Ambulatory Electroencephalography (aEEG)

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Please read this information carefully before coming in for your Ambulatory Electroencephalography (aEEG).

What is an ambulatory EEG?

EEG stands for electroencephalogram. Ambulatory monitoring involves recording the electrical activity in your brain when you are going about your normal daily activities, meaning you leave the department with the electrodes attached. This recording is usually done for 48 hours. 

What does an ambulatory EEG involve? 

An ambulatory EEG recording involves coming to Southmead Hospital for 3 separate appointments, 3 days in row. 

What happens during an ambulatory EEG?

Your first appointment 

This appointment will take around 60 minutes.

  • Your head will be measured, then rubbed gently and 23 small metal discs will be applied to your head with soluble sticky paste, before being firmly attached with Mavidon glue.
  • 2 electrodes will be applied to your shoulders to measure your heart rate during the EEG.
  • These discs will then be attached to the small recording box with wires.
  • The box will stay attached to you for the duration of the test and can be carried in a bag over your shoulder.
  • You will be given a diary to complete. You will need to give a basic outline of your daily activities (eating, sleeping etc) as well as any typical events.
  • We will also ask you to press a red event button, which is attached to the recorder, if you have any of your typical events. If you have no recollection of your events happening, it could be useful to have someone stay with you overnight to help you fill in the diary.

Your second appointment

This appointment will take around 30 minutes.

  • You will need to bring your diary sheet back. The information on the recorder will be downloaded, the batteries will be replaced and all discs will be checked.

Your third appointment

This appointment will take around 60 minutes.

  • The discs will be removed with acetone and as much glue as is possible will be removed, but you may still find loose bits in your hair.
  • Use conditioner and a fine comb at home to help remove the final bits of glue.

Preparing for the test 

  • You must arrive with clean, dry hair with no grease, gel, wax, or other hair products - these can impair electrode/skin contact. You will not be able to wash your hair until after the electrodes are removed on the third day.
  • Wear clothing which is loose fitting around the neck, preferably an open neck shirt/blouse with button fastening or a wide necked T-shirt. This will make it easier to undress when going to bed.

When will I get my results?

You will not get your results straight after the test or see a doctor on the day, as the ambulatory EEG needs to be fully analysed.

A full report will be sent to the GP or consultant who referred you within 2 weeks, they will then contact you to discuss the results. Please note, results are not sent directly to you.

Contact details

This information is intended as a guideline only. If you have any further questions about your test (excluding about results) please contact the department on the numbers below and a member of staff will be happy to help.

0117 414 1048 
0117 414 1050 

Your responsibility as a patient

Outpatient services at North Bristol NHS Trust are in great demand. Even so, every week an average of 600 patients fail to attend, which wastes appointments. Please tell us with as much notice as possible if you no longer need your appointment and we can allocate this to another patient. 

What if I am unwell or need to change my appointment?

If you have an infectious condition, such as COVID-19, measles, mumps, chickenpox, flu, stomach upset, have head lice, or are unable to attend your appointment for any other reason, please let us know with as much notice as possible so that your appointment can be rescheduled and offered to someone else.

If you want to change the appointment for a second time, we cannot offer you another date unless there are exceptional circumstances.

What if I don’t attend?

We will assume that you no longer require your appointment, and we will not offer you another one. We will write to the consultant/doctor who referred you and inform them that you did not attend.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003736

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Actigraphy

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Please read this information carefully before coming in for your actigraphy test. 

What is an actigraphy? 

Actigraphy is a non-invasive way to find out your sleep patterns by monitoring your rest and activity cycles over 1 or 2 weeks. 

Why have an actigraphy?

If you are having problems with your sleep such as irregular sleep and wake times or excessive sleepiness, you may be referred for an actigraphy test. 

What happens during an actigraphy?

Actigraphy monitors movement over days or weeks in real life situations. It involves wearing a device like a watch which has an accelerometer that detects movements.

