The GenOMICC (Genetics of Susceptibility and Mortality in Critical Care) study seeks to identify the specific genes that cause some people to be susceptible to specific infections and consequences of severe injury.

When a patient is already sick, different genetic factors determine how likely they are to survive, and our genes are what determine how susceptible we are to life-threatening infection.

Susceptibility to COVID-19 is almost certainly, in part, genetic. By identifying these genes, we should be able to determine the best use of existing treatments, and design new treatments to help people survive critical illness. This will be achieved by comparing DNA and cells from carefully selected patients with samples from healthy people.

GenOMICC was designed for this crisis. Since 2016, the open, global GenOMICC collaboration has been recruiting patients with emerging infections, including COVID-19. All patients with confirmed COVID-19 in critical care are eligible for this study.

GenOMICC is prioritised as an NIHR Urgent Public Health Study in the UK.

North Bristol Trust: Thrombectomy Referral Criteria – External Hospitals

Thrombectomy service for patients from the Severn region, England operate 24/7.

Referrals from outside Severn and Wales should be discussed with your nearest thrombectomy centre. If the referral time falls outside operating hours for your nearest thrombectomy centre then please discuss with us via referapatient. 

Referrals should be made via Homepage (referapatient.org) to North Bristol Trust in the first instance

   (Search ‘Mechanical Thrombectomy’ and ‘Southmead Hospital’)

If no response is received in 10 minutes, please phone the thrombectomy phone directly

 07784 359723

In case of difficulties, alternative contacts are stroke registrar bleep 1490, or ANPs 0117 9549092.

Before referral, the following should have been carried out:

• Upload of all new brain imaging to cloud portal (Biotronics 3Dnet).
• Input all referral information via: Homepage (referapatient.org)
• Where intravenous thrombolysis is indicated this should not be delayed.

Referrals should fulfil all of the following criteria:

Clinical

• NIHSS >= 6 or disabling/fluctuating deficit
• Independent before the index stroke (modified Rankin Scale 0-2).
• Fit for emergency transfer. If concerns exist regarding patients being safe for inter-hospital transfer seek advice from local anaesthetic / critical care team
• Sufficiently well to benefit from treatment. This includes co-morbidities and frailty; while age influences fitness for treatment age does not by itself limit capacity to benefit.

Radiological

• All patients should undergo a NCCT and CTA with coverage from aortic arch to the vertex*
  • This should be uploaded to Biotronics 3DNet routinely,
  • This should have a local diagnosis of an LVO (carotid-T, M1, proximal M2 or tandem occlusions) via a consultant radiologist or automated post processing tool such as Rapid or Brainomix.

*Multi or dual phase CT angiography is preferred.

• For patients arriving at Southmead within 6 hours:
  • NCCT and CT angiography is required.

• For patients arriving at Southmead within 12 hours:
  • NCCT and CT angiography is required. 
  • Minimal early ischaemic change required (defined as NCCT ASPECTS >= 3 if perfusion imaging is not available locally).
  • Additional CT perfusion with automated post processing is preferable.

• For patients arriving at Southmead between 12 and 24 hours:
  • NCCT, CT angiography and CT perfusion is required. 

NOTE:   If a patient does not fulfil the above criteria but it is felt that they would benefit from treatment, for example young patient with large ischaemic core, basilar occlusion, referrals will still be considered

Please ensure a ReSPECT  form has been completed prior to transfer

What is diabetes?

Diabetes means the body can no longer control the level of glucose (sugar) in the blood. Our bodies make insulin (a hormone) which allows glucose in the blood to be used by the body for energy. In diabetes:

• The body doesn’t produce any insulin, or        
• The body doesn’t produce enough insulin, or            
• The body cannot use insulin efficiently (most common)

The body particularly struggles to use insulin when you are unwell. 

Aims of this page

When a person with diabetes is unwell, glucose levels often rise as a result of the illness.  High glucose levels can lead to further problems and a longer stay in hospital.  For this reason, your diabetes medication may need to be adjusted. You will have help to do this in hospital. It is also important that you continue to follow a healthy balanced diet.

