• Reference Number: HEY1241/2021
• Departments: Radiology
• Last Updated: 30 June 2021

Introduction

This leaflet has been produced to give you general information about having insertion of an inferior vena cava (IVC) filter.  Most of your questions should be answered by this leaflet.  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 any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is an IVC filter?

An IVC filter is a small metal device (like an umbrella) 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 an IVC filter inserted?

Blood clots (thrombosis) sometimes form in the veins of the legs and pelvis.  They are known as 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 a pulmonary embolism (PE).  This 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.  In a few patients this does not prevent further PEs, and in others thinning the blood is too risky.  When this happens, patients are considered for treatment by inserting an IVC filter.

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 doctor will explain the reasons they think you should have an IVC filter.

Can there be any complications or risks?

IVC filter insertion is a very safe procedure and serious complications are very rare.  There may be a small bruise at the needle site and 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.

Like all keyhole procedures, there may be serious risks to life such as internal bleeding or heart attack, but these are extremely rare. The benefits of the procedure, however, far outweigh the risks, and these will be discussed in detail with you by the doctor before the procedure is performed.

How do I prepare for the angiogram?

Please read this information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

The procedure is carried out under local anaesthetic in the Radiology Department at Hull Royal Infirmary, usually via a vein in your groin. There are no specific preparations that you need to make and you may eat and drink normally prior to the procedure.

You will need to alert the staff of any allergies you have, and they will need to know a list of your current regular medication.  Please inform the staff if you take any medication to thin your blood as this may need to be omitted for a day or two prior to your procedure.

What will happen?

The procedure will be performed in the Radiology Theatre at HRI.  This is similar to an operating theatre where special X-ray equipment has been installed.

You will have preliminary checks made by a radiology nurse such as blood pressure reading and arrangements for who to contact to take you home.

You will meet the Interventional Radiologist who is a doctor with special expertise in reading X-ray and using these to guide catheters and wires to aid treatment.  The radiologist will explain the procedure and ask you to sign a consent form.  This is to ensure you understand the test and its implications. Please feel free to ask any questions that you may have and remember that, even at this stage, you may decide against going ahead with the procedure if you so wish.

You will be asked to change into a hospital gown. You will lie on your back on the X-ray table and you will be attached to a monitor to check your blood pressure and oxygen levels.

The skin around the groin will be cleaned with antiseptic (this can sometimes feel cold but will not be painful).  The rest of your body will be covered by a large sterile sheet. The radiologist will inject some local anaesthetic into your groin (or rarely your neck) to make it numb. The radiologist will then make a small nick in the skin. A needle is then inserted into the vein. A fine plastic tube called a catheter is then placed over the wire and into the vein. The radiologist will watch all of this on a tv-like monitor. A special clear X-ray dye called contrast, is then injected through the catheter.  This dye allows the blood vessels to be visible on the X- ray and will help the doctor guide the placement of the IVC filter. You may be asked to hold your breath for 5 -15 seconds while some of the X-ray are taken. If you wish, you may be able to see the X-ray pictures on the screen during or after the test. When the radiologist has placed the filter through the tube, the catheter is removed. You might have a small amount of bruising in the groin. The radiologist will press firmly on the skin entry – site for several minutes.  This is done to prevent any bleeding from the vein.

Is it painful?

When the local anaesthetic is injected into the skin you may feel some discomfort like a bee sting. After this, the procedure should not be painful but you may have the sensation of gentle pushing and pulling in your groin. There will be a nurse standing nearby looking after you during the procedure. If the procedure becomes painful, please inform the nurse or doctor so that they will be able to give you some pain relief medication. As the dye is injected into the veins you may feel hot (usually only lasts 20 seconds), a flushed sensation from the dye or the urge to urinate.

What happens afterwards?

You will be taken out of the X-ray theatre onto a trolley in the Day Unit recovery area. The nurses will carry out regular observations such as pulse and blood pressure measurements, to ensure that there are no problems after the procedure. They will also look at the skin entry site in your groin. You will have to stay in bed for about an hour after the procedure. During your recovery period, you should keep the leg that was punctured still to reduce bleeding from the puncture site. You will be advised when you can sit up and then walk about. You will be allowed to go home on the same day, unless you are already an inpatient. You should not drive immediately after this procedure, you should arrange for someone to take you home. You may resume normal activity the following day.

Will the filter stay in?

Modern IVC filters may be left in place permanently, however it is common for them to be removed at between 2 – 6-months following placement.  Your doctor will advise the best course for you, and a further appointment will be given to you if the filter needs to be removed.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to Interventional Radiology Department (01482) 675667

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

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 wellbeing 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.