What YOU need To Know about Bronchoscopy
What is a Bronchoscopy?
A flexible bronchoscopy is a procedure whereby a doctor can look at the aim airways in the lungand also take some samples. It is performed with a flexible tube which is passed through the nose or mouth, through the voice box, into the windpipe and then into the bronchi (branches of the airways). All of these airways down to the size (width) of the tube can be visualise. Before the camera is passed the back of the throat is numbed with a local anaesthetic and usually a sedative is given intravenously. The sedative is used more for relaxing the person undergoing the procedure rather than for completely sedating the person. People react differently to sedation with some individuals feeling more sleepy and some none at all. The procedure is not painful but may be unpleasant and, at times, uncomfortable.
‘Wash’ or Bronchoalveolar Lavage (BAL)
Performing a wash involves passing a small amount of salty water through the bronchoscope into a certain part of the lung and sucking it back out again. The fluid that is sucked back out is sent for laboratory examination. The bronchoalveolar lavage (BAL) is a similar procedure but uses a larger amount of fluid (up to 240mls).
This involves passing a wire down the bronchoscope with a small pincer at the end. The pincer is used to take a tiny piece of lung (biopsy), which is then sent for laboratory examination under a microscope.
There are four different types of biopsy: endobronchial (EBB), transbronchial (TBB), transbronchial needle aspiration (TBNA) and Endobronchial ultrasound guided transbronchial fine needle aspiration (EBUS-TBNA).
Endobronchial (EBB) – During this biopsy a small piece of tissue is gently pinched off the surface of the lining of the bronchi. There are few side effects with this biopsy.
Transbronchial (TBB) – This biopsy is taken from deeper into the lung and carries a higher risk than an EBB (please see ‘Potential risks and complications of the procedure’). This type of biopsy still involves gently pinching a small piece of tissue, which is taken from the lung. discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.
Risks & Complications
A bronchoscopy is a relatively safe procedure. The chance of having a complication is small. All medical procedures are associated with a degree of risk and hospitals have to tell patients about the potential risks and complications involved, even if the risks are small. Prior to the test you will be seen by the endoscopist. This is an opportunity to discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.
Sore throat and hoarse voice: This is due to the bronchoscope rubbing the lining of your throat and should disappear within 48 hours. Drinking plenty of fluids or sucking sweets may help relieve the symptoms.
Nose bleed or soreness: This is due to the bronchoscope rubbing the lining of the nose and should disappear within 48 hours.
Slightly blood-stained phlegm: This may occur if biopsies have been taken but should clear up within 24–48 hours. If it continues please contact your hospital doctor.
Fever, flu-like symptoms or aching across the lungs: These symptoms can occur and last for 24–48 hours. Usually they will settle by taking paracetamol. If these symptoms continue for several days, please contact your hospital doctor as you may have developed a chest infection.
A drop in your oxygen levels: This can occur during the procedure but does not usually have long-lasting effects. Your levels are constantly monitored during and after the procedure so that additional oxygen can be given if necessary
Rare complications A rare complication of this procedure is chest infection. This occurs in less than 1% (1 in 100) of cases.
Very rare complications Bronchoscopy is a very safe procedure. The chances of a serious complication that results in death are extremely low, and probably below 0.0002% (1 in 500,000).
Before the Procedure
If you are having sedation, you must organise for someone to take you home after the test and be with you for 24 hours
If you are diabetic, please let your doctor or team know in advance. You must also inform your doctor if you are taking any blood thinning medications.:
-Warfarin, rivaroxaban, apixaban, dabigatran, edoxaban
-Clopidogrel, prasugrel, ticagrelor
-Aspirin or any other medication used to thin the blood (anti-coagulant)
Please do not eat anything or drink any milk for four hours before your bronchoscopy and please do not drink anything else for two hours before the procedure.
All your usual medications should be taken as normal with a little water. Please make sure you have stopped and blood thinning medications for the appropriate time interval as advised by your doctor.
Please bring a list of all your medications with you including inhalers and insulin.
Please let us know if you suffer from any long-term illness (especially if it causes breathing difficulties or heart problems), if you are pregnant, or if you have had any serious adverse (bad) reactions to any medications in the past.
Please wear loose fitting, easily washable clothing and leave valuables at home. The appointment time is only approximate and, as such, you may be waiting up to two hours or more before your procedure is performed. Some procedures take longer than expected and emergencies take priority.
This procedure usually involves the use of sedation, which will make you feel relaxed and sleepy during the bronchoscopy. You will actually be awake throughout, but may remember very little about it.
After the Procedure
A nurse will take you to the recovery area to rest. The effects of the sedative will gradually wear off. This normally takes around 2 hours but varies from person to person. Some people snooze after the test, but you may want to bring a book to read. Until your throat returns to normal, you should not eat or drink anything. You will be given a drink of water about 2 hours after your procedure.
Eating and drinking After the bronchoscopy you will not be able to eat or drink for about two hours—this is because your throat will still be numb and there is a risk that you could choke on your food or drink. It is not safe to eat or drink until the anaesthetic has worn off and full sensation has returned. The nurses monitoring you will let you know when it is safe to eat and drink again. When you get home, please avoid eating or drinking anything too hot as you may scald your throat.
When you can leave hospital
After the bronchoscopy you will be taken to a recovery area while the sedation wears off. This may take up to 2 hours. When you are sufficiently awake, and can drink safely, you can then go home. You will need to arrange for an adult, such as a relative or friend, to come with you to the department and to take you home.
When you can resume normal activities including work
As you will have been given a sedative you might continue to feel sleepy for the rest of the day. Therefore, it is important that an adult, such as a relative or friend, stays with you for 24 hours after the procedure and that during this time you do not drive, ride a bicycle or operate machinery, perform tasks requiring skill or judgement (including signing official documents or making important emotional or financial decisions), return to work or drink alcohol.
Sedation has its own set of effects, separate from the procedure. The length of time you will be under sedation depends on the difficulty of the procedure, and the need for extra investigations such as a biopsy.
- People vary in their response to sedative drugs—some may need higher doses while others need minimal or no sedation.
- There is a possibility that the sedative may not be effective, which means that some people may not feel sleepy or relaxed even when safe high doses are used. Should this be the case the procedure will still go ahead if you are happy for it to do so. You should not feel any more discomfort/pain than if you had responded to the sedation. Sedation often means that you do not have memory of what happened but if the sedation is not effective, it is likely that you will remember the procedure.
- Some people may experience an adverse (bad) reaction to the sedative drugs that are used. These reactions are usually minor but can include rash, nausea, vomiting and fainting due to lowering of blood pressure.
Do I need to be escorted home?
Please ensure the nurses have the contact details for your escort prior to the procedure. A nurse from the unit will call your escort once you are ready for collection. Please note: You will not be able to have sedation or general anaesthetic if you do not have an escort arranged to collect you.
The sedative will make you drowsy and even if you feel wide awake your reactions may still be affected. You may find it difficult to concentrate and you may forget things that you have been told after the procedure. The nurses will give you written discharge information. This includes the advice that for 24 hours after sedation you should not drive, ride a bicycle, operate machinery, take sedatives, drink alcohol or sign any legally binding documents.