All relevant activities are licensed by the Human Tissue Authority, license 12413.
The Neuropathology Department takes part in the following External Quality Assessment (EQA) schemes:
UKNEQAS for Cellular Pathology Technique: Neuropathology
UKNEQAS for Cellular Pathology Technique: Muscle Histochemistry
UKNEQAS ICC: Neuropathology
UKNEQAS Bolt-on Scheme: Frozen Sections and Mega Blocks
We hope that you never have reason to feel concerned about any of our services. However, if you do have an issue, the best thing to do is speak with a senior member of team (Neuropathology Team | North Bristol NHS Trust (nbt.nhs.uk). If you do this as soon as possible we can hopefully resolve the matter immediately.
The Gynae Oncology team at North Bristol NHS Trust (NBT) are a team who are experienced in providing comprehensive, specialist services of individuals who are either undergoing investigations for suspected gynaecological cancers or those who have been diagnosed with a cancer of the ovary, cervix, womb, vulva, vagina, and some rare gynaecological cancers.
We understand that waiting for test results and appointments can be a worrying time. We are available to 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 Michaels Hospital, UHBW and/or the Bristol Haematology and Oncology Centre.
As NBT is not the main cancer treatment centre for Bristol, there will be different people involved in your care and we therefore act as a ‘link’ to improve communication between them, you and the wider cancer team. We are here to answer any queries or concerns and provide support and information for you, your family, and carers.
Meet The Team
Amy Slater – Miss Amy Slater, MBChB, MRCOG.
"I am a Consultant Gynaecologist, and lead for the Gynaecological Cancer Services at NBT.
"You may meet me or one of my other colleagues at North Bristol NHS Trust, but I am often involved in co-ordinating your care behind the scenes. We know that undergoing investigation for suspected cancer and treatment for cancer is stressful and worrying but my team of professional and caring colleagues and I are here to support you through this challenging time and ensure you receive the highest standards of care."
Clinical Nurse Specialist Team (CNS) – Our role is to provide support and information to you if you are undergoing investigations for suspected gynaecological cancers or have been diagnosed with a cancer of the ovary, cervix, womb, vulva, vagina and some rare gynaecological cancers. We will act as your keyworker until you are either discharged from our services or your care has been taken over by the gynaecological CNS team at St Michaels Hospital, UHBW and/or the Bristol Haematology & Oncology Centre.
Leanne Hopkins – Lead Gynae-Oncology Nurse Specialist
When you come to see the team at NBT(North Bristol NHS Trust) or UHBW (University Hospital's Bristol and Weston NHS Trust), you may have a lot of questions. It is not uncommon to find it difficult to remember things at the time of and/or after your appointment so here are some tips to help you. These ‘Questions to Ask’ may be accessible in a language of your convenience. Please contact the Gynae-Oncology CNS team if this is needed.
Before your appointment
Write down your most important questions.
List or bring all your medicines and pills – including vitamins and supplements.
Write down details of your symptoms, including when they started and what makes them better or worse.
Ask your CNS team for an interpreter or communication support if needed.
Ask a friend or family member to come with you, if you like.
During your appointment
Don't be afraid to ask if you don't understand. For example, 'Can you say that again? I still don't understand.'?
If you don't understand any words, ask for them to be written down and explained.
Write things down, or ask a family member or friend to take notes.
After your appointment, don't forget the following
Write down what you discussed and what happens next.
Keep your notes.
Ideas of questions to ask at the time of your appointment
'what's happening if I'm not sent my appointment details,' and 'can I have the results of any tests?'
If you don't get the results when you expect – ask for them.
Ask what the results mean.
Tests, such as blood tests or scans
What are the tests for?
How and when will I get the results?
Who do I contact if I don’t get the results?
What next
What happens next?
Do I need to come back and see you?
Who do I contact if things get worse?
Do you have any written information?
Where can I go for more information?
Is there a support group or any other source of help?
Here are some useful organisations and websites that we feel you may find helpful. If you've come across any other useful resources not listed here that you think could benefit others, please inform us.
The Pain Management Centre is linked to the Pain Clinic at North Bristol NHS Trust and provides rehabilitation treatments for people suffering with chronic pain. We offer assessments at Southmead Hospital and Cossham Memorial Hospital. This service is delivered in conjunction with UBHW NHS Foundation Trust and some of our groups take place there in the Central Health Clinic.
