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

Why do I need a pleural vent?

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

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

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

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

What is a pleural vent?

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

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

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

How will the pleural vent be put in?

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

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

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

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

What are the benefits of a pleural vent?

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

What are the risks of a pleural vent? 

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

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

How do I look after the pleural vent at home?

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

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

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

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

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

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

Do not remove the device yourself.

Fluid collection chamber

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

How is the pleural vent removed?

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

Who do I contact for more advice or help?

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

Pleural Clinical Nurse Specialist Anna Morley 0117 414 1900 

Respiratory Secretary Louise Brennan 0117 414 6451 

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

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

What is a pleural aspiration? 

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

Why do I need a pleural aspiration? 

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

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

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

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

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

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

How should I prepare for my pleural aspiration?

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

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

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

What happens before and during the pleural aspiration procedure?

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

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

Are there any risks with pleural aspiration?

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

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

What happens after the aspiration?

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

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

(Conservatively managed fragility fracture of the clavicle).

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

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

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

Summary:

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

Practical considerations

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

Supporting your arm

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

Some options include:

A full arm sling or ‘Polysling’

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

A collar and cuff 

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

Walking aids

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

Pillows

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

Pain control

Monitoring your skin

Preventing chest infections

What to expect in your recovery

Using your arm

Eating and drinking

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

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

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

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

Exercises

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

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

Getting your shoulder moving from about 3 weeks after your injury 

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

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

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

Bone health and fracture prevention

What else can you do to keep your bones healthy?

How to contact us: 

Frailty Trauma Practitioner
07511 166031

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

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

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

(Conservatively managed fragility fracture of the humerus).

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

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

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

Summary: 

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

Practical considerations:

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

Giving your neck a rest from the sling

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

Looking after your skin

Preventing chest infections

What to expect in your recovery

0-3 weeks 

Pain and swelling

Exercises

To prevent the joints from becoming stiff you should:

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

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

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

Using your arm

Eating and drinking

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

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

Walking aids

3-6 weeks 

Using your arm

Removing your sling

Getting your shoulder moving

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

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

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

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

From 6 weeks

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

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

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

When to seek further support or advice

Injury concerns

Bone health and fracture prevention

What else can you do to keep your bones healthy?

How to contact us: 

Frailty Trauma Practitioner
07511 166031

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

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

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

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

What is bronchoscopy?

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

Why is this bronchoscopy necessary?

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

What you need to consider before you come for your procedure

What about medication?

What will happen on the day?

During the procedure

The bronchoscopy investigation

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

Advice for people with diabetes undergoing bronchoscopy

Risks of a bronchoscopy

Contact your doctor or hospital if you have:

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

How will I receive the results of the test? 

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

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

Purpose 

Our League of Friends coffee shop is run by a wonderful team of volunteers who like to give a few hours every week to serving customers with a smile.

Some volunteers do several shifts a week whilst others do just one, but they all play a key role in the friendly service that we aim to give our customers. In turn this encourages more people to visit the coffee shop, to buy refreshments and so to raise more money for Southmead Hospital.

Every day the coffee shop needs volunteers to run effectively. Could you become a League of Friends volunteer?

Commitment level

3-4 hours a shift

Shifts available 10am – 2pm or 1:45 – 5:15, Monday to Friday

Summary of duties

• Serve refreshments and light snacks.
• Operate the till.
• Provide a vital customer service for patients, visitors and NHS staff – greeting and serving customers.
• Be part of a friendly team of dedicated, public-spirited people
• Help raise funds for essential hospital equipment and services.

Skills, experience, attitudes, and qualities needed

Essential

• Excellent listening skills and a non-judgmental attitude 
• A friendly and open manner
• To feel comfortable in an acute hospital environment
• To adhere to the Trust values of treating others with respect at all times
• Understand the importance to stay within the boundaries of the role description.
• Positive attitude to working in a clinical environment.
• Reliable and trustworthy

Desirable

Experience working with people with cognitive impairments 

Training and information provided

• League of Friends Volunteer mandatory training programme (please find further information on our FAQs page)
• Department orientation and induction
• Specialist training if required, such as Dementia Level 2
• Shadowing induction sessions with an existing volunteer or staff member demonstrating the role.
• Ongoing supervision and support 
• Ongoing updates and information

Challenges of the position

•    Coming into hospital can be an anxious time for patients and their relatives. Sometimes this may make people less tolerant than they might usually be and they may come across as impolite. It is important that the volunteer remains calm and listens politely and seeks staff support immediately if required.
•    Potentially supporting patients with cognitive impairments or dementia (around 25% of inpatients at NBT have dementia), additional training and support will be provided. 

