• Reference Number: HEY-997/2018
• Departments: Haematology
• Last Updated: 10 July 2018

Introduction

This leaflet has been produced to give you general information to help you prepare for your assessment and management of your condition. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is an incidental Pulmonary embolism?

An incidental pulmonary embolism is a small blood clot in the lungs, diagnosed following a computed tomography (CT) scan that was done for other reasons. Most patients who have them do not know they have one because these blood clots are usually too small to cause any symptoms.

If these blood clots are left untreated they can grow and start causing symptoms that in some cases can be troublesome, such as shortness of breath and fatigue.

Following a diagnosis of an incidental pulmonary embolism you will be referred for assessment to a Clinical Nurse Specialist (CNS) in the Queen’s Centre at Castle Hill Hospital who has specific experience in the management of incidental pulmonary embolism.

The assessment may take place on the same day as your scan or it might be done the next working day. However, if you begin to feel unusually breathless or unwell following your scan, but prior to your assessment, please contact the main hospital switchboard on (01482) 875875 and ask to speak to bleep 500. You will be given advice on what to do next.

What will happen during the assessment?

On your arrival at the Queen’s Centre please book in at the outpatient reception

desk. You will then be asked to take a seat and wait to be called for a blood test.  Following your blood test you will be called down to the clinic room, where your weight and other general observations will be undertaken.

You will be asked specific questions related to your condition and a decision will be made about appropriate treatment and whether you will be able to receive your treatment as an outpatient or need to be admitted to the ward.

The assessment will take approximately one hour.

What is the treatment of an Incidental Pulmonary?embolism?

A medicine to thin the blood, known as an anticoagulant, is used to treat an incidental pulmonary embolism.

Anticoagulants can be given in a number of different ways:

• Fragmin, a heparin based blood thinner, that is injected under the skin may be prescribed and you may leave hospital with a supply of pre filled syringes for you to inject yourself daily at home. You will be shown have to do this yourself, by the nurse undertaking your assessment
• Warfarin is a blood thinning tablet which takes several days to become effective and you will require regular blood tests to ensure the correct dose is being given. Regular blood tests may be required for some time to monitor your warfarin levels to ensure that they are stabilised.
• You may have a combination of both.

The nurse / doctor undertaking your assessment will inform you of the treatment you will be receiving.

In the rare case that you are already on an anticoagulant, a decision on whether adjustment of the dose you are receiving, or a change of the anticoagulant you are taking; will be taken by the team depending on your specific circumstances.

Can there be any complications or risks?

As you are receiving a medicine to make your blood thinner you may notice that you bruise more easily.  Any bleeding for example, if you accidentally cut yourself or have a nosebleed, will be heavier than normal.

If you are injecting a heparin based blood thinner you may notice bruising around the injection site. This is normal and is usually something not to be concerned about. You can help prevent this by touching the injection site as little as possible during and after the injection is given.

Serious bleeding is uncommon (less than 5%).  If you experience any bleeding that you cannot control or explain, or you notice soft black tarry stools, you should report to the Emergency Department of your nearest hospital.

What happens afterwards?

Following your assessment, if you are treated as an outpatient you will receive a month’s supply of your medication and an information pack.

You will need a repeat blood test 7 days after starting your medication and you will be given a follow up appointment to see your consultant.

If you are admitted, treatment will be initiated on the ward. The expected length of stay will depend on your condition. On discharge you will be given a small supply of medication and a follow up appointment to see your consultant.

Your consultant will advise you on how long you need to take your medication; however, length of treatment is usually 3 – 6 months.

Future prescriptions for your medication should be obtained from your GP.

Should you require further advice about the issues contained in this leaflet, please do not hesitate to contact the Clinical Nurse Specialist Team on (01482) 461082

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and well being and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.