The clinical team includes:
Psychologists.
Physiotherapists.
Occupational Therapists.
Clincal Nurse Specialists.
Assistants.
What does the Pain Management Centre do?
The Pain Management Centre is linked to the Pain Clinic at North Bristol NHS Trust and provides rehabilitation treatments for people suffering with chronic pain. We offer assessments at Southmead Hospital and Cossham Memorial Hospital. This service is delivered in conjunction with UBHW NHS Foundation Trust and some of our groups take place there in the Central Health Clinic.
What happens next?
After attending an information session your first appointment at the Pain Management Centre will last for roughly an hour. You will be assessed by one of the specialist clinicians in the team. They will ask you about the nature of the pain you have been suffering and about the effects this has on your everyday life. We do not offer a cure for your pain and you will not be given any direct treatments for pain relief.
Our focus is on helping people improve their lives despite having chronic pain.
In the past you may have been asked to undergo a physical examination or to demonstrate how the pain is affected by affecting your movement and posture. You will not be asked to do this at your first appointment here.
The assessment meeting provides an opportunity for you to meet with a member of our team with a view to seeing if a different approach to managing your situation may be worth investigating and what it could offer you. We will be happy to try and answer any questions you may have. We will then think about what the next steps might be, which could include joining a group or working with a member of the team in a 1:1 setting.
What do people who have seen us before say?
“Living with pain that doesn’t go away can be hard and make you feel miserable. The support written about in this leaflet can really help you find ways of coping and make your life easier. It’s up to you, but after doing the course you’ll have lots of tools to help give you a better quality of life. Can you afford not to go for it? Come and find out more about how you can make simple changes that will help make life easier!” (Sandra)
“When I was offered a place on the Self Management Programme I was unsure whether I would find it helpful. I went along and found the course leaders very welcoming and friendly. I knew the sessions would not stop my chronic pain, but I hoped I would gain some advice or strategies to help me cope. I was surprised by how interesting and helpful I found the programme. It has given me lots of ways to help cope, including lifestyle changes, helpful thinking and relaxation techniques. I enjoyed learning with a group of people which helped me realise others have the same problems as I have.” (Diane)
These are quotes from two of our patients who both attended one of the pain management groups. Not all of our patients attend these courses, and other approaches are available.
What should I do if I can’t attend my appointment?
Please contact the service administrator for the Pain Management Service on 0117 414 7357 who will be happy to help you.
Please note that we are not a crisis service and we may not be able to answer your call but you are more than welcome to leave us a voice message and we will get back to you within 2-3 working days.
If you need urgent medical support or advice you will need to contact your GP, or phone 111 or 999.
If you feel you need emotional support urgently, please contact your GP, or if you live in Bristol, the Bristol Mental Health Service response line on 0800 953 1919.
If you wish to speak to to the Pain Clinic, please visit the Pain Clinic page.
Information for patients who've been advised to take phosphate binders.
Why do I need to take phosphate binders?
Phosphate binders are tablets to help keep the phosphate level in your blood within the normal range. You may not have any symptoms of a high phosphate but taking your phosphate binders may prevent problems with your bones, blood vessels and heart. The normal range for blood phosphate is between 0.8mmol/l and 1.5mmol/l.
How do phosphate binders work?
They work by binding to the phosphate in your food, allowing it to pass out in your stool. You may also be advised to reduce your intake of phosphate containing foods. Your renal dietitian can provide you with information if this is needed.
How do I take my phosphate binders?
To work properly phosphate binders will either need to be chewed or swallowed whole either before, during or immediately after any meals, snacks or drinks containing phosphate. Your renal dietitian can guide you based on the phosphate binders you have been prescribed by the doctor. See the information below. Take your prescribed dose daily and spread your tablets throughout the day when you eat. Your renal dietitian can guide you on how to take these tablets with your usual meal pattern and food choices. See the information on page 4. You do not need to take your phosphate binders if you miss a meal. If you forget to take your binders with a meal try to remember to take the next dose at your following meal.
Practical tips
Keep a container of binders in each of the places you eat.
Keep a container of binders in your bag/pocket/in the car ready for when you eat out.