The information on this page is designed to help you to:

• Understand the importance of a healthy balanced diet in diabetes
• Understand North Bristol NHS Trust’s menus
• Understand the importance of making an individualised choice at mealtimes

Does it matter what I eat?

Yes. What you eat affects the levels of glucose and fat in your blood, your blood pressure and your weight. It is therefore important to follow a healthy, balanced diet. The below recommendations are the same as for the general population. 

Healthy eating involves:

• If you are overweight, try to lose some weight (when you are well).
• Eat at regular intervals during the day i.e. breakfast, midday and evening meal. Don’t miss meals.
• Include starchy food (carbohydrate) at each meal (approximately one quarter to one third of the plate). Aim to have about the same amount of starchy food each day. Go for wholegrain, high fibre options where possible.
• Have two or three portions of vegetables each day.
• Have two or three portions of fruit spread throughout the day.
• Limit foods with a high fat content.
• Cut down on sugar, sugary foods and sugary drinks (this includes smoothies and fruit juice).
• Drink alcohol in moderation.
• Cut down on salt.
• Special diabetic foods are not necessary.

Further information is available on healthy eating with diabetes.

Is there a diabetes specific menu in hospital?

No. Healthy eating recommendations are the same as for the general population. There is no need for a specific ‘diabetes menu’ or meal options to be coded as ‘suitable for individuals with diabetes’. The main menu at Southmead Hospital offers a variety of options that allows a person to eat a balanced diet. 

Please note some main courses from the menu already contain a portion of starchy carbohydrates. For example, cheese and potato pie already has a portion of carbohydrate in it in the form of potato. In this instance, you may wish to choose two vegetable side dishes rather than a further potato, pasta or rice accompaniment.

Menu options which contain high amounts of sugar should be limited

Some options on the menu are higher in calories and sugar. Examples include: fruit crumbles, sticky toffee pudding, bread pudding or parkin cake, sponge puddings, rice pudding, chocolate crunch etc

Due to their high sugar content, these options may significantly increase blood glucose levels. Intake of these options should be limited. Small portions of these can be enjoyed occasionally.

Lower sugar and calorie alternatives include:

• Fruit in natural juices
• A portion of stewed fruit
• A small pot of yoghurt

Some patients in hospital may be identified as being at ‘higher nutritional risk’:

• If the patient is underweight.
• If the patient has recently lost weight.
• If the patient has a poor appetite and intake (how much food they eat).

These patients are encouraged to increase the amount of food they eat. They will benefit from having some of the higher calorie and sugar options, as noted above. This is not the case for everyone in hospital and meals should be chosen on an individual basis. Please ask the ward staff for support if you are unsure.

Hospital meal times

Meal times in hospital may be at different times to at home. Depending on the type of medication or insulin you take to manage your diabetes, the difference in meal times could increase your risk of having a ‘hypo’ (blood glucose less than 4mmol/L). 

If you take rapid-acting insulin (NovoRapid™, Humalog™, Apidra™ or Fiasp™) with meals, it is advised that you wait until your meal has been served to you before injecting your insulin. This reduces your risk of having a hypo if the meal is delayed, is different to what you ordered, or you don’t expect to eat the full portion.

Snacks such as cereal, toast, sweet biscuits and milky drinks are routinely available on the ward. Please ask a member of ward staff if you require a snack to prevent a hypo if your meal is delayed, at a different time to home, or, if you have been advised to have a snack before bed.

References

North Bristol NHS Trust Healthy Eating with Diabetes

British Dietetic Association:  The Nutrition and Hydration Digest: Improving Outcomes through Food and Beverage Services (PDF). 2nd Edition. Last updated July 2019. 

Diabetes UK (May 2011) Evidence-based Nutrition Guidelines for the prevention and management of diabetes (PDF).

National Institute of Clinical Excellence. NICE. (Last updated July 2016) Type 1 diabetes in adults: diagnosis and management

National Institute of Clinical Excellence. NICE. (Last updated May 2017). Type 2 diabetes in adults: management

How to contact us

See your appointment letter for the number to phone with any queries you may have.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office:

• Telephone: 0117 414 3764
• Email: overseas.patients@nbt.nhs.uk

Promoting a culture of supporting and working in partnership with carers within our hospitals

North Bristol NHS Trust (NBT) and University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) value the vital work done by those with unpaid caring responsibilities (referred to as ‘carers’ within this charter) and are committed to working together with them as expert partners in care.

