medical team know as soon as possible so they can stop aspirating further air or fluid.
• Organ damage: A very rare complication of a pleural aspiration (less than 1 in 200) is puncture of another organ. This could include other structures in the chest (e.g. the lung, heart, diaphragm or major blood vessel) or abdominal organs (e.g. stomach, liver or spleen). Usually this requires no specific treatment, but could mean you need to be admitted to hospital and very rarely would require an operation or other intervention. If the drain punctures the underlying lung, it may require a small tube to be inserted into the pleural cavity.

What happens after the aspiration?

• After the procedure you will have your blood pressure, pulse and oxygen saturations checked. Some patients may require a chest X-ray.
• You will have a dressing or sticking plaster over the area, which can be removed the following day.
• The full results of the pleural aspiration will not be available immediately and usually take 7-14 days.
• If you are an outpatient, an appointment will be made to discuss the results with you. Sometimes the pleural aspiration does not establish a firm diagnosis and other tests will be needed. We will discuss this with you if necessary.

© North Bristol NHS Trust. This edition published October 2022. Review due October 2025. NBT003501.

(Conservatively managed fragility fracture of the clavicle).

This information is for people who most likely won’t need an operation after breaking their clavicle (collar bone). This means you don’t need to come back to the hospital to see the orthopaedic doctors or have another X-ray in the Fracture Clinic routinely. 

Please see the phone numbers at the end of the page if you have any questions or concerns following your injury.  

These guidelines work for most people in your situation who have had a similar injury. It will help your recovery if you follow them as best you can. The information can also be used by the people involved in your care for those that are unable to follow the advice on this page themselves. 

Summary:

• Ask someone to help during your recovery.
• Wear loose clothing.
• Support your arm either in a sling or on pillows for comfort.
• Take regular pain killers as advised by your doctor.
• Stay well hydrated and take laxatives if needed.
• Monitor the skin over the broken bone – contact Fracture Clinic if the skin becomes inflamed or blistered or broken.

Practical considerations

• You should write down the date you have broken your clavicle.
• You are unlikely to be able to use your arm properly while it is healing so you might need extra help during this time.  This can be from family, friends, or you may need extra help from the community support team. 
• Consider loose clothing for comfort, ease of dressing and getting to the toilet. A loose shirt for your top half and trousers or skirts with elasticated waists can make a big difference on how you cope at home. Put your injured arm in the sleeve first (and remove last) to reduce pain and unnecessary movement. 
• When you are feeling more comfortable and your pain is improving you can use your arm normally to care for yourself– including putting weight through your arm to use walking aids if required.  

Supporting your arm

Your sling can gradually be removed as your pain improves. There are various sling options and you may need to experiment to find what works best for you. Please contact the Plaster Room on 0117 414 8606 if you are struggling with your sling.  

Some options include:

A full arm sling or ‘Polysling’

This may be most comfortable in the early stages and if correctly applied and tightened regularly can provide good support for the broken bone. It can however be difficult to put this sling on and off by yourself.  And it can make it too difficult to use your arm and look after yourself. 

A collar and cuff 

This sling can be easily adjusted for comfort and is easier to put on and off yourself. 
Try to position it so it is supporting the weight of your arm well as pictured. 

Walking aids

If you use a walking aid such as a frame you may not need your sling on as the frame will provide the support your arms needs.

Pillows

You can support your arm on pillows instead of the sling when you are sitting down. This will give your neck a rest from the sling. 

Pain control

Monitoring your skin

Preventing chest infections

What to expect in your recovery

Using your arm

Eating and drinking

You may need some help to eat and drink initially especially if you have injured your dominant arm.

• Eating ‘finger foods’ such as sandwiches can be easier than food that needs to be cut up.
• There are adaptations such as a ‘plate guard’ (pictured below) or wide handled cutlery that can make it easier to eat. These items are widely available to purchase if required.                                      
• Please ask a health professional if you are struggling and unsure what to do. 

Gradually increase the use of your arm as your confidence increases and the pain settles. Trying to use your arm to eat, drink and care for yourself gives you the best chance of a successful recovery. 

• Practicing with an empty cup will build your confidence for meal times if you’re struggling to begin with. 
• Practice washing your face with your injured arm while sat at the sink. You can use the other hand to help if needed. 

Exercises

Keep your fingers and wrist moving – make a tight fist and open your hand fully throughout the day.

Remove your sling and gently extend your arm.
Now bend you elbow and try to bring your hand up towards your shoulder.

Getting your shoulder moving from about 3 weeks after your injury 

The following exercises are suggestions. The important thing is to gradually get your shoulder moving in whatever way you feel able to. 
You might need help for the following exercises. Please speak to your community therapy team if they are involved in your care to help you with exercises.

Place your hand under the elbow of the injured arm.  Lift gently until you feel a stretch at your shoulder.
Start to gradually increase how far you can move your shoulder. 

Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders. 

Bone health and fracture prevention

What else can you do to keep your bones healthy?

How to contact us: 

Frailty Trauma Practitioner
07511 166031

Single Point of Access: Sirona community based assessments
0300 125 6789

Plaster room
0117 414 8606
0117 414 8607
Available: Monday - Friday 8:30am - 5pm Saturday, Sunday, and bank holidays 8:30am - 1pm

© North Bristol NHS Trust.  This edition published May 2024. Review due May 2027. NBT002391.

(Conservatively managed fragility fracture of the humerus).

This information is for people who most likely won’t need an operation after breaking their arm. This means you don’t need to come back to the hospital to see the orthopaedic doctors or have another X-ray in the Fracture Clinic routinely. 

Please see the phone numbers at the end of the page if you have any questions or concerns following your injury.