You will wear the watch on your wrist at all times for around 2 weeks and complete a diary sheet of your daily activities and sleep times. You must only remove the watch when you shower, bathe, or wash and then log this on the diary sheet. It is important that you remember to re-attach the watch after this.

You will press a button on the watch when you go to bed and when you wake up. This will be fully explained to you by the clinical neurophysiologist at your initial appointment. During this appointment, you will be given some diary sheets to write down your daily activities whilst wearing the watch.

After you have completed your period of actigraphy you must return the watch in person at the time specified in your letter. These watches are in high demand for use by other patients and failure to return at the specified time may result in the cancellation of other patients’ appointments.

Preparing for the test

  • You can eat and drink as normal before the test.
  • Please follow the guidance provided by your consultant neuropsychiatrist about reducing or stopping medications before coming for the test. This information should be in the clinic letter following your appointment. Please call 0117 414 1048 or 0117 414 0452 if you have any concerns or questions.
  • You will be asked if you understand this information and whether you consent to the test before we start. You are welcome to ask the neurophysiologist doing the test to give you any further information or to explain more about the procedure.
  • Your appointment should take about 10-15 minutes.

How long until I get my results?

The results will be sent to your GP/consultant. You will not receive any results during the test. Your consultant may send you a letter with the results or see you again for a follow-up appointment. Please note, results are not sent directly to you. 

Contact details

This information is intended as a guideline only. If you have any further questions about your test (excluding about results) please contact the department on 0117 414 1048 or 0117 414 1052 and a member of staff will be happy to help.

Your responsibility as a patient

Outpatient services at North Bristol NHS Trust are in great demand. Even so, every week an average of 600 patients fail to attend, which wastes appointments. Please tell us with as much notice as possible if you no longer need your appointment and we can allocate this to another patient. 

What if I am unwell or need to change my appointment?

If you have an infectious condition, such as COVID-19, measles, mumps, chickenpox, flu, stomach upset, have head lice, or are unable to attend your appointment for any other reason, please let us know with as much notice as possible so that your appointment can be rescheduled and offered to someone else.

If you want to change the appointment for a second time, we cannot offer you another date unless there are exceptional circumstances.

What if I don’t attend?

We will assume that you no longer require your appointment, and we will not offer you another one. We will write to the consultant/doctor who referred you and inform them that you did not attend.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003735

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Looking after your eyes whilst taking Dupilumab (Dupixent®)

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How dupilumab may affect your eyes

Dupilumab is an effective treatment for severe asthma, but it has been linked to side effects of the eyes in some people. Most of the side effects are mild, but some can become serious if they are not managed properly.

Mild side effects which you can often manage yourself:

  • Dry eyes: dryness, burning, or grittiness in the eyes.
  • Conjunctivitis: red, itchy, watery eyes with possible discharge.

Uncommon side effects which require advice from a healthcare professional: 

  • Blepharitis (eyelid inflammation): redness and swelling around the eyelids, often with crusting.
  • Keratitis (corneal inflammation): eye pain, blurred vision, light sensitivity, or feeling like something is in your eye.

Managing mild eye side effects

If you have eye symptoms while on dupilumab, try these steps:

  • Use artificial tears: over-the-counter lubricating eye drops (for example sodium hyaluronate) can help with dryness and irritation. Use preservative-free drops if needed. Speak to your community pharmacist for advice on eye drops.
  • Warm compresses: apply a warm, moist compress to your eyelids for a few minutes to relieve discomfort.
  • Maintain eye hygiene: clean your eyelids daily with a warm cloth or mild eyelid scrub.
  • Limit contact lens use: wear glasses more often than contact lenses if you have symptoms of conjunctivitis or dry eyes.
  • Avoid touching or rubbing your eyes: this can make symptoms worse and cause infections.
  • Protect your eyes from irritants: avoid smoke, dust, and strong wind. Sunglasses can help.