Set an alert on your mobile phone to remind you to take your binders when you eat.
Phosphate binders and other medication
Phosphate binders and some tablets should not be taken at the same time. Some tablets will need to be taken 1 to 3 hours before or after taking your phosphate binders. Check the patient information leaflet provided with your phosphate binders for information. You can also ask your pharmacist or doctor or dietitian.
You or your health care professional can complete the following pages to remind you when and how to take your phosphate binders. Follow the advice of your pharmacist, doctor or dietitian.
Things you should write down:
The name and daily dose of your phosphate binder.
When to take your phosphate binders: meals/snacks, the binder, and the recommended dose.
The timing of your phosphate binders with meals/snacks: before, during, or after.
How to take your phosphate binders: chew well or swallow whole.
Managing your fluid intake is an important part of your treatment
Drinking less can:
Help you breathe more easily.
Prevent your ankles swelling.
Help you keep your blood pressure stable.
Help prevent faintness or cramp on dialysis.
It is also very difficult to control your fluid intake if you eat a lot of salt. Try not to add salt to cooking or at the table. Speak to your dietitian for more information on how to eat less salt. Your doctor nurse or dietitian can advise you how much fluid to have.
Write down the amount of fluid you have been advised to have.
Useful measurements
Standard cup = 150ml.
Standard mug = 250ml.
Standard tumbler = 250ml.
Standard wine glass = 125ml.
Other helpful amounts
600ml = 1 pint.
1000ml = 1 3/4 pints.
Remember liquid foods could as part of your food allowance
Some typical servings
Item
Quantity
ml
Custard/jelly/yoghurt
1 typical pot
100
Ice cream
1 typical scoop
50
Milk pudding
1 serving
200
Ice cube
1 standard
30
Soup
1 serving (1/2 can)
200
Milk on cereal
1 serving
125
If you are feeling thirsty, try one of these first
Slice of lemon or orange.
Frozen grapes or pineapple cubes.
Boiled sweets or sugar free mints.
Chewing gum.
Try this to help space your drinks through the day
Pour water into a jug in the morning that is the same as the amount of fluid you can have daily.
Every time you have a drink such as squash, tea, coffee, milk, pour away the same amount of water from the jug.
This will help you keep track of the amount you are drinking and how much fluid you have left in your allowance for that day.
Helpful tips
Use a small cup or glass for drinks. This should be about 150mls (5½fl.oz).
Keep a record of your fluid intake to help you see how much you are consuming.
Spread your fluids through the day and have smaller drinks.
Remember spicy foods can make you feel thirsty. Try to reduce these foods.
Use plastic ice cubes in drinks to save on fluid.
Brushing your teeth or rinsing your mouth with water or mouthwash can help to freshen your mouth.
If you have a dry mouth, artificial saliva sprays such as Glandosane (available on prescription) can help.
Try swallowing tablets with food instead of fluid.
If you drink less on one day, save some of your fluid allowance for the next day.
You can drink sociably, but choose smaller drinks and try to drink less before or afterwards.
Modern slavery is the removal of personal freedoms in order to exploit human beings for financial or personal gains. It can take many forms including forced labour, human trafficking and sexual exploitation. It is a complex issue with a global reach. There were an estimated 50 million people in modern slavery in 20211 and these numbers are increasing. We recognise that modern slavery will exist in our supply chain, and we are committed to do all we can to identify and manage the risks that our business and purchasing activities pose.
Our Statement
This Modern Slavery and Human Trafficking statement is for the financial year ending 31 March 2023. It outlines the shared commitment and actions that have been carried out by Bristol and Weston NHS Purchasing Consortium (B&WPC), North Bristol NHS Trust (NBT) and University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) over this time period. In the statement, terms such as ‘our’ and ‘we’ refer to all three organisations. This is the first modern slavery statement that we have produced. It covers the following areas of our business activities;
The recruitment of both temporary and permanent employees.
The working conditions and practices for our employees.
The procurement of goods and services.
Organisation Structure and Supply Chains
Bristol and Weston Purchasing Consortium B&WPC provide a comprehensive range of purchasing services to support local Trust and Healthcare Providers.