These guidelines work for most people in your situation who have had a similar injury. It will help your recovery if you follow them as best you can. The information can also be used by the people involved in your care for those that are unable to follow the advice on the page themselves. 

Summary: 

• Ask someone to help during your recovery.
• Wear loose clothing.
• Take regular pain killers as advised by your doctor.
• Stay well hydrated and take laxatives if needed.
• Use a simple sling (collar and cuff) to help ease the pain when you are moving.
• Wash your injured arm every day, then ensure it’s properly dry.
• Allow your arm to hang straight at least twice a day.
• Remove rings or jewellery on your injured limb as soon as possible after the injury and keep them off until the swelling has gone down fully. 

Practical considerations:

• You should write down the date you have broken you upper arm/shoulder. 
• It’s unlikely you will be able to use your arm properly while it is healing so you will need extra help during this time.  This could be from family, friends or you may need extra help from the community support team.
• Please do not put pillows or support under your elbow or behind your upper arm. This can increase pain by pushing on the broken bone. You can however rest your hand on a pillow to elevate it which may help a little with the swelling.
• Consider loose clothing for comfort, ease of dressing, and getting to the toilet. A loose shirt for your top half and trousers or skirts with elasticated waists can make a big difference on how you cope at home. Put your injured arm in the sleeve first (and remove last) to reduce pain and unnecessary movement.

Giving your neck a rest from the sling

This is a good position to give your neck a rest from the sling. 

Looking after your skin

Preventing chest infections

What to expect in your recovery

0-3 weeks 

Pain and swelling

Exercises

To prevent the joints from becoming stiff you should:

Allow your injured arm to hang straight at the elbow at least twice a day – more often if possible. 
Standing with your arm hanging as pictured can be a good position to clean under your arm and to put your arm into clothing when dressing.  
If you are not safe to stand, try to hang your arm straight from a seated position if you can safely and carefully do so. You may need help from a family member or carer to do this. 

Keep your fingers and wrist moving – make a tight fist and open your hand fully throughout the day.

Once your pain has settled a bit it’s time to get your elbow moving.  Remove your sling and gently extend your arm. Now bend your elbow and try to bring your hand up towards your shoulder.

Using your arm

Eating and drinking

You may need some help to eat and drink at first especially if you have injured your dominant arm.

• Eating ‘finger foods’ such as sandwiches can be easier than food that needs to be cut up using a knife and fork.
• There are adaptations such as a ‘plate guard’ (pictured below) or wide handled cutlery that can make it easier to eat. These items are widely available to purchase if required.                                     
• Please ask a health professional if you are struggling and unsure what to do. 

Walking aids

3-6 weeks 

Using your arm

Removing your sling

Getting your shoulder moving

The following exercises are suggestions. The important thing is to gradually get your shoulder moving in whatever way you feel able to. 

You might need help for the following exercises. Please speak to your community therapy team if they are involved in your care to help you with exercises. 

Place your hand under the elbow of the injured arm. Lift gently until you feel a stretch at your shoulder. Start to gradually increase how far you can move your shoulder. 

Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders.

From 6 weeks

Continue with the previous exercises but start increasing how much you use your affected arm. You may only feel ready to do the exercises from week 3 at this point but keep trying to build up little and often.

If you are able to attend outpatient appointments and feel able to follow an exercise program, you might want to request an outpatient physiotherapy appointment at this stage. Your GP can send a referral or please contact the Frailty Trauma Practitioner for advice if required.

With these types of injuries it is not unusual to take 6-12 months for you to get your maximal usage back in your arm – aim for as much movement as possible but you may not get the same movement as you had before your injury.

When to seek further support or advice

Injury concerns

Bone health and fracture prevention

What else can you do to keep your bones healthy?

How to contact us: 

Frailty Trauma Practitioner
07511 166031

Single Point of Access: Sirona community based assessments
0300 125 6789

Plaster room
0117 414 8606
0117 414 8607
Available: Monday - Friday 8:30am - 5pm Saturday, Sunday, and bank holidays 8:30am - 1pm

© North Bristol NHS Trust.  This edition published May 2024. Review due May 2027. NBT002398.

This information is for patients who have been advised by a doctor to have a bronchoscopy. Please read this information carefully. 

What is bronchoscopy?

Bronchoscopy is a procedure that allows the doctor to look into the airways of your lungs. A flexible tube (bronchoscope) is passed into your windpipe (trachea) through your nose or mouth. A small camera at the end of the bronchoscope enables the doctor to view your windpipe and air passages (bronchi). It also allows taking samples in the form of biopsies and washings (lavage) through a small channel.

Why is this bronchoscopy necessary?

This test is done to help diagnose your respiratory problem, although sometimes it may not give a definite answer. It can also be used to retrieve a foreign body that has been inhaled.

What you need to consider before you come for your procedure

What about medication?

What will happen on the day?

During the procedure

The bronchoscopy investigation

It may sometimes be necessary to take samples either in the form of a lung biopsy or lavage:

Advice for people with diabetes undergoing bronchoscopy

Risks of a bronchoscopy

Contact your doctor or hospital if you have:

• Fever that does not go away.
• Vomiting.
• More than a tablespoon of blood when you cough.
• Contact your doctor or hospital immediately if you have:
• Shortness of breath.
• Chest pain.
• Coughed up more than a quarter of a cupful of blood.
• Passed out, or fainted.

How will I receive the results of the test? 

You will receive an end of procedure letter before leaving that states what your bronchoscopy showed. Your hospital consultant may arrange a follow-up appointment when the results will be discussed with you.

© North Bristol NHS Trust. This edition published March 2024. Review due March 2027. NBT002288.