Bronchoscopy

• You must not eat for 4 hours before the test, but you may have clear drinks for up to 2 hours beforehand.
• Because you will be having sedation, it is vital that you arrange transport to and from the hospital and that someone is with you overnight.
• If you are unable to keep your appointment, please phone the Endoscopy Booking Department as soon as possible on 0117 414 5054. This will enable the staff to give your appointment to someone else and they will be able to arrange another date and time for you.
• This procedure requires your formal consent. You will be asked to sign the consent form in the presence of the doctor. 
• If you need an interpreter please contact the department before your appointment on 0117 414 5054. 

• Your normal medication should be taken.
• If you are diabetic and take insulin or tablets for this, please note the advice later on in this page. Please ensure the Endoscopy Booking Department is aware that you are diabetic so that the appointment can be made at the beginning of the list. 
• Blood thinning medication – your hospital doctor will have advised you whether and when to stop your blood thinning medication if you are on warfarin, clexane, clopidogrel, DOACS (rivaroxaban, dabigatran, apixaban, and endoxaban). If you are unsure or you have not been told, please phone your consultant’s secretary. 
• Allergies: Please phone the department for information if you have a latex allergy.

• You will have a brief medical assessment by a nurse to confirm that you are sufficiently fit to undergo the bronchoscopy.
• The nurse will also confirm the phone number of the person picking you up so that they can contact them when you are ready for discharge.
• A doctor will then come to talk to you about the procedure and ask you to sign the consent form if you are happy to proceed.

• A cannula (narrow plastic tube) will be inserted in the back of your hand or your elbow crease to allow us to give you intravenous sedation
• The doctor performing the procedure will spray the back of your throat and nose with anaesthetic throat spray that will make your throat numb. 
• Sedation will be given to make you slightly drowsy but not unconscious. You will still be able to hear the doctor and nurse talking to you. This state is called co-operative sedation. 
• Please note that if you are having sedation you are not permitted to drive, take alcohol, operate heavy machinery, or sign any legally binding documents for 24 hours following the procedure and you will need someone to accompany you home. We advise you to have sedation to help you to relax during the procedure.

• During the bronchoscopy you may feel some slight discomfort as the bronchoscope is passed through your nose or mouth. 
• You may cough when the local anaesthetic is administered to your vocal cords and air passages. As the anaesthetic takes effect your throat will relax and you will be able to breathe normally. 
• The procedure will take between 10 - 30 minutes

• Endo-bronchial biopsy: A small sample is taken from the inside lining of the air tubes.
• Bronchial brushings: The doctor passes a small brush over the inside lining of the air tubes.
• Bronchial washings: A small amount of fluid is put into the air tubes and sucked back through the bronchoscope into a specimen jar.
• Broncho-alveolar lavage: Fluid (about 1 cupful) is put into a single small air tube in the lung then sucked back up into a specimen jar. This collects cells from the air sacs of the lung.

Morning Appointments

Insulin treated patients:

• You should have nothing to eat after midnight but may have water until 6am.
• Have a suitable drink equivalent to 20g carbohydrates between 6 and 7 am to avoid the risk of hypoglycaemia.
• Omit normal morning dose of insulin prior to the procedure unless taking lantus or levemir.
• Tell the nurse immediately if you have any symptoms of hypoglycaemia. As soon as it is considered safe you will be allowed to eat and drink.
• Only tea and biscuits are available for patients in the endoscopy department. Please, bring your insulin with you. You should be aware that blood sugar levels may be disturbed by the change in your routine but should return to normal within 24 – 48 hours. 

Tablet treated patients:

• Hypoglycaemia (low blood sugar) is unlikely to be a problem for patients treated with sulphonylurea tablets e.g. gliclazide, glibenclamide except if fasting is prolonged.
• Omit morning diabetes tablets.
• Take your morning tablets as soon as you can eat and drink safely after the procedure followed by breakfast.

Afternoon Appointments

Insulin treated patients:

• You should have nothing to eat at least 4 hours before your appointment, but you can have clear fluids up to 2 hours before.
• Have a suitable drink equivalent to 20g carbohydrates to avoid the risk of hypoglycaemia between 10:30 and 11am.
• Have half the morning dose of insulin with a light breakfast at 8am
• Tell the nurse immediately if you feel any symptoms of hypoglycaemia.
• You should be aware that blood sugar levels may be disturbed by the change in your routine but should return to normal with 24 - 48 hours. 

Tablet treated patients:

• You should have nothing to eat at least 4 hours before your appointment, but you can have clear fluids up to 2 hours before.
• Do not take diabetes tablets before the procedure. You may resume normal medication after the procedure when you are able to eat and drink safely.
• Be aware that blood sugar levels may be disturbed by the change in your routine but should return to normal within 
  24 - 48 hours.

There are some risks and complications with this procedure.

They include but are not limited to the following:

• Specific risks:
• Low oxygen levels (hypoxemia): during the test your oxygen levels are measured and you may be given oxygen.
• Narrowing of vocal cords (laryngospasm): this is usually temporary and rarely a problem.
• Hoarse voice (this usually settles after a few days).
• Asthma like reactions: the air tubes can be narrowed due to irritation by the procedure. This is usually treated with asthma drugs.
• Damage to dental crowns and teeth – this is very rare. You will be wearing a mouth guard during the procedure to protect your teeth from damage but also to protect the bronchoscope from your teeth.
• Rarely, you may get a chest infection
• Fever: this may happen after broncho-alveolar lavage and is treated with paracetamol (Panadol).
• Bleeding: this can happen after biopsies. Normally it is minor and settles quickly. If the bronchoscope is passed through the nose then bleeding from the nose may occur. Severe bleeding is rare and is more common after trans-bronchial biopsies. Bleeding is more common if you have been taking warfarin, aspirin, DOACs, clopidogrel or drugs for arthritis or back pain (NSAIDS). Your doctor should have advised you about this by now, if you have not had any advice regarding this you should ask your doctor.
• Collapsed lung (pneumothorax): a small hole in the surface of the lung can happen after a transbronchial lung biopsy for up to 1 in 20 people. Air then leaks from the lung, causing the lung to collapse. The lung may come back up itself, but for 1 in 2 people who get a collapsed lung, a tube has to be put through the skin, into the chest. This removes the air from around the lung and may need a longer hospital stay. Rarely this can happen up to 24 hours after trans-bronchial biopsy.
• Heart problems: bronchoscopy may put a brief minor strain on the heart. This can cause abnormal beating of the heart. It rarely causes fluid to collect in the lungs, a heart attack, or the heart may stop beating.
• Reactions to sedation or local anaesthetic: can include vomiting and rare allergic reactions.
• Death is extremely rare - about 1 in 2,500.