B&WPC staff are NHS employees, hosted by North Bristol NHS Trust and the services provided include all aspects of clinical and non-clinical purchasing and supply chain management. B&WPC’s main clients include both NBT and UHBW and cover an annual spend of approximately £750m. B&WPC work closely with both Trusts to support compliance with all purchase-to-pay procedures and deliver improved efficiencies.
North Bristol NHS Trust
NBT has over 12,000 staff delivering healthcare across main sites at Southmead Hospital Bristol, Cossham Hospital and Bristol Centre for Enablement and within the local community of Bristol, North Somerset and South Gloucestershire. NBT is a regional centre for neurosciences, plastics, burns, orthopaedics and renal services. NBT’s aim is to deliver an outstanding patient experience and its values of caring, ambitious, respectful and supportive underpin everything that we do.
University Hospitals Bristol and Weston NHS Foundation Trust
UHBW has a workforce of over 13,000 staff, delivering over 100 different clinical services across 10 different sites serving a core population of more than 500,000 people locally and from across the southwest.
With services from the neonatal intensive care unit to care of the elderly, UHBW provides care to the people of Bristol, Weston and the southwest from the very beginning of life to its later stages.
Our Supply Chain
Our supply chain is large, multi-tiered, global and complex. We procure a wide range of clinical and non-clinical goods, services and works. This includes medical equipment, personal protective equipment and uniforms, dressings, mattresses and bed linen, laptops, software, furniture and mechanical and electrical services to name but a few.
Many of our purchases are from sectors that are known to be high risk for modern slavery. Our approach to identifying and managing modern slavery risks must be embedded into any new procurement activity and within our existing contracts to be effective.
We let contracts over a range of timescales from medium to long term relationships to oneoff purchases. As part of our procurement policy, we actively seek to utilise frameworks provided by public sector organisations such as NHS Supply Chain and Crown Commercial Services. We have over 2,500 tier 1 suppliers and over 1,000 active contracts in place.
Policies in relation to slavery and human trafficking A number of national regulations and mandates have been set over the past 12 months that allow for modern slavery to be prioritised as a topic for consideration in the purchases that we make.
The Health and Care Act 2022 allow for regulations to be set to eradicate modern slavery and human trafficking in NHS supply chains. NHS England has also adopted the mandatory inclusion of Net Zero and Social Value criteria in the evaluation of all tenders. This is also mandated for all NHS Trust procurements. Modern slavery can be a topic addressed under social value where it is proportionate and relevant to the contract.
We have created two policies that build on this national level focus to address to this issue. The B&WPC procurement strategy 2022-25 is published online and is publicly available having been signed off and approved by the Trust Boards of both NBT and UHBW.
B&WPC Procurement Strategy 2022-25. This document sets out our values and outlines the areas of focus for B&WPC to ensure that we are maximising the value obtained from our external spend. There are 4 objectives within the strategy. The Anchor in the Community objective includes a clear commitment to remove modern slavery for our supply chain and to use our market leverage to drive an ethical supply chain. The aim is to ensure that our supply chains and procurement processes are ethical, free from worker abuse and exploitation and provide safe working conditions. An away day was held with all B&WPC staff to engage with and explore the strategy and what its aims mean in the short, medium and long term to the team.
Joint Ethical Procurement Strategy. This document will reflect our joint vision and aims to support the delivery of exceptional healthcare services in a sustainable manner. Included within the definition of ‘sustainable’ is ethical conduct and social value. We will document a specific commitment to ensure that our supply chain and procurement processes are ethical, free from worker abuse and exploitation and provide safe working conditions. This policy will be approved and be available publicly during 23/24.
Our existing recruitment policies set out the processes that cover the recruitment of both our temporary and permanent employees. The overall approach is governed by compliance with legislative and regulatory requirements and the maintenance and development of good practice in the fields of employment.
Our recruitment processes are robust and adhere to safe recruitment principles. We have a range of policies and procedures to protect staff from poor treatment and/or exploitation which comply with all respective laws and regulations. This includes policies on recruitment, pay and equality, diversity and inclusion.
In addition to this, we have clear systems and polices in place to encourage the reporting of concerns, speaking up and the protection of whistleblowers Our policies such as Safeguarding Adults and Children, Dignity at Work, Grievance procedure and Freedom to Speak Up policy provide additional platforms for our employees to raise concerns about poor and inappropriate working practices. We have a number of dedicated Freedom to Speak Up Guardians and Executive and Non-Executive Director leads for Freedom to Speak Up. Whilst these are not exclusively for the purpose of raising concerns for modern slavery and human trafficking, their remit covers any issues linked to this.