When to contact a healthcare professional

Phone the Severe Asthma team on 0117 414 2030 if you have:

  • Eye discomfort that won’t go away or is getting worse.
  • Vision changes, like blurred vision or light sensitivity.
  • Severe redness or swelling of the eyes.
  • Symptoms that don’t improve with over-the-counter treatments.

When to go to A&E at the Bristol Eye Hospital

If you have any of the following eye symptoms go to Bristol Eye Hospital A&E for urgent care.

  • Sensitivity to light.
  • Significant pain.
  • Sudden changes in vision.
  • Severe itching.

Please inform the Severe Asthma team if you have gone to the eye hospital A&E when possible. Contact us on 0117 414 2030.

Eye care tips while on dupilumab

  • Regular eye exams: schedule eye exams to detect changes early.
  • Report new symptoms: inform the severe asthma team about any new or worsening symptoms.
  • Follow treatment instructions: stick to your treatment plan to minimise side effects and get the full benefit of dupilumab.

Summary

Eye issues can be a side effect of dupilumab but can often be managed with the right steps. Knowing the symptoms, how to manage them, and when to seek help will help you continue to benefit from dupilumab while protecting your eye health.

For any concerns or questions, contact the severe asthma team on 0117 414 2030.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003755

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Cardiopulmonary Exercise Testing (CPEX)

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What is a CPEX test?

Person sitting on exercise bike wearing mask and blood pressure cuff for cardiopulmonary exercise test

A Cardiopulmonary Exercise Test (CPEX, also known as CPET) is a safe exercise test used to measure your fitness. It is the best test to measure how your heart and lungs will cope with surgery. It is a short exercise test on a static bicycle (like exercise bikes you see in gyms). Many hospitals offer it as part of your pre-operative assessment and planning for surgery.

Why do I need to have this test? 

We do this test to find out how you are likely to react to surgery. This will inform surgeons and anaesthetists how best to look after you. This may reduce your risk of complications, and it will also provide useful information about your potential recovery time following the operation.

What happens during the test?

Before your test begins, staff will fully explain what will happen and answer any questions you may have. The test usually lasts between 5 and 12 minutes. Staff will ask you to tell them if you feel any discomfort or pain during the test. You are free to stop if you feel fatigued (tired) or uncomfortable; but the longer you can go, the better the information we will get.

Whilst cycling your breath will be analysed and your heart and blood pressure monitored. You will have some simple medical equipment attached to you so that we can take these readings. A specialised mask will measure the oxygen and carbon dioxide in your breath.

A health professional will be with you at all times. We may ask you to stop if we see you look fatigued or there are changes to your heart rate or blood pressure.

The test begins gently, with a low intensity cycle; you will feel no resistance as you pedal. Gradually you will feel increased resistance when pedaling. Most people do enough of the test for us to get the medical information we need. After the test, you rest on the bike until you are ready to sit down and discuss the results.

Occasionally, with your permission, we may include your anonymised results in research to improve patient care.

Important information

  • Please continue to take all your medications as normal – or how you have been instructed by your doctor.
  • Please do not wear nail varnish to your appointment.

Will I experience any discomfort or side effects?

There are no known side effects. CPEX testing is very safe. Rarely patients experience problems with abnormal blood pressure, irregular heart rates, or chest pain.

Complications happening during the test is actually a good thing. This identifies patients who will potentially have problems during surgery and minimises the risk of surgery that you are exposed to.

Every effort will be made to minimise any risk by evaluation of your medical information before the test, and careful observation during the test.

Is there a different test I could have?

There is no other test that provides this information about your heart and lung ‘fitness’.

When will I be told the results of my test?

You will be told of the results on the same day by the doctors performing the test. The information will also be shared with the doctor or surgeon who requested the test.

What if it tells me I cannot have my operation?

Sometimes the information will tell us that your body will find the stresses and strains of the operation too much. We will discuss the risks and benefits of the surgery with you and your surgeon.

I have bad joints and am worried about riding the bike? 