A carer is someone who provides care for someone else who, due to illness, mental health problems, substance misuse, physical and learning disability, old age or frailty, is unable to care for themselves without their support. This charter includes young carers and parent carers.

Carers as equal partners

We will ensure that the role you have, as a carer, is valued by all staff and will make sure that we respect, listen to and understand carers and what they do. We will identify carers as early as possible.

Supporting carers

We will inform you as a carer of your right to an assessment under the Care Act 2014 and the Children & Families Act 2014, providing information about the range of support and advice services available to you as a carer. We recognise the importance of your needs being met and will support you to have breaks away from the ward when you need them.

Young carers

We will ensure that we involve young carers and will work to support you and recognise the valuable role you play in the health of our patients.

Sharing information

With the relevant consent obtained, we will provide information that is timely, appropriate and accessible. We will involve you in decision making, with the patient wherever possible, whilst respecting the need for confidentiality.

Having a voice

We will ensure that you have an easily accessible means of giving feedback, that this is responded to and that you are involved in the planning and development of our services.

Discharge planning

We will begin discharge planning as soon after admission as possible. We will help you understand the processes, including you in all discussions, respecting your detailed knowledge of what happens outside the hospital. With the relevant consent obtained, we will include you in all discussions on all aspects of care and medication. 

To contact us

For Southmead and the BRI:

• Southmead 0117 937 5626
• BRI 0117 435 0188 or 0117 435 0193

or email carerliaison@carersbsg.org.uk

For Weston-super-Mare:

• 01934 636363 and ask for extension 3193

or email hospitalteam@alliancehomes.org.uk

This information is for patients who have been directed to this page as you are starting, or already taking, a medicine, known as enoxaparin. It is most likely that the enoxaparin brand you will be using is called Inhixa®. Enoxaparin is part of a group of medicines called anticoagulants. An anticoagulant medicine prevents blood clots forming in your blood vessels by making your blood take longer to clot.

Enoxaparin contains a product derived from pigs. If you have any ethical objections to the use of animal products please discuss this with a healthcare professional before using enoxaparin.

Enoxaparin reduces blood clot risk

A blood clot can develop in the large veins of the body, usually in the legs. This is called a deep vein thrombosis (DVT). 

Sometimes, a blood clot can break free and travel through your blood vessels. If a clot lodges in the blood vessels of your lungs it is called a pulmonary embolism (PE). A PE can cause chest pain and difficulty in breathing and, if severe, can cause death. Rarely, a clot may move to the brain and cause a stroke. 

After surgery there is an increased risk of blood clots forming. Evidence shows that following some types of surgery, an extended period of treatment with enoxaparin reduces this risk. You will usually need to inject enoxaparin for between 10 and 28 days after your surgery.

Why do I need enoxaparin?

There are lots of reasons why you may be at higher risk of blood clots. Here are some of the most common ones:

• Age over 40, as the risk increases with age. 
• Taking any kind of oral contraceptive pill (OCP). 
• Taking hormone replacement therapy (HRT). 
• Some heart problems. 
• Severe breathing difficulties. 
• Varicose veins.
• Obesity .
• If you have had a DVT before. 
• If you have a family history of DVT. 
• If you have previously suffered a stroke. 
• The type of surgery, such as knee or hip replacement or abdominal surgery.

How can I tell if I have a DVT or PE?

Early signs of a deep vein thrombosis (DVT)

Early signs of a pulmonary embolism (PE)

How should I inject enoxaparin?

You need to inject Inhixa® under the skin (a ‘subcutaneous injection’). You should have the injection at the same time every day. 

A healthcare professional will have shown you how to inject yourself using the Inhixa® syringe. They should also tell you how long the treatment will be for. It is important that you know the correct technique before you try to inject yourself. If you are unsure, you should ask a healthcare professional for advice.