Risk Assessment and Management
A category level environmental, social and governance risk assessment has been carried out for our spend profile. This assessment included the identification of modern slavery risks across the lifecycle of goods and services purchased on criteria including the risk of forced labour, child labour, working conditions and discrimination. The following purchasing categories were identified as high risk:
Construction.
Information Technology (IT).
Food and Catering.
Medical Equipment.
Textiles (clothing, bed linen etc).
Waste Management.
Temporary Staff and Recruitment Services.
Due Diligence Process
Our robust recruitment processes are in line with relevant employment legislation and adhere to safe recruitment principles. We follow strict pre-employment checks on all directly employed staff, Bank Workers and others undertaking work within our organisation. These include identification, right to work, qualification, registration and reference checks. Our pre- employment checks are in line with the NHS employment check standards and our Resourcing functions oversee fair and equitable recruitment and selection practices.
We align to nationally negotiated NHS pay rates and terms and conditions of employment. We consult and negotiate with recognised Trade Unions on proposed changes to working arrangements, policies and contractual terms and conditions.
Only approved frameworks are used for the recruitment of temporary agency staff. All providers are audited to provide assurance that pre-employment clearance has been obtained in line with the NHS Employment Check Standards.
We also provide access to learning and development opportunities and provide a comprehensive staff benefits and health and wellbeing offer.
As part of our standard checks within our procurement process, bidders are checked (where relevant) for their compliance with the Modern Slavery Act (2015).
We have been engaging with our category leads and main suppliers within our IT category to raise awareness and understand the maturity levels of work across the sector in this area. We aim to replicate this approach for other high-risk categories.
We will use this to inform the due diligence processes we need to implement. We recognise that our current due diligence processes are not adjusted to reflect the risk associated with the purchase involved. We will develop our process over the coming year to ensure that our due diligence processes are proportionate to the risk posed by the purchase in question.
KPIs to measure effectiveness of steps being taken
We have a robust governance mechanism for monitoring the delivery of the commitments set out in our policies. The Sustainable Procurement Workstream as part of the ICS Green Plan Implementation Group is made up of representatives from all three organisations. It is responsible for driving the delivery of the commitments and reporting on their progress to the Green Plan Steering Group that sits above this and feeds into Executive and Board level activities at each organisation.
Training on Modern Slavery and Human Trafficking
We provide advice, training and support about modern slavery and human trafficking to all staff through our safeguarding children and adults mandatory training, our safeguarding policies and procedures and our safeguarding teams.
We also ensure that all staff receive a comprehensive induction programme which includes information on, and guidance regarding modern slavery and human trafficking.
Specifically within our procurement function, B&WPC has been developing a capability framework for all procurement job roles. This framework will be completed in the next financial year and will include modern slavery and social value.
A list of available training resources, including those on modern slavery, has been complied and is available for B&WPC staff to access.
UHBW and NBT plan to develop education resources and make them available to their staff and, over the coming year, map the key stakeholders who are involved in the procurement and contract management process to focus engagement efforts and further drive our shared commitment to eradicate modern slavery and human trafficking from our supply chains.
Information for patients who have been advised to have a CT scan.
Introduction
You have been advised by your doctor to have a Computerised Tomography investigation which is more commonly referred to as a CT scan. This leaflet will explain what CT is, the benefits and risks, as well as what the examination involves. If you have any further questions please speak to your doctor, nurse or radiographer looking after you.
CT scans take place in the Imaging department which can also be known as the Radiology or X-ray department. This is the facility within a hospital that carries out radiological examinations such as X-rays, CT scans, Magnetic Resonance Imaging (MRI) scans, Ultrasound scans along with other types of radiological investigations.
Radiologists are doctors specially trained to interpret the images and carry out more complex examinations. They are supported by highly trained operators, known as radiographers, that carry out X-rays and other imaging procedures.
What is a CT scan?
A Computerised Tomography (CT) scanner is a machine that uses ionising radiation (X-rays) and a computer to produce very detailed cross-sectional images of any part of the body. The information is then built up into a series of pictures for the radiologist to view.
