Having a bronchoscopy

Transcription

1 Having a bronchoscopy Patient s ID Label You have been advised to have a bronchoscopy by the doctor. This sheet briefly explains what will happen to you. Before the test, the doctor will explain the procedure and answer any questions. Please read the following instructions carefully and bring this information sheet with you on the day of your bronchoscopy. Your bronchoscopy procedure Your procedure will take place in the Endoscopy Unit at the Royal Derby Hospital. This date will be filled in below, either at your outpatient clinic appointment, or by the Endoscopy booking department via the postal service. On: (date). At: (time). If you are unable to attend this appointment, please telephone as soon as possible. When you arrive at the hospital, please go to level 1 in the Main Hospital building, and then follow the signs to the Endoscopy Unit and report to reception. Upon arrival, the receptionist will check your details. A nurse will then ask you some questions about your general health, the medicines you take and any allergies you may have. Before your bronchoscopy You should not have anything to eat from midnight on the day before the procedure. You may have an early (not after 7.30am) morning cup of tea or coffee on the day of the examination. If you are taking Warfarin, Clopidogrel or any other blood thinning drugs, it is important that you let the Endoscopy Unit know before the procedure, as special arrangements may need to be made to stop this for a few days. If you answer YES to any of the following questions, please contact the Unit for advice: Have you been notified that you are at an increased risk of CJD or vcjd, for public health purposes? Have you received multiple (300 or more donors) transfusions of blood or blood components (red cells, cryoprecipitate or platelets), or plasma (150 or more donors) since January 1990?

2 If you are taking any regular medicine or tablets, you MUST bring them with you. If you have diabetes, please do not take your tablets on the morning of the examination. Take your tablets with you to hospital and tell the doctor that you have not taken them that morning. If you are on insulin, please telephone the Unit the day before your appointment. Do not wear nail varnish or false nails, as a probe will need to be placed on your finger to monitor oxygen levels. Although you will not be required to wear a hospital gown, you may prefer to wear some old clothes in case they get spoilt. Please do not bring excess money or valuables with you. What is a bronchoscopy? This is an examination which allows the doctor to look at your breathing tubes and lungs. A bronchoscope is a fine flexible tube with a light at the end. This is passed though one nostril and into your windpipe (trachea) and then into the breathing tubes (bronchi) in your lungs. Right lung Windpipe (trachea) Doctor looks down bronchoscope Bronchoscope passed down nose and windpipe into the airways of the lungs (bronchi) Right main bronchus Left main bronchus Alternatives Your consultant has recommended this procedure as being the best option. There is no alternative to a bronchoscopy. If you feel you do not want to have this test, please talk to your consultant.

3 The bronchoscopy examination In the