Boundaries of the position

Volunteering within the NHS has clear boundaries to ensure that we are keeping our patients and volunteers safe. Please download the detailed role description below for further details. 

Reimbursement of expenses

•    Travel expenses to and from the hospital can be reimbursed
•    Meal vouchers for use in the staff Vu restaurant are offered if volunteering for over 4 consecutive hours in one day

Benefits of volunteering

• Gain practical volunteer experience and learn about the healthcare environment. 
• Enjoy ‘putting something back’ into the NHS
• Provide a smile and comfort to patients and their visitors in trying times
• Give support and friendly service to our NHS staff customers
• Keep mentally and physically active, if retired
• Develop skills and experience that may be transferable to paid employment, such as working as a part of a team!
• Opportunity to help/support patients during a difficult time.
• References can be provided on completion of three months volunteering, if required 
• Ongoing support and supervision sessions
• Making friends with other volunteers and meeting new people
• Awards in recognition of volunteering contribution
• Light refreshments when on duty
• Free parking

Recruitment information

You will be asked to provide two independent references from people who have known you for more than three years (this cannot be a family member).

You will also need to have a basic Disclosure and Barring Service (DBS) check for this role, which will be paid for by the Trust.

How to apply

If you would like to apply for this volunteer opportunity, please click the link below to be taken to the application portal, where you will be able to apply online: 

Current Vacancies | North Bristol NHS Trust (nbt.nhs.uk)

If you would like an alternative method to apply, such as a paper application form, please get in touch with us directly on: 

Telephone Number: 0117 414 0110

Email: Volunteer.services@nbt.nhs.uk

Postal Address: Volunteer Services, North Bristol NHS Trust, Brunel building, Level 1, Gate 18, Southmead Hospital, Bristol, BS10 5NB

This information is for patients who have been referred to to be seen in the Same Day Emergency Care (SDEC) department.

This is in the Brunel building of Southmead hospital, Gate 36, Level 1. This is for investigations to rule out acute Cauda Equina Syndrome (CES), which may be one of the causes for your symptoms.

What is CES?

CES is caused by compression of the nerves travelling down the central spinal column of your lumbar spine (lower back), which control your legs, bladder, bowel, and sexual function. Disc prolapse or degenerative changes can put pressure on these nerves and may require urgent surgical intervention if you have new (acute):

• Numbness/altered sensation in the buttocks, inner thighs, genital/saddle (bottom) area which is new or not normal for you. 
• Pain in the lower back and legs, with or without leg weakness and numbness, which is severe or getting worse.
• Sudden difficulty with bladder or bowel function, including loss of feeling and control (incontinence), not being able to pass, or have the urge to pass urine (retention) which is not normal for you.
• Loss of sexual function/feeling, which is not normal for you, including (for men) an inability to achieve erections or ejaculation.

CES is a relatively rare but serious condition, affecting between 1-3 in 100,000 people. This is just 2–6% of all lumbar disc problems which require surgery. 

Urgent diagnosis is extremely important so we can treat it as soon as possible. We know that earlier surgery is associated with better outcomes, particularly when symptoms are recent onset and progressive (new and getting worse).

Most surgeons prefer to carry out surgery as soon as it is safe. 

What happens when I come to the SDEC? 