What are the risks and benefits of having a CT scan?
A CT scan involves the use of ionising radiation (X-rays); we are all exposed to natural background radiation every day from radioactivity in the air, food that we eat and even from space. Exposure to ionising radiation from a CT scan carries a small risk, however, the main benefit of having the scan is to get an accurate diagnosis so that you can get the right treatment for you. A specialist will have agreed that the benefit of the scan outweighs the risk of the ionising radiation, and we can assure you that all safeguarding to minimise ionising radiation exposure is taken.
If you are between the age of 12 and 55 years of age and there is any chance that you could be pregnant then please contact the Imaging department before you attend for your appointment. The contact details will be on your appointment letter.
Patients should ideally be scanned within the first 10 days of their menstrual cycle. If you are between the age of 12 and 55 and your appointment does not lie within this timeframe, or you are or may be pregnant please contact the Imaging department before you attend. The contact details can be found on your appointment letter.
Some patients will require an injection of contrast medium, also described as X-ray dye, for their scan which increases the amount of information seen on the scan. There is a small chance of an allergic reaction to the injection of contrast medium, however, the Imaging team are trained to deal with any complication, and the risk is very small.
The Imaging team will make sure you are feeling alright and have recovered before letting you leave the department.
Is there anything I need to do before my CT scan?
Please read your appointment letter as this will give you specific details of how to prepare before your CT scan.
If your appointment letter asks you to drink water before your scan please do so, slowly, over one hour prior to your appointment time. This will keep you hydrated and will also highlight the bowel if we are imaging your abdomen and pelvis. You do not require a full bladder for your CT scan.
If you are taking any medication prescribed from your doctor, please continue to take these as normal, unless told otherwise by your doctor.
If you are asthmatic please bring your inhaler with you to your appointment.
It is recommended that you attend your appointment in clothing that doesn’t contain any metal fastenings, zips or decoration as they show up on the CT scan. If this is not possible, we may require you to change into a hospital gown which will be provided.
Please be punctual to your appointment time. We are a busy department and if you are late for your appointment, we may not be able to fit you in. If you are running late on the day of your appointment, then please let us know by contacting our booking office on 0117 414 8989. If we know you may be delayed, then we may be able to rearrange things to fit you in.
What happens during my CT scan?
From the reception waiting area you will be escorted through to the CT waiting area. From this point onwards you will be cared for by a small team of radiographers, image support workers and possibly a radiologist. The radiographer will be the professional carrying out your CT scan.
In the CT waiting area a member of the CT team will begin to get you ready for your scan. If necessary, you will be asked to change into a hospital gown or to remove any metallic items from the area being scanned.
The radiographer will take you through to the CT scan room and, if necessary, assist you onto the CT scan couch. The radiographer will then raise the couch up and move it into the CT scanner until the part of the body we need to scan is in the centre of the hole in the middle of the CT scanner.
Once you are in the correct position the radiographer will leave the room to perform your scan in an adjacent room. The radiographers can always see and hear you throughout your CT scan and can communicate with you through an intercom if required.
You will be required to keep still throughout your CT scan to avoid blurry images being produced. You might also be asked to follow breathing instructions given by the CT scanner which the radiographer will explain to you before they leave the scan room.
If an injection of contrast medium or X-ray dye is required, a cannula will be placed into a vein in your arm. The radiographer will connect this to a machine called an injector pump that will administer the dye during the scan. When the contrast is injected, it is common for some patients to feel a sensation of warmth around their body, a metallic taste in the mouth or throat and the sensation of peeing. These feelings are normal and are just sensations, they usually pass within the first 30 seconds. Please be assured that the feeling of peeing is just a feeling and not actually happening. Not all patients will experience these feelings.
How long will my CT scan take?
If you have been given an injection of contrast media as part of your CT scan, then you will be required to stay in the department for an extra 15 minutes after your scan has finished. This is so that we can ensure that you have not had an allergic reaction.
If you have not received an injection of contrast media, then in most cases, you will be able to leave the department immediately after your CT scan has been completed. You can eat and drink as normal after your scan.
If you experience any problems after your CT scan, then please contact your GP or 111.
How will I get the results of my CT scan?