Unless you have very severe joint pain, most people are able to ride the bike for the duration of the test.

How ‘fit’ do I have to be to perform the test?

People of all levels of ability, ages and fitness are able to perform the test.

I am worried or anxious about completing the test

We understand that many patients find the idea of this test worrying for many reasons. We have excellent staff at hand to reassure and support you through the process. Feel free to answer ask questions on the day. We will do our best to make you feel safe and well-cared for during your appointment.

What should I wear for my test?

You should wear normal comfortable clothing and flat shoes (ideally trainers) suitable for cycling in.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002669

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Newborn Screening

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A peice of equipment within the Laboratory that screens for conditions

The department of Clinical Biochemistry provide the Newborn Bloodspot Screening service for a large part of the South West Region. Testing is undertaken on filter paper bloodspots which are collected from babies between 5 and 8 days of age. Our UKAS accredited laboratory currently screens approximately 42,000 babies each year for nine conditions:

  • Sickle cell disease (SCD)
  • Cystic Fibrosis (CF)
  • Congenital Hypothyroidism (CHT)
  • Inherited Metabolic Diseases:
    • Phenylketonuria (PKU)
    • Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
    • Maple syrup urine disease (MSUD)
    • Isovaleric acidaemia (IVA)
    • Glutaric aciduria type 1 (GA1)
    • Homocystinuria (pyridoxine unresponsive) (HCU)

Early detection through screening and prompt treatment significantly reduces the morbidity and mortality associated with these conditions.
The newborn screening bloodspot programme is provided in close collaboration with health care professionals throughout the region.

Information for public and professionals regarding the SCID evaluation.

Screening for SCD is provided with the department of Haematology at North Bristol NHS Trust (NBT) and Cystic Fibrosis with the Bristol Genetics Laboratory

The screening laboratory works very closely with the South West Regional Metabolic Biochemistry laboratory which provides diagnostic testing to support the newborn screening programmes and monitoring of patients identified though the Inherited Metabolic Disease screening programmes. Bloodspot testing for PKU, hypothyroidism (TSH) and a monitoring service for Congenital Adrenal Hyperplasia (17-OHP) is also available.

In early 2014 we began uploading all of our results to the Newborn Blood Spot Failsafe Solution (NBSFS). This is a national web-based solution which allows maternity units, child health record departments, and screening laboratories to verify the screening status of any baby registered in England. It enables easy early identification of those babies who have had no blood spot card received in the laboratory, making it less likely that any babies will miss screening, and also promotes timeliness of repeat sampling.

Laboratory Visits

We offer half-day training sessions to midwives, health visitors, dieticians, nurses, doctors and other healthcare professionals involved in the collection of bloodspots. Please contact us to arrange a visit.

Please see below for responses to our most recent user survey

Key Contacts

Dr Helena Kemp
Director of Newborn Screening & Consultant Chemical Pathologist
Telephone: 0117 4148425

Maryam Khan
Principal Clinical Scientist
Telephone: 0117 4148418

Emma Smith-Thomas
Senior Clinical Scientist
Telephone: 0117 4148427

Dr Sophie Otton
Consultant Haematologist
Telephone: 0117 4148359

Grace VanDerMee
Lead Biomedical Scientist - Haematology
Telephone: 0117 4148356

Rebecca Whittington
Principal Clinical Scientist - Genetics
Telephone: 0117 4146175

Clare Le Masurier
Senior Biomedical Scientist
Telephone: 0117 4148430

Bryony Wright
Senior Biomedical Scientist
Telephone: 0117 4148346

Contact Newborn Screening

Newborn Screening Laboratory (Bristol)
PO Box 407
Bristol
BS9 0EA

Email: newbornscreening@nbt.nhs.uk
Telephone: 0117 414 8412
 

Opening times: 9am - 5pm Monday - Friday excluding bank holidays.

Clinical advice & interpretation is available during working hours.