Step-by-step instructions for injecting Inhixa®

Things to look out for

Heparin-induced thrombocytopenia (HIT)

Dos

Don'ts

Your questions answered

After discharge from hospital who can I contact for help or advice?

The patient information leaflet that came with enoxaparin advises against using a particular medicine that I am taking. Is this okay?

Can I inject anywhere other than my stomach?

Where should I keep the enoxaparin syringes?

What should I do if there is an air bubble in the syringe?

What should I do if I have injected too much enoxaparin?

What should I do if I miss an enoxaparin injection?

How can I find out more about enoxaparin?

What should I do with my used syringes?

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002719

Key points

• A miscarriage is the early loss of a pregnancy.
• Recurrent miscarriage is when this happens three or more times.
• Around 1% of women have recurrent miscarriages.
• Most couples who have had recurrent miscarriages still have a good chance of a successful pregnancy in the future.
• If you have had recurrent miscarriages, you may be offered blood tests and a pelvic ultrasound scan to try and identify the reason for them.
• Despite careful investigations, it is often not possible to find a reason for recurrent miscarriage.
• Your doctors will not be able to tell you for certain what the outcome will be if you become pregnant again.

About this information

This information is for women and couples who have had three or more miscarriages. It is based on the Royal College of Obstetricians and Gynaecologists (RCOG) guidance, last reviewed in 2011. It explains:

• Some of the known reasons for recurrent miscarriage;
• The most effective ways of investigating and treating women who have experienced recurrent miscarriages.

National guidance aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace advice from a doctor or midwife about your own situation.

This guidance does not look at reasons or treatment for a single miscarriage.

What is recurrent miscarriage?

A miscarriage is the loss of a pregnancy at some point during the first 23 weeks. There is a 10 - 15% chance of miscarriage with any pregnancy, and most miscarriages occur within the first 12 weeks.

Recurrent miscarriage is when three or more pregnancies end in miscarriage. 1% of couples who are trying to conceive have recurrent miscarriages, and for women and their partners it can be an incredibly distressing situation.

For some women experiencing recurrent miscarriage, there is a specific reason for their losses. For others, however, their repeated miscarriages may be due to chance alone.

For around half of women who have recurrent miscarriages, no underlying cause is found.

What are the reasons for recurrent miscarriage?

A number of factors may play a part in recurrent miscarriage. It is a complicated problem and more research is still needed.

Abnormalities in the embryo

An embryo is a fertilised egg. An abnormality in the embryo is the most common reason for single miscarriages. However, the more miscarriages you have, the less likely this is to be the cause of them.

Your age and past pregnancies

The older you are when you become pregnant, the greater your risk of having an abnormality in the embryo and therefore the greater your chance of having a miscarriage.

Having multiple miscarriages in the past may also increase the likelihood of having another one.

Lifestyle factors and weight

Smoking, excessive alcohol or caffeine intake, and having a body mass index (BMI) above 25 are all associated with increased risk of miscarriage, and may therefore be a factor in recurrent miscarriage for some women.

Genetic factors

For around 3 - 5% of women who have recurrent miscarriages, they or their partner have an abnormality in one of their chromosomes (the structures within our cells that contain our DNA and therefore determine the genetic features we inherit from our parents).

Although such abnormalities may cause no problem for you or your partner, they may sometimes cause problems if passed on to your baby, and therefore be a reason for recurrent miscarriage.

Autoimmune factors

Antibodies are substances produced in our blood in order to fight off infection. Some people produce antibodies that react against the body’s own tissues; this is known as an autoimmune response.

Antiphospholipid antibodies (aPL) are an example of antibodies that react against the body’s own tissue and are strongly associated with recurrent miscarriage.

About 15% of women who have had recurrent miscarriages have antiphospholipid antibodies in their blood, compared to fewer than 2% of women who have normal pregnancies. If you have antiphospholipid antibodies and a history of recurrent miscarriage, your chances of a successful pregnancy may be reduced.

Abnormalities in womb structure

It is not clear how far major irregularities in the structure of your womb can affect the risk of recurrent miscarriage. Women with serious anatomical abnormalities affecting their womb, and who do not have treatment for them, appear to have a higher risk of miscarrying or giving birth early.