After your appointment, your CT scan images will be reviewed by a radiologist. The radiologist will write a report which is then sent to the doctor who requested a scan for you. The doctor who requested your scan will inform you of the results.
This page is for patients whose doctor has requested you have a kidney (renal) biopsy. We hope the following information will answer some of the questions you may have about this procedure.
What is a kidney biopsy?
A kidney biopsy is a medical test, where a small sample of tissue is removed from your kidney with a needle. The sample is then sent to the pathology department where it is examined under a microscope.
Why do I need to have a kidney biopsy?
A kidney biopsy helps to assess and diagnose the problem, if any, in your kidney. Kidney biopsies are usually done for one of three reasons.
To find out why a kidney is not functioning properly.
To get a sample of a mass on a kidney.
To assess a kidney before a kidney transplant.
The importance of a kidney biopsy is that it allows for the kidney cells to be assessed by a pathologist to help make a correct diagnosis and plan any necessary treatment.
Are there any alternatives to a kidney biopsy?
There is no other procedure that will give your doctor the same information as a kidney biopsy.
What are the risks associated with kidney biopsies?
A kidney biopsy is usually a safe procedure. Potential complications are uncommon and include:
Some people experience pain, which is usually not severe and can be controlled with simple painkillers.
Bleeding or bruising around the puncture site which should settle down by itself.
There is a small risk of minor internal bleeding after the biopsy. The risk is around 1 in 20 and will usually settle down by itself. The nurse will monitor your blood pressure and pulse during and after the procedure and you will stay in hospital for up to five hours after the procedure so that we can monitor you.
Some people pass blood in their urine after a biopsy. This will usually settle on its own within a few days. If you continue to pass blood for more than 1 week or if you pass a lot of blood, then contact the Imaging department to ask for assessment and advice. If you become unwell out of working hours, then attend A&E. The number for the Imaging department can be found on your appointment letter.
Occasionally people will have a significant bleed, in which case it may be necessary to do a further procedure to try to stop the bleeding. This will occur in approximately 1 in 50 people.
There is a very small risk of death. This risk is less than 1 in 1000.
What happens before the procedure?
You will need to have a blood test a few days before the procedure to check that you are not at increased risk of bleeding and that it will be safe to take the biopsy. This may be arranged to take place at your GP surgery.
You can continue taking your normal medication. If you are on any medication that thins the blood we ask you to call the Imaging department using the number on your appointment letter. We may need to adjust your medication before undergoing this procedure. These may need to be stopped to keep the risk of bleeding to a minimum. This medication includes but is not limited to; aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran and apixaban.
Please arrange for someone to collect you from the hospital and take you home by car, as we advise you not to use public transport. You are not permitted to drive for 24 hours post-procedure and we would like someone to stay with you at home in the first 24 hours. Please inform the department if this is not possible, as we will need to identify alternative arrangements.
On the day of the procedure:
You should eat nothing for six hours before your appointment. You may drink water until the time of your appointment.
You will arrive at Gate 19 and be accompanied into our day case area.
You may take your normal medication unless instructed otherwise. It would be useful to bring a list of your usual medications.
Please inform us if you are allergic to anything. n You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into your arm.
A radiologist (x-ray doctor) will discuss the procedure with you. You will be given an opportunity to ask questions. If you want to go ahead with the procedure you will be asked to sign a consent form.
Once all the checks have been performed and consent signed, you will be taken to the procedure room on the trolley. There will be a nurse and a radiologist with you throughout the procedure.
The radiologist will use an ultrasound machine to look at your kidney to find the correct area to take the biopsy from.
Your skin will be cleaned with an antiseptic solution and covered with sterile drapes.
The radiologist will then inject a local anaesthetic into the area selected for biopsy, which will briefly sting and then go numb. Most people will feel a pushing sensation, but the biopsy is not usually painful. A special needle is used to remove a small piece of kidney tissue. Occasionally it is necessary to take more than one sample.
Once the radiologist has taken the sample, the needle will be removed, and the radiologist will apply a dressing.
What happens after the procedure?
You will be taken back to the day case area so that the nursing staff may monitor you closely.
If you are in pain tell the nursing staff so you can be given appropriate painkillers.
You will be required to stay flat for one hour and then sit up for a further two hours. Then walk around for half an hour.