Access the NHS Blood Spot Screening Programme Centre

Newborn Screening

Metabolic Biochemistry

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The Metabolic Biochemistry Laboratory (previously Biochemical Genetics) at Southmead Hospital provides a regional diagnostic and monitoring service for the investigation of inherited metabolic diseases. Routine analyses performed include urine organic acids (including quantitative methylmalonic acid, if required), bloodspot/plasma acylcarnitines (including free carnitine), plasma/urine/CSF quantitative amino acids, qualitative galactosaemia screening test, plasma free fatty acids and 3-hydroxybutyrate.

In addition, the laboratory provides specialist testing for the investigation of peroxisomal disorders (plasma very long chain fatty acid analysis, including pristanic and phytanic acids), Smith-Lemli-Opitz syndrome (plasma 7-dehydrocholesterol and 8-dehydrocholesterol)

The Metabolic Biochemistry department is a Centre for Galactosemia investigations and offers a variety of tests for the diagnosis and monitoring of disorders of galactose metabolism including:

  • first line galactosaemia screens,
  • quantitative galactose-1-phosphate uridyltransferase activity for confirmation of classical galactosaemia;
  • urine galactitol for screening and monitoring of galactokinase deficiency or screening for classical galactosaemia if infant has been transfused; 
  • galactokinase activity for confirmation of galactokinase deficiency;
  • galactose-1-phosphate for monitoring treatment of classical galactosaemia.

The Metabolic Biochemistry Laboratory at Southmead Hospital is a member of the UK National Metabolic Biochemistry Network (MetBioNet). 

The Metabolic Biochemistry laboratory works very closely with the Southwest Newborn Screening Laboratory to aid in the diagnostic testing to support the newborn screening programmes and monitoring of patients identified though the Inherited Metabolic Disease screening programmes. Bloodspot monitoring for PKU (Phenylalanine and tyrosine) and CAH (17-OHP) for known patients and testing for hypothyroidism on bloodspot (TSH)

We provide a comprehensive advisory service and welcome enquiries to discuss appropriate patient investigation and result interpretation. Clinical and laboratory advice is available during working hours, via contacts listed.

Details of Sample Requirements and Transport can be found under “Requesting” and “Test Information” via the menu at the top of this page.

For any urgent analyses or additional testing on samples already received, please telephone the laboratory to discuss.

CSF amino acid reference ranges currently in use
CSF analyte<6 months6m - 1 year1 - 5 years5 years
Glycine2-152-102-102-10
Threonine21-11512-5512-5512-55
Serine32-8027-6324-5608-44
Alanine18-5913-4113-4113-41

(Source: CSF amino acid reference intervals from the Cardiff Working Group, MetBioNet)

User Handbook

Request form


 

User Survey

Useful Links

National Metabolic Biochemistry Network (MetBioNet)
British Inherited Metabolic Diseases Group
Cardiff Porphyria Service

Metabolic Biochemistry

Dr Helena Kemp, Consultant Chemical Pathologist
helena.kemp@nbt.nhs.uk
helenakemp@nhs.net
Tel: 0117 4148425

Maryam Khan, Principal Clinical Scientist
maryam.khan@nbt.nhs.uk
maryam.khan2@nhs.net
Tel: 0117 4148418

Bryony Wright, Senior Biomedical Scientist
bryony.wright@nbt.nhs.uk
Tel: 0117 4148430/4148346

Clare Le Masurier, Senior Biomedical Scientist
clare.lemasurier@nbt.nhs.uk 
clare.lemasurier1@nhs.net 
Tel: 0117 4148430/4148346

Emma Smith-Thomas, Senior Clinical Scientist
emma.smith-thomas@nbt.nhs.uk
Tel: 0117 4148427

Southwest Newborn Screening and Metabolic Biochemistry Laboratory
Pathology Sciences Building
Southmead Hospital
Westbury-on-Trym
Bristol,  BS10 5NB
Telephone: 0117 4148346

NBS&MetabolicBiochemistry@nbt.nhs.uk

 

Opening times: 9am – 5pm Monday – Friday excluding Bank Holidays

National Metabolic Biochemistry Network includes national guidelines for investigation of inherited metabolic disorders.

