Adrenal venous sampling – A guide for patients

Introduction

This leaflet is for patients booked for an adrenal venous sampling procedure as part of the diagnostic pathway for high blood pressure.

What is adrenal venous sampling?

Adrenal venous sampling is a procedure which involves inserting a small plastic tube into the veins from the adrenal glands and taking a small sample of blood. This sample is then sent to the laboratory for testing.

Normally veins do not show up on an ordinary X-ray so a special dye, called contrast medium, is injected into the veins through a fine plastic tube called a catheter to make them visible.

Why do I need this procedure?

Your doctors have asked for you to have adrenal venous sampling because they suspect that you may have high blood pressure related to the adrenal glands. This can also be related to low levels of potassium in the blood. This disorder is sometimes called primary hyperaldosteronism, or Conn’s syndrome.

Occasionally, adrenal venous sampling might be performed for other reasons, usually related to high levels of hormones produced by the adrenal glands.

Who has made the decision for me to have this procedure?

• The consultant in charge of your case and the radiologist performing the procedure will have discussed your case and come to the conclusion that this is the best way of treating your condition.
• You will have the opportunity for your opinion to be taken into account, and if after discussion with your doctors, you do not want the procedure carried out, you can decide against it.

Who will be performing the procedure and other staff you are likely to meet?

• A specially trained doctor called an interventional radiologist will be performing your procedure.
• Radiologists have special expertise in using x-ray equipment and in interpreting the images produced, as well as performing minimally invasive procedures.
• They will look at these images whilst carrying out the procedure.
• The radiologist will be assisted by a radiographer and nurses and/or other Radiology doctors or trainees.

Where will the procedure take place?

You will be taken to the Interventional Radiology Department.

What happens before my procedure?

• Sometimes your blood pressure medication will need to be altered in advance of the procedure, as certain types can interfere with the results. If this is the case your medical team will get in touch beforehand. You will be asked to attend the hospital on the day of the procedure, either to the Endocrine Investigation Unit, or to the Radiology Day Unit.
• A doctor or nurse will take a history from you.
• You might have a small needle put into a vein in your arm for a medication drip to be set- up. This infusion is called synacthen, or ACTH.
• Standard blood tests might be carried out. You may eat a light meal beforehand.
• If you have any allergies, you must let your doctor know.
• If you take any medications to thin the blood (anticoagulants or antiplatelets) please let us know beforehand, as these will need to be stopped a certain length of time before the procedure.
• Examples include:
• warfarin, dalteparin, enoxaparin, tinzaparin, dabigatran, rivaroxaban, apixaban, clopidogrel, ticagrelor.
• Low dose aspirin (75mg) is safe to continue.
• Please discuss with a doctor before stopping any medicines, as sometimes other treatment will need to be given.
• If you have previously reacted to intravenous contrast medium (the dye used for CT scans), you must also tell your doctor about this.

What happens during the procedure?

• You will get dressed into a hospital gown.
• You will lie on the x-ray table, generally flat on your back.
• You will have a monitoring device attached to your finger and will have a blood pressure cuff placed around your arm.
• The procedure is performed under sterile conditions and the radiologist and scrub nurse will wear sterile theatre gowns and operating gloves.
• Your groin area will be cleaned with an antiseptic solution.
• Local anaesthetic will be injected to numb the area and stop any pain. A small tube will then be inserted into the groin vein.
• Smaller tubes will be inserted into the adrenal veins to take the samples.
• When the tubes are in the right position, some contrast dye will be injected to confirm the position before the samples are taken.
• Once all the samples have been taken the tube in the groin vein will be removed and pressure will be applied to stop any bleeding.

Will the procedure hurt?

• Some discomfort might be felt in the skin and deeper tissues during injection of the local anaesthetic. You may feel a warm sensation for a few seconds when the dye is injected and feel like you are passing urine.
• There will be a nurse, or another member of the clinical staff, in the room looking after you.
• If the procedure does become uncomfortable, please let a member of staff know, and more pain relief can be given.