You will be able to eat and drink as normal.
If everything is satisfactory, you will be free to go home. Please arrange for someone to collect you on discharge rather than drive yourself. n Have someone stay with you overnight.
You should rest for the remainder of that day and the following day, avoiding any strenuous activities for 36 hours.
Keep a regular check on the biopsy site. The dressing can be removed after 24 hours.
If you have any discomfort, take your usual pain relief as prescribed. But, if the pain is severe please contact the Imaging department using the number on your appointment letter.
Some people pass blood in their urine after a biopsy. This will usually settle on its own within a few days. If you continue to pass blood for more than 1 week or if you pass a lot of blood, then contact the Imaging department to ask for assessment and advice. If you become unwell out of working hours, then attend A&E.
What happens next?
The results of the biopsy will be sent to the consultant who referred you, who in turn will either contact you or write to your GP with the results.
If you experience any symptoms you are concerned about, please contact the Imaging department directly on the number on your appointment letter or contact your GP or the emergency department.
Finally, we hope this information is helpful. If you have any questions either before or after the procedure the staff in the Imaging department will be happy to answer them.
References
North Bristol NHS Trust (2022) “Ultrasound Guided Liver Biopsy”
North Bristol NHS Trust (2022) “Kidney Biopsy Information for Patients”
Halimi, J., Gatault, P., Louguet, H., Barbet, C., Bisson, A., Sautenet, B., Herbert, J., Buchler, M., Grammatico-Guillon, L. & Fauchier, L. Clinical Journal of the American Society of Nephrology (2020) “Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies”
What is a Fractional Exhaled Nitric Oxide (FeNO) test?
This is a quick and easy way to measure inflammation (irritation) in the lungs.
The test may be done in the diagnosis of asthma, to evaluate a chronic cough, or to see how well treatment is working in a patient who has already been diagnosed with asthma.
What does the test involve?
You should not smoke on the day of the test.
You should avoid eating nitrate rich foods (such as leafy green vegetables and beetroot) on the day of the test.
You will be asked to sit in a chair for testing
You will be asked to take a deep breath in as fully as possible and blow out at a steady pace for about ten seconds.
The test takes about five minutes to complete.
What happens after the test?
The results will be sent to the healthcare professional that requested the test and they will discuss the results with you at your next appointment.
Reference
ATS/ERS Recommendations for standardized procedures for the measurement of exhaled nitric oxide 2005 (Joint statement).
An exercise assessment, also called cardiopulmonary exercise test, involves performing an increasing level of activity so that your heart and lungs can be monitored to assess your level of fitness.
Why do I need to have this test?
These tests will help us understand what may be causing any limitation to the amount of activity you can undertake. This will help to give you the most appropriate treatment or advice.
Who will perform my test?
The test will be performed by two respiratory physiologists. Respiratory physiologists are staff who have extensive training and knowledge in respiratory physiology and performing lung function tests.
What will happen during the test?
Before the test begins the physiologist will explain the test to you in detail and answer any questions that you have.
To begin with you will be asked to perform some breathing tests through a mouthpiece. You will then have some electrodes attached to your chest so we can monitor your heart and be fitted with a facemask so we can monitor your breathing.
The exercise is usually performed on a bicycle. Every minute the workload will increase until you feel you can no longer continue.
Important information
Please avoid vigorous exercise on the day of your appointment.
Please take all medication as normal and please bring a list of all medication with you.
Please do not smoke, consume alcohol or eat a heavy meal within four hours of the test.
Please wear loose clothing and shoes suitable for exercise.
Do not wear lipstick or nail varnish/false nails.
Please do not wear any body lotion.
Thank you for your co-operation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment.
Frequently asked questions
Will there be any discomfort or side effects of this test?
This is a maximal test so you will feel short of breath and fatigued at the end but this will resolve once the test has ended. Your breathing and heart rhythm are monitored continuously during the test. At any time either you or the physiologist can stop the test.
Is there a different test I could have?
There is no other test that would give us all this information about your exercise tolerance and limitations.
When will I be told the results of my test?
The results will be sent to the professional that requested the test. They will discuss the results with you at your next appointment.
Further information
If you have any questions regarding your appointment please call us on 0117 414 9939.