Biochemical Genetics

Transport

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Within North Bristol NHS Trust (NBT)

  • Samples for Blood Sciences: (Biochemistry, Haematology and Immunology) and Infection Sciences: (Bacteriology, Virology, Antimicrobial assays (ARL) and Mycology (MRU)) should be sent via the air tube unless the sample type/reason appears in the list below.
  • Samples that MUST NOT be sent via the air tube include:
    • Urine for TB or suspected TB.
    • Viral haemorrhagic fever.
    • Histology or cytology.
    • Category 4 microbes.
    • Volumes over 100ml.
    • Samples which need to remain frozen (e.g. via dry ice).
    • Samples which need to be kept warm - special flasks are available for the transport of samples which have essential requirements to be kept warm (i.e. cryoglobulins, patients with cold agglutinins) - contact the Immunology or Haematology departments for these.
  • Samples for COVID-19 can be sent via the air tube, but these MUST be double-bagged, sealed and sent in a new leak-proof carrier.
  • Blood components and products will be transported in an appropriate, validated container packed by the Transfusion Laboratory.For Primary Care locations where Pathology Services are provided by North Bristol NHS Trust (NBT)

Sample collections from external locations (e.g. primary care, community) are made by the Pathology’s appointed medical courier Delivery Direct Logistics (DDL). For queries regarding this service please email Allison Brixey, Blood Sciences Manager, Allison.Brixey@nbt.nhs.uk.

What is Normal-Pressure Hydrocephalus?

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This information is for patients referred to the the Adult Hydrocephalus team at North Bristol NHS Trust as a brain scan has shown features of Normal-Pressure Hydrocephalus. 

What is Normal-Pressure Hydrocephalus (NPH)?

Cerebrospinal Fluid (CSF) is produced continually in the ventricles (cavities of the brain). Normally CSF circulates through the brain acting as a protective cushion and providing nutrients. NPH affects people aged over 60 and happens when the fluid becomes poorly absorbed, causing an abnormal amount of CSF to build up in the ventricles. This does not cause high pressure in the brain, but it does affect its function, and a person’s quality of life. 

What are the symptoms? 

Mobility and balance

  • Difficulty taking large steps, and shuffling when walking.
  • Unable to turn quickly due to losing balance.
  • Falling backwards, sometimes when getting out of a chair.
  • A general feeling of unsteadiness when walking.

Memory and thinking

  • Slowness in thinking, and problems with attention.
  • Memory difficulties.
  • Changes in behaviour, loss of motivation.
  • Worsening mood, depression, and anxiety.

Urinary incontinence

  • Increased urgency to pass urine (go to the toilet).
  • Sudden leakage of urine.
  • Not making it to the toilet in time.

Why am I being referred to the Adult Hydrocephalus team? 

You were referred by a specialist doctor or GP following a brain scan which may have shown features of NPH. We are a team of skilled nurses, doctors, advanced clinical practitioners, physiotherapists, and neuropsychologists. We will do multiple assessments (walking and memory tests) to see if you would benefit from further assessment and treatment by our team. 

Physiotherapy-led prehab service

Before being seen in the Hydrocephalus Clinic, we offer patients the opportunity to discuss the diagnosis with a Specialist Physiotherapist. We will phone you once your referral has been accepted and can advise you on lifestyle choices you can make to optimise your health while waiting for your face-to-face review.

If you feel you need further advice, you can phone the hydrocephalus advice line on 0117 414 6613. This is for non-urgent queries.

How is it diagnosed? 

You have been  directed to this page as we suspect you have NPH but the diagnosis has not been confirmed.

NPH is a clinical diagnosis that cannot be confirmed with brain imaging (scans) alone. We need to do other tests to confirm the diagnosis.