How long does the procedure take?

Every patient’s situation is different, and it is not always easy to predict how complex or straightforward the procedure will be. Generally, the procedure will last approximately one hour.

What happens after the procedure?

• You will be taken back to the Radiology Day Unit for two hours of bed rest after the procedure.
• Nursing staff will carry out routine observations including taking your pulse and blood pressure and will also check the treatment site.
• If you experience pain or sickness let the nursing staff know.
• You will need someone to pick you up and take you home. You must not drive or use public transport to get home.
• You should rest for the rest of the day of the procedure, and possibly the next day depending on your recovery. You can then resume normal activities. Please avoid heavy lifting for 48 hours following the procedure.

What are the benefits and possible risks of the procedure?

Benefits

Adrenal venous sampling can provide important information about the possible causes of high blood pressure. This information can be used to guide further care, including planning for possible surgery to treat an adrenal cause of high blood pressure.

Risks

Adrenal venous sampling is a very safe procedure, but as with all procedures there are some possible risks:

• The adrenal veins are very small, so there is a chance that samples will not be able to be obtained from the veins, or that the samples that are taken cannot provide enough information to make a diagnosis. If this happens then your doctors will discuss whether the procedure should be repeated, or if another test might be required.

Other risks from the procedure include:

• A small risk of bleeding and bruising at the site of venous access in the groin. A very small risk of infection.
• A very small risk of causing a blood clot to form in the vein, which can move to the lungs (known as a pulmonary embolism).
• A very small risk of injury to the adrenal glands.

Your doctor will discuss the risks with you and give you the opportunity to ask any questions.

Radiation

• You have been referred for an Interventional Radiology procedure to help deliver your treatment. A specialist in radiology agrees that this is the best procedure to treat your clinical condition and that the benefit of the examination is greater than the risk.
• The x-ray involves a dose of ionising radiation equivalent to a few months or years of natural background radiation which we are all exposed to every day.
• Ionising radiation can cause cell damage that may turn cancerous, however the risk of this happening from your examination is considered low.
• Depending on the length of the procedure there may also be a small risk of an excess radiation dose to the skin leading to short term and long-term effects (e.g. reddening of the skin and burns).
• If this happens as a result of this procedure, you will receive further advice following the procedure. The dose delivered will be kept as low as is practicable.
• For further information please see the information on our webpage.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us by email: cuh.accessibility@nhs.net or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medication

Bring all of your medicines (including inhalers, injections, creams, eye drops or patches) and a current repeat prescription from your GP.

Can I bring someone with me?

Those accompanying you may be required to stay out of the examination room during the procedure and remain in the waiting area.

Childcare whilst in the department

Staff are unable to look after or supervise children whilst your procedure is taking place. Please make alternative arrangements for the care of your children whilst you attend for your procedure. If you attend an appointment with children with no one to look after them whilst you have your procedure, then your appointment will unfortunately have to be cancelled and rescheduled.

Personal belongings

Patients are advised to bring minimal belongings and not to bring valuable items. Any valuable belongings (mobile phone, wallet etc.) will go with the patient while having their procedure and can be secured in a locked box/safe.

How, when and by whom will my results be communicated?

Imaging examinations are reported in order of clinical priority to ensure those with the highest urgency are reported first.

Your referring team or clinician will be responsible for communicating reports back to you.

Test results are made available via MyChart but there is 3-week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Contacts/Further information

Please call the Radiology Day Unit and speak to the Imaging Nurses, on telephone number 01223 254639 if you have any questions or concerns about this procedure.

Some of your questions about the procedure should have been answered by this leaflet, but remember this is only a starting point for discussion about your treatment with the doctors looking after you and you will be able to discuss any questions you have with them.

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Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straightaway.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, via email at cuh.pals@nhs.net, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart (opens in a new tab)

This document has been adapted from one prepared by the British Society of Interventional Radiology (BSIR).