This information leaflet has been produced to give you general information and hopes to answer most of your questions prior to attending for the removal of a Vena Cava filter. It is not intended to replace the discussion between you and the healthcare team but may act as a starting point for discussion. If after reading it you have concerns or require further explanation, please discuss this with a member of the healthcare team.
Why do I need this procedure?
You may have needed a filter to reduce the risk of clots entering your lungs whilst you were having or recovering from surgery or you may have had other tests that show you have blood clots in your blood vessels. Generally these are dealt with by using blood thinning drugs, but in your case it may be that these drugs were not suitable at the time.
This procedure is required to remove the Vena Cava filter once the doctors have determined that you are well enough to restart/start medication to reduce the risk of blood clots and the filter no longer required.
How do I know if it is a suitable procedure for me?
When you had the filter inserted you would have been advised that this was a temporary treatment. The filter should be removed when it is no longer needed.
Your doctor and the Radiologist (a doctor who specialises in reading images) or senior radiology nurse (who has trained to undertake these procedures) have discussed your symptoms and will discuss with you the reasons why they want you to have the filter removed. Whilst filters have an important role in preventing clots reaching your lungs, very few people need them indefinitely. It is always best to have them removed to avoid long term complications.
Who will remove the filter?
A radiologist or a senior radiology nurse who have the special skills and training that is needed to both insert and remove the filter.
Can I take my medication as normal?
Most medications can be taken as normal. However if you are taking Metformin and/or any blood thinning medication such as Aspirin, Warfarin, Clopidogrel or Rivaroxaban it is important that you let the nursing staff know. It is advisable to bring a list of your medications with you to the hospital.
What happens during the procedure?
The procedure is very similar to the insertion of your Vena Cava filter.
On the ward
The procedure is usually a day case, but occasionally an overnight stay is required. You will be asked to go to a ward for a couple of hours to prepare before the procedure. On the ward you will be asked to put a hospital gown on and a cannula (plastic needle) will be inserted into one of your veins. You can continue to eat and drink normally.
In the x-ray department
A nurse will complete a checklist with you before leaving the ward. The procedure is performed in the x-ray department. On entering the x-ray room a radiologist (x-ray doctor), radiographer (person who takes the x-ray pictures) and a nurse will greet you. They will check your personal details and discuss the procedure with you, including where they will access the vein (access site).
You will be asked to lie flat on the x-ray table with a pillow under your head. You will be awake during the procedure and there will be a member of staff nearby at all times to support you. Your blood pressure, oxygen levels and heart rate will be measured regularly.
During the procedure
The skin above the access site to the vein will be cleaned (this is usually the same place the filter was inserted but this will be discussed with you prior to your procedure) and some local anaesthetic will be injected into the skin. The local anaesthetic will make this part of your body go numb. You may feel a little pressure as a thin catheter (tube) is placed into the vein. The doctor/senior nurse will then use x-rays to see the position of this catheter. Contrast (x-ray dye) is injected through the catheter. X-rays will be taken at the same time and will show the position of the filter in the vein. As the x-ray dye enters the veins, you may feel a warm sensation. It may feel as if you urgently need to pass urine, but this is only a feeling, it is normal and will pass quickly.
The filter is removed through the catheter and all the tubes are removed from the neck. The radiologist/senior radiology nurse will apply some pressure over the access site whilst bleeding stops. A small plaster is applied to the skin.
What happens after the procedure?
You will be helped back onto a trolley. There will be someone with you until the ward nurse arrives to escort you back to the ward.
A nurse will observe your access site regularly and continue to measure your blood pressure, oxygen levels and heart rate. If you feel any swelling, oozing or pain in the area of the access site, please inform the nurse immediately.
You will be allowed to eat and drink after this procedure. It is important to drink plenty of fluids after this procedure to help your kidneys flush the x-ray dye from your body.
If you need to use the toilet during this time, please ask for a bedpan or bottle.
If you have come into hospital only to have the filter removed you are normally able to go home the same day.
Are there any risks?
Vena Cava Filter removal is a safe procedure but all procedures carry some risk.
Minor: Sometimes there is a bruise at the access site.
Major: Very rarely some damage can be caused to the vein by the tube and this may need treatment by surgery.
There is a possibility that the filter cannot be removed; if some clot has collected in the filter then the filter will be left in place. You will be asked to continue your blood thinning medication for about another 6 weeks after which a CT scan will be arranged to see if the clot has dissolved. At this stage new arrangements can be made to remove the filter.
There is a potential for the device to become displaced during retrieval.
This is a rare complication. Normally the device can be collapsed down and is removed through the same tube that slides into position through the neck puncture.
Devices that have been in place for some time can be closely attached to the wall of the vein and inevitably some of the vein tissue may also detach from the inside of the vein during retrieval. However we have not encountered long term problems arising from this.
Very rarely air can get trapped in the vein (air embolus). The radiologist or senior nurse performing the procedure will discuss all the risks and benefits with you before you have the procedure.
How soon will I be back to normal?
After you have had two hours in bed you can start to mobilise again, providing that you are feeling well. After this time you can return to your normal activities. You may feel a little bit tender for the first few days in the area that the filter passed out through. There are no restrictions to driving after this procedure.
What happens if I decide not to have the procedure?
You will be referred back to the doctor who recommended the vena cava filter removal to discuss it further.
What if I have any special requirements?
If you have any special needs or requirements please discuss this with the nurse at your preassessment visit or contact the radiology nurses on the number below.
Where can I get more information?
Radiology Nurse
0191 482 0000 hospital switchboard and ask for bleep 2687
Monday – Friday
–
NHS 111
If you require advice outside the above hours after you have had the vena cava filter inserted then please contact your General Practitioner.