Lumbar drain

A lumbar drain is a procedure that allows us to see if your symptoms are improved by temporarily removing cerebrospinal fluid (CSF) from your brain. 

The lumbar drain is a piece of flexible tubing that is inserted into the lower part of the spinal canal. The tubing is connected to a drain which allows us to control how much CSF is drained. If you benefit from the drain, you may be considered for a permanent shunt. 

Not everyone is suitable for a lumbar drain, we will review your brain imaging, and if this is the case we will discuss alternative options with you. 

 

Diagram of person from behind, lying on side, with lumbar drain inserted into lower back

 

CSF shunting

A tube is inserted that diverts fluid from the ventricles of the brain to the abdomen through a small valve. This is connected to another tube passed under the skin to the abdomen. This valve can be adjusted to control the flow of the fluid from your brain. 

We will the reassess your symptoms through various tests to confirm if the procedure has been beneficial. At this stage we will be able to confirm the NPH diagnosis. 

Diagram of person with CSF shunt going from ventricles of brain do drain the peritoneal cavity

Follow-up

If you do have a CSF shunt inserted you will be followed up regularly to assess your progress and make sure your symptoms are improved.

During these appointments we complete walking and memory tests to monitor for changes in your symptoms.

What can I do whilst on the waiting list for assessment? 

Due to the symptoms of NPH, you may find it more challenging to do your day-to-day activities such as going to the shops, going on walk, engaging in hobbies, and social activities. However there are certain things you can do to help maintain your physical health during this time. 

Physical activity

NPH can make walking much more challenging, however continuing to move is extremely important. Like many things in life if you don’t use it, you can lose it.

Going for a walk a few times a week is an excellent way to keep yourself fit and strong. If you like to do more structured exercise like exercise classes, then this is also encouraged.

Practical tips: going for a daily walk of 20-30 minutes will make sure you meet the government guidelines for weekly activity. If you are very unsteady, you may find it helpful to use a walking aid such as a walking stick or 4 wheeled walker.

You can speak to your GP about referral to a Community Physiotherapist to provide advice and guidance about maintaining your fitness and reducing your risk of falls.

Occupational therapists can give expert advice and provide equipment to ensure you are able to complete your everyday tasks, speak to your GP about getting referred.

Incontinence

It can be challenging to live with the urinary symptoms of NPH without advice and guidance. Speaking to your GP about referral to incontinence services can be a useful way to get professional advice on how to maintain your quality of life with these symptoms.

Practical tips: keep access to the toilet clutter free and remove any trip hazards to prevent risk of falling if you need to hurry. Consider a commode or urine bottle in your bedroom to use at night.

Memory and cognitive impairment

This type of hydrocephalus can change your brain’s ability to stay focus, remain organised, and can affect your memory. These symptoms can develop relatively quickly compared to other forms of dementia - over just a few months.

Practical tips: speaking to your GP/pharmacist about medication tools such a dosette box can prevent medication errors. Diaries and calendars be useful for keeping track of appointments and routines, as well as whiteboards for writing lists and reminders.

Family and friends

We recommend including your family and friends in this process, showing them this page may help them understand the condition and how the symptoms affect your life.

If you have any further questions or concerns at any stage in the process, please contact the Adult Hydrocephalus team on the details below. If it is out of hours, please contact your GP or local Emergency Department.

How to contact us

0117 414 6613

24 hour answer machine available
Monday - Friday
08:00 - 16:00

Adult Hydrocephalus Team

  • Mr Richard Edwards
  • Kelly Wride
  • Cecily King
  • Katie Holdsworth
  • Jacob Spong

© North Bristol NHS Trust. This edition published November 2024. Review due November 2027. NBT003702

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Fibreoptic Endoscopic Evaluation of Swallowing (FEES)

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This information is for patients who have been referred for a FEES examination. This page explains the process. 

What is FEES? 

