Inferior Vena Cava Filter Placement- A guide for patients

Introduction

This leaflet is designed for patients who have been advised to have an inferior vena cava (IVC) filter placement as part of the treatment for preventing blood clots going to the lungs.

What is an IVC filter placement?

An IVC filter is a small metal device usually placed in a large vein called the inferior vena cava (IVC) that drains blood from the legs and lower part of the abdomen.

The IVC filter allows blood to flow through normally but traps any large blood clots, stopping them from getting to your lungs.

Why do I need this procedure?

• Blood clots (thrombosis) sometimes form in the veins of the legs and pelvis. They are known as a deep vein thrombosis (DVT).
• The clot can sometimes break free and enter with the blood flow into the lungs and make you very sick. This is called pulmonary embolism (PE). They can be fatal. An IVC filter prevents a large PE by trapping a clot before it reaches the lungs.
• The usual treatment for DVT and PE is drug treatment to thin the blood. This is usually with warfarin. In a few patients, warfarin does not prevent further PEs, in others thinning the blood is too risky. When this happens, patients are considered for treatment by inserting an IVC filter.
• Very occasionally, a patient is advised to have an IVC filter inserted even though they do not have a DVT or PE at that time. Your doctors will explain the reasons why they think you should have an IVC filter.

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

The consultant in charge of your case and the radiologist performing the IVC filter placement 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 Interventional 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?

• You may be admitted to hospital on the day of, or the night before the procedure.
• A doctor will take a medical history from you.
• You may have a small needle put into a vein in your arm for painkillers to be given if necessary.
• Standard blood tests may be carried out.
• You may eat a light meal and drink as normal unless otherwise informed – in which case, you may be fasting for 4-6 hours prior.
• You may be given antibiotics or other pre-medication on the morning of the procedure if required.
• If you have any allergies you must let your doctor know and a red allergy band will be attached to your wrist.
• 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 skin will be cleaned and local anaesthetic given to numb the area and prevent any pain. A small tube is then placed into the vein. Usually from the groin, but occasionally from the neck.
• Small catheters (plastic tubes) will then be guided into the correct position.
• When pictures need to be taken some iodine dye will be injected; you will be asked to hold your breath for a short time at these points. You may feel a hot feeling from the dye, and it can make your bladder feel full.
• The IVC filter is passed through the catheter into position and the released. 4
• Small hooks on the IVC filter grip the wall of the vein to keep it in the appropriate position.
• Once the procedure is completed you will be moved back onto your hospital bed.
• The tube in the vein will then be removed, and pressure applied on the site for several minutes.

Will the procedure hurt?

• Some discomfort may 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 x-ray dye is injected and some people report a metallic taste in the mouth. You may also feel like you are passing urine; this is normal.
• There will be a nurse, or another member of the clinical staff, in the room looking after you.

How long does the procedure take?

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will last approximately 1 hour.

What will happen after the procedure?

• You will be taken back to your ward for observations and a period of bed rest.
• You may also stay for further treatment or investigations.
• Nursing staff will carry out routine observations including taking your pulse and blood pressure readings and will also check the treatment site.
• If you experience pain, sickness, abnormal swellings or are generally feeling unwell, please let the nursing staff know.
• You will need to stay in bed for a few hours until you have recovered and are ready to be sent home.
• Occasionally, you may need to stay in hospital overnight.
• Take it easy for the rest of the day but you can resume normal activities the next day.

What are the benefits and possible risks of the procedure?

Benefits

The IVC filter will stop the large clots from entering your lungs and causing other complications.

Risks

• IVC filter insertion is a very safe procedure, but as with any medical procedure there are some risks and complications that can arise:
• There may be a small bruise at the needle site.
• Very rarely there may be damage to the vein or blockage of the inferior vena cava.
• Extremely rarely, the filter can migrate which may require a further procedure to reposition the IVC filter.
• If you need a magnetic resonance (MRI) scan in the future, you should tell the person doing the scan that you have a filter.

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
  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.

Require leaflet in a different format or language?

The Recite Me toolbar makes our website digitally inclusive by allowing you to customise the contents so that it works best for you. It features an accessibility tools bar positioned at the top of webpage:

Key functions:

• Screen reader – option for all information on the website to be read aloud.
• Translation – option to translate all information into over 100 different languages.
• Styling and customisation – option to change the text, font style, size, colour and spacing so that the information is easier to read.
• Reading aids – including a screen mask (tint) and magnifier to help make the information more accessible for all.

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, 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

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