• Before you have arrive to SDEC you will have already been assessed by a clinician. This may be your GP, the physiotherapist, or emergency department clinician. 
• Your assessment will have met the criteria to rule out CES and you will have been referred to the emergency Neurosurgery service for an MRI of your lumbo-sacral spine (lower back). The MRI scanning unit is located at Gate 19 on Level 2. Once you have had your MRI, you will be asked to return to SDEC Gate 36, Level 1.
• After your MRI, the SDEC team managed by nurses will contact the on-call neurosurgery registrar to review your referral and MRI scan with the report.
• Whilst awaiting the MRI report, we may ask for a pre- and post-void bladder scan which will require you to tell the SDEC nurses before and after you pass urine.
• If there is no evidence of cauda equina compression following assessment of your case the Neurosurgery registrar will tell the SDEC nurses by phone after discussing with the on-call consultant. You will be discharged with relevant advice.
• If there are any concerns identified, the Neurosurgery registrar will see you in person to discuss options. You may be asked to only drink clear fluids until then in case you need urgent surgery.

Reason for urgent surgical intervention may include: 

• True cauda equina compression.
• Nerve root compression which may be causing foot drop. 

What is an MRI scan? 

An MRI scan is a way of assessing the space around your nerves of your lower back. It requires lying flat for approximately 30 minutes in a scanning unit. 

Please tell the MRI radiographer and the SDEC team if you have any of the following: 

• A permanent pacemaker. 
• Any surgical clip inserted in a previous operation or procedure. 
• Ever had a metallic foreign body in your eye. 
• Severe claustrophobia or inability to lie flat. 

Will I need any other tests? 

As part of this assessment, and depending on your symptoms, you may require a scan of your bladder.  This is an ultrasound scan where gel is applied to your lower abdomen to assess your bladder. 

Measurements need to be taken both before and after you go to the toilet to empty your bladder (pee). Therefore, please try not to pass urine until you have your assessment. If you need to use the toilet before your assessment, please speak to one of the nursing staff.

If I don’t need an operation, why do I still have pain and what do I do next? 

Pain can be caused by degenerative changes to the spine that are not always seen on the MRI scan. This may cause you to experience abnormal sensory changes, low back spasm, foot weakness and even bladder, bowel problems and erectile dysfunction in men. Without nerve compression shown on the MRI, surgery will not be required. 

In these cases, we will advise you see your GP for a pain review and consider stronger pain killers and referral to MATS (Musculoskeletal Assessment and Treatment Services) for further treatments. 

Stronger pain killers such as amitriptyline, gabapentin, pregabalin that work specifically on nerves, should be started by a clinician who can monitor your progress and side-effects. SDEC will be able to provide simple pain killers and laxatives to prevent constipation. 

The SDEC is only able to diagnose or rule out CES which is a neurosurgical emergency.  If this is ruled out, you will be asked to see the GP to consider other diagnoses that may cause referred back/leg pain (e.g. abdominal/pelvic pathology).

What happens if I get worse when I go home? 

If you develop any new symptoms when you go home, please seek urgent medical advice as the assessment done in the SDEC does not exclude future problems. It is important you seek advice urgently (within 24 hours of onset) if you develop: 

• New leg/foot weakness. 
• Bowel/bladder problems not related to severe levels of pain (new incontinence, inability to start or stop void, new urinary retention, or constipation unrelated to medications)lower back pain with buttock or leg pain that is getting worse. 
• New sensory changes affecting your buttock (bottom), for example you cannot feel when wiping.  
• New loss of sexual function or feeling during sex. 

Whilst you are in severe pain, please avoid strenuous levels of exercise, heavy weightlifting, long distance running that may make your pain worse and make you prone to injuries. Gentle exercises and physical activity are encouraged as reduced mobility may make your symptoms worse.

Is there anything else I should be aware of? 

Whilst attending SDEC please do not have anything to eat and only have clear fluids until the neurosurgery registrar and the SDEC nursing team have discussed your case. This is in case you require any form of anaesthetic for an operation to relieve any pressure on your nerves. 

Please consider any additional arrangements that may need to make such as childcare, contacting your work or family whilst you await your assessment, investigations and results.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003620. 