FEES (Fibreoptic Endoscopic Evaluation of Swallowing) is an examination that looks at how you swallow. It aims to find out how your muscles work when you swallow and what might be causing you any difficulties.

How will this help?

We use FEES to understand and help with swallowing problems. It allows us to see whether:

  • Food, drink, or saliva is going down the wrong way (into your airway).
  • Some food and drink consistencies are easier for you to swallow than others and why.
  • Your swallowing difficulties can be helped by altering the position of your head or body.
  • There are any other changes we can recommend that may help you.

How is this done?

Two Speech and Language Therapists (SLT) will do the procedure while you are sitting down. A small, lubricated, flexible camera will be placed into one nostril. When the end of the camera is passed just beyond the back of the nose, we get a clear view of your throat. You will be able to see the images if you choose.

We make a recording of the images so we can analyse it afterwards.

You may be given some food and drink. This is dyed with blue/green food colouring to help us see it. This is usually: 

  • Milky water.
  • Fruit puree.
  • Cake.
  • Biscuit.
  • Thickened drink.

If you have any food allergies or strong food dislikes, please tell your Speech and Language Therapist. You may bring in alternative food if you choose to. This part of the appointment will take up to 30 minutes.

Is the procedure safe? 

The procedure is safe with a low risk of complications or side effects.

Is it uncomfortable? 

Passing the camera through the nose can sometimes cause mild to moderate discomfort. The Speech and Language Therapist will reassure you through throughout the procedure. Local anaesthetic will not be used as this will affect your swallow. 

What happens next?

The Speech and Language Therapists will analyse the images whilst you wait in the waiting area. This could take up to to 30 minutes. You will then be invited back in to discuss what we have seen. 

We will also speak with you about what the results mean for your swallowing. You will leave with a summary of this information and a plan for follow-up if needed.

You can go home immediately after the appointment. The procedure should not affect your ability to drive.

How long does it take?

The whole appointment (including assessment and advice) should take no more than 90 minutes. Please be patient if there are any delays, we will keep you informed if this is it the case. 

Can I eat before my appointment?

Unless you have been advised otherwise, you can eat and drink a light meal before your appointment. If you are currently feeding through a tube, you can take your feeds as normal.

What happens after I leave?

Detailed results will be sent to all relevant healthcare professionals involved in your care. 

What do you do with the recordings? 

The images are saved electronically and kept securely for 8 years. 

Where can I find more information? 

If you have any questions, please contact your Speech and Language Therapist. 

When and where is the appointment?

Your appointment will be at:

Gate 36 (Pink Zone)
Brunel building
Southmead Hospital

You will receive a letter/email with the time and date.

Cancelling an appointment

Please tell us as soon as possible if you need to cancel your appointment by phoning the Speech and Language Therapy Department on 0117 414 5130.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003751

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Analytes

Regular Off Off

Benzylpenicilin (Penicillin G)

Gentamicin

As of 2nd December 2024, this test will be provided on the Clinical Biochemistry analytical platform, however clinical advice will still be offered by the Microbiology service 0117 4146222. Please see updated test information Gentamicin test page link.

Isoniazid (+ N-Acetyl-Isoniazid)

Sulphamethoxazole in (Co-trimoxazole)

Trimethoprim in (Co-trimoxazole)

Vancomycin

As of 2nd December 2024, this test will be provided on the Clinical Biochemistry analytical platform, however clinical advice will still be offered by the Microbiology service 0117 4146222. Please see updated test information Vancomycin test page link.

Antimicrobial Reference Laboratory Contact Details

Antimicrobial Reference Laboratory
Level 2, Phase 1, Pathology Sciences Building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB

For General Enquiries and Results:

Telephone: 0117 4146269 or 0117 4146220
For Clinical Advice: 07802 720900
Fax: 0117 4146282
Email: arlenquiries@nbt.nhs.uk

Laboratory Hours

Monday to Friday 9am - 5.15pm, Saturday 9am - 12 noon