Minor variations in the structure of your womb do not cause miscarriage.

Weak cervix

In some women, the entrance to the womb (the cervix) opens too early in the pregnancy and results in a miscarriage. This is known as a weak cervix, and is only recognised as a possible cause of miscarriage in the second and third trimester (from 13 weeks onwards).

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common condition in which an imbalance of hormones causes symptoms including irregular or absent periods, or changes in aspects of your appearance.

It is sometimes, but not always, associated with ovaries that appear larger than normal on an ultrasound scan and have more follicles (fluid filled spaces containing developing eggs) than normal ovaries. Having polycystic ovaries on an ultrasound scan does not necessarily mean you have PCOS, and not all women with PCOS have polycystic ovaries.

Having a diagnosis of PCOS has been linked with having an increased chance of miscarriage, however the exact association with recurrent miscarriage isn’t clear.

Diabetes and thyroid problems

Diabetes or thyroid disorders can be factors in single miscarriages. They do not cause recurrent miscarriage, as long as they are treated and kept well controlled.

What can be done to investigate and treat recurrent miscarriage?

Supportive pregnancy care

Women who have supportive care from the beginning of a pregnancy have a better chance of a successful birth.

There is some evidence that being under the care of a dedicated recurrent miscarriage service can reduce the risk of further miscarriage.

Blood tests

Hormone levels on day 2 - 3 of your first period after your most recent miscarriage may be measured. If this falls at a weekend, please attend the early pregnancy clinic (EPC) after the weekend, as these blood tests can be taken on day 1 - 5 of your period.

Other blood tests are carried out 6 weeks after your most recent miscarriage.

Hormone treatment

It has been suggested that taking progesterone early in pregnancy could help prevent a miscarriage. This may be offered to you in the recurrent miscarriage clinic depending on the results of your tests.

Treatment for antiphospholipid antibodies

There is some evidence that if you have aPL antibodies and a history of recurrent miscarriages, treatment with low-dose aspirin tablets and low-dose heparin injections (blood thinner) in the early part of your pregnancy may improve your chances of a live birth.

Screening for abnormalities in the embryo

If you have a history of recurrent miscarriage and you lose your next pregnancy, your doctors or the early pregnancy clinic may suggest checking for abnormalities in the embryo or the placenta afterwards.

They will do this by checking the chromosomes of the embryo through a process called karyotyping (although it is not always possible to get a result). They may also examine the placenta through a microscope.

The results of these tests may help them to identify and discuss with you your possible choices and treatment.

Screening for abnormalities in the structure of your womb

You will be offered a pelvic ultrasound scan to check for and assess any abnormalities in the structure of your womb, so that they can be treated if necessary.

Tests and treatment for a weak cervix

If there is a suspicion of a weak cervix based on your previous pregnancy history, you will be referred to the preterm labour clinic.

At the clinic, scans of your cervix will be undertaken in the second trimester of your pregnancy, and treatment may be offered if a weak cervix is confirmed.

Immunotherapy

Treatment to prevent or change the response of the immune system (known as immunotherapy) is not routinely recommended for women with recurrent miscarriage. It has not been proven to work, does not improve the chances of a live birth and can be associated with certain risks.

What could it mean for me in future?

Your doctors will not be able to tell you for sure what will happen if you become pregnant again.

However, even if they have not found a definite reason for your miscarriages, you still have a good chance (75%) of a healthy birth.

What to expect following a referral to the recurrent miscarriage clinic

• Whilst you are waiting for your first appointment in the recurrent miscarriage clinic, you are advised to avoid pregnancy if possible.
• It will not be possible to offer any additional treatment, scans or advice beyond routine pregnancy and miscarriage care, if you do become pregnant before being seen.
• When you come to the clinic, your investigations and possible treatment options will be discussed.
• After you have been seen, you may be offered any necessary treatment as well as repeat reassurance scans during the first trimester of future pregnancies, as part of your ongoing care.

Further information and support

You can find more information and support around recurrent miscarriage through the following organisations.