Haematology advice

For non-urgent advice. Haematology aim to respond to Careflow referrals within 24 hours, Monday to Friday. If TTP or acute leukaemia is suspected please bleep 9441 in addition to sending the written referral, as these are Haematological emergencies. Provide your bleep/contact telephone number in case further discussion is required. For all other queries, please ensure you have reviewed Haematology Trust guidelines on LINK (Home Page - LINK (nbt.nhs.uk) and have discussed with your senior team member first. Answers to common Haematology questions can also be found via Guidelines for Primary Care (Remedy BNSSG ICB) and the Buku Medicine app (free to access via Apple Store or Google Play)

Haematology referral - new low level paraprotein detected

If the patient has a normal full blood count, renal function, calcium, negative BJP and normal SFLC ratio, and Monoclonal paraprotein of IgG less than 15g/L, IgA or IgM less than 10g/L and no bone pain then this is likely to be Monoclonal gammopathy of undetermined significance (MGUS). These patients do not need to be seen by a Haematologist and simply need GP monitoring. Please ask the Haematology secretaries for the MGUS GP information document, ask the GP to monitor according to this guideline. If you wish to speak to a Haem registrar, avoid bleeping before 2pm - unless urgent - as they will be in clinic or on a ward round

Haematology referral - new unexplained lymphadenopathy

If the patient has unexplained palpable or radiological lymphadenopathy please request a lymph node biopsy (not FNA) & request CT NCAP to look for other sites of Lymphadenopathy. Please also check FBC, renal and liver function, calcium, serum electrophoresis and LDH. We will be happy to advise on patient management if biopsy shows a haematological malignancy. Feel free to send patient details to us and then update us with biopsy results once available . It remains YOUR responsibility to chase up the biopsy results. If you wish to speak to a Haematology registrar, please avoid bleeping them unless it is urgent before 2pm as they will be in clinic or on a ward round

Haematology referral - suspected new myeloma

If patient has monoclonal paraprotein of IgG more than 15g/L, IgA or IgM more than 10 or IgD/E of any level, then please request FBC, renal function, liver function, Urine for BJP, SFLC, B2M, PV and request CT NCAP and head, and put CT whole body for myeloma in clinical details. We are happy to see/advise on management of these patients. If you wish to speak to a Haem registrar, please avoid bleeping before 2pm - unless urgent - as they will be in clinic or on a ward round

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 the relevant department. If you do this as soon as possible we can hopefully resolve the matter immediately. 

You can also contact the Trust's Patient Experience Team.

Trust Links

How to Raise a Concern or a Complaint | North Bristol NHS Trust (nbt.nhs.uk)

How to say thank you and offer a compliment | North Bristol NHS Trust (nbt.nhs.uk)

How to make a suggestion | North Bristol NHS Trust (nbt.nhs.uk)

Pathology Concerns and Complaints

These are best directed to the relevant department and either the service lead or laboratory manager. Contact details for each department are available in the following areas of our website:

• Antimicrobial Reference Laboratory: Antimicrobial Reference Laboratory | North Bristol NHS Trust (nbt.nhs.uk)
• Blood Transfusion: Blood Transfusion | North Bristol NHS Trust (nbt.nhs.uk)
• Bristol Genetics Laboratory: South West Genomic Laboratory Hub | North Bristol NHS Trust (nbt.nhs.uk)
• Cellular Pathology: Cellular Pathology Key Contacts | North Bristol NHS Trust (nbt.nhs.uk)
• Clinical Biochemistry: Clinical Biochemistry Contacts | North Bristol NHS Trust (nbt.nhs.uk)
• Haematology: Contact Haematology | North Bristol NHS Trust (nbt.nhs.uk)
• Immunology: Immunology & Immunogenetics Laboratory Contact Details | North Bristol NHS Trust (nbt.nhs.uk)
• Infection Sciences: Infection Sciences (Microbiology & Virology) | North Bristol NHS Trust (nbt.nhs.uk)
• Point of Care Testing: Point of Care | North Bristol NHS Trust (nbt.nhs.uk)

GMC number: 7077649

Year & location of first qualification: 2010, University of Aberdeen

Specialty: Obstetrics and Gynaecology

Clinical interests: Ambulatory Gynaecology, Gynaecology two week wait Lead

Secretary: Cherilyn Griffiths

Secretary phone number: 0117 414 6757
 

Member of the Royal College of Obstetricians and Gynaecologists
British Society of Gynaecological Endocopy