Tommy’s foundation

www.tommys.org/baby-loss-support/miscarriage-information-and-support/recurrent-miscarriage

Miscarriage association

www.miscarriageassociation.org.uk/information/miscarriage/recurrent-miscarriage

How to contact us

Early Pregnancy Clinic

0117 414 6778

www.nbt.nhs.uk/epac

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office:

Tel: 0117 414 3764

Email: overseas.patients@nbt.nhs.uk

© North Bristol NHS Trust. This edition published May 2024. Review due May 2027. NBT002544.

We are sorry that you have had a miscarriage

We are very aware that this a distressing time, and want to ensure you are well supported during this time. Everybody deals with miscarriage differently, and there is no ‘right way’ to be. Our aim is continuity of care, however this is not always possible, and when you are in hospital you will be looked after by a team of doctors and nurses.

Understanding the terms used for miscarriage

Complete miscarriage

This is when the scan shows that your womb is empty after a miscarriage. No further treatment is needed.

Incomplete miscarriage

This is when your scan shows that there is some tissue remaining in the womb.

Missed miscarriage

This is when your scan shows that the baby is not developing, or has not developed and there is no heartbeat. 

Some women will have already miscarried when we see them. A scan or a negative pregnancy test will confirm this. If a miscarriage has not already happened, there are a number of ways to treat you.

Expectant management of miscarriage (waiting for a natural miscarriage to happen)

Medical management of miscarriage

Surgical management of miscarriage

Frequently asked questions

How long will I bleed after the miscarriage?

Can we be told the sex of our lost baby?

What happens to the pregnancy, or pregnancy tissue after a miscarriage has happened?

When will my periods come back?

Why did I miscarry?

Will it happen again?

How soon can I resume my normal life?

When can we start having sex again?

Is there anything we can do to remember our baby?

If and when you feel ready to decide to plan another pregnancy you may wish to refer to the information below.

How soon can we try again?

Diet

Folic acid

Smoking

Medication

Pregnancy loss

Information and Support Services for patients and their families 

Grief and sadness are additional burdens for individuals, families, and other carers. Support may help you to manage more easily. The list of support agencies below is not exhaustive and inclusion does not imply endorsement. If the organisation you are seeking is not listed here it is worth looking in the front of the Yellow Pages where there is a list of useful national helpline phone numbers. It is also worth remembering that many GPs have counselling services attached to their practices.

Further help and advice

References

© North Bristol NHS Trust. This edition published January 2024. Review due January 2027. NBT002479

Following specialised X-ray procedures, it is possible that a small patch of skin may have been exposed to radiation for a long period of time; this can produce changes to the skin.

The changes depend on which area of the body the x-rays were pointing at (for example the head or the back) and the length of the procedure.

Skin reddening (also known as Erythema)

This is the first sign that the small patch of exposed skin has been affected. This looks like sunburn and can feel warm, sensitive and tight. This can happen anything from the first 24 hours up to 2 weeks later.

Temporary hair loss

This may also start up to three weeks following your procedure, depending on the exposed area of skin.

If any of these symptoms appear, please contact the Imaging department to let us and your referring consultant know, as we may need to arrange a follow up appointment.

Further recommendations

• Apply a creamy moisturiser (e.g. Epimax) sparingly to the affected skin. You can buy this or something similar from your pharmacist. Do not apply the cream to broken skin.
• Wash skin with lukewarm water and pat gently dry.
• Whilst symptoms persist, wear loose cotton clothing (if skin damage is to the body) and try to let air circulate around the affected area.
• Protect any affected skin from direct sunlight.
• If you contact your GP about this issue, please inform them of your radiology procedure.
• If you are required to have any further x-ray procedures within 14 days, please let the hospital staff know.

References

1. The Society and College of Radiographers (2020) Radiation Dermatitis Guidelines for Radiotherapy Healthcare Professionals

2. The Society of Interventional Radiology. Interventional Fluoroscopy-reducing radiation risks for patients and staff.NIH Publication No.05-5286. March 2005

How to contact us

Brunel building
Southmead Hospital
Westbury-on-trym
Bristol
BS10 5NB

If you have any queries please contact the number on your appointment letter.

Your doctor has requested that you have a myelogram. We hope that the following information will answer some of the questions you may have about this examination.

What is a myelogram?

A myelogram is an x-ray examination of the spinal cord and the space surrounding it. It provides a very detailed picture of the spinal cord and spinal column and of any abnormalities that may be present such as herniated or ruptured intervertebral disc.

Contrast medium (or ‘X-ray dye’) is injected via a small needle into the lower part of the spine. This is done by a radiologist (a doctor who specialises in X-rays used for diagnosis) into the fluid filled space around the spine called the subarachnoid space. This is called a lumbar puncture or LP.

The table used for a myelogram can be tilted so that contrast medium will run up and down within this space and surround the nerve roots that enter and exit the spinal cord.

Images are then taken as the contrast medium flows into the various areas of the spine. Far more information can be obtained from a myelogram than from plain spine X-rays.

Why do I need to have a myelogram?

A myelogram is performed when other tests such as Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) have not provided enough information, or when patients cannot have an MRI for any reason.

How do I prepare for the examination?

It is important that you drink plenty of fluids before your myelogram to help remove the contrast medium from your body and to prevent headache. You may also eat light meals prior to the procedure.

If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, dabigatran) we ask you to call the Imaging department on the number on your appointment letter as we may need to adjust your medication before undergoing this procedure. 

These may need to be adjusted to keep the risk of bleeding to a minimum.

On the day of the procedure

You will arrive at the Imaging Department (Gate 19) and be accompanied to our day case area.

Please inform us if you have any allergies or if you think there is a chance you may be pregnant. 

You will then be asked to change into a hospital gown.

Once all the checks have been performed, you will be taken to the X-ray room on the trolley. There will be a doctor, radiographer and imaging support worker with you throughout the procedure. 

What will happen during the procedure?

• Before the examination begins, the radiologist will explain what they are going to do. You will be given the opportunity to ask any questions you may have.
• If you are happy to proceed you will be asked to sign a consent form.
• You will then be asked to lie on your front on the X-ray couch.
• The skin on your back will be cleaned and a small amount of local anaesthetic will be injected under the skin. This stings for a few seconds and the area then goes numb.
• A very fine spinal needle will be guided into the correct place using the X-ray machine. If needed, a small amount of cerebral spinal fluid can be withdrawn for laboratory studies.
• When the contrast medium is injected, you may feel slight pressure. It is common to experience heavy legs and a momentary increase in symptoms. Headache, flushing or nausea are other symptoms you may experience following the contrast injection.
• The X-ray table is slowly tilted to different angles and X-ray pictures are taken. Rests and straps (or supports) will keep you from sliding out of position.
• A CT scan is often performed after the myelogam while contrast is still present in the spinal canal. You will be brought to the CT scanner on the trolley.

Are there any risks associated with a myelogram?

Generally it is a very safe procedure. Potential complications are uncommon and include:

• Bleeding or haematoma (a bruise under the skin) around the injection site. (This should settle down by itself).
• Infection. Contact your GP if you experience any redness or tenderness at the injection site.
• An allergic reaction to the contrast medium. (RCR 2015). Please inform the radiologist performing the myelogram if you have any allergies.
• Headache (see information about this below).

X-rays are used in this procedure but with modern equipment the risk is low (NRPB 2014).

It is important that patients inform the Imaging Department if there is any possibility of pregnancy before attending for the examination.

Will I experience any serious side effects?

Serious side effects are rare but you should notify your GP if you experience:

• A high fever
• Excessive nausea and vomiting
• Severe headache for more than 24 hours
• Neck stiffness
• Numbness in your legs
• Trouble urinating or passing a stool.

Who interprets the results and how do I get them?

The results will not be available at the time of your myelogram.

The radiologist, who performed your myelogram, will examine your images in detail and forward a report to the doctor who referred you for the myelogram. You will be able to get the results from this doctor.

We hope this information is helpful. If you have any questions either before, during or after the procedure, the staff will be happy to answer them.

References

© North Bristol NHS Trust. This edition published July 2023. Review due July 2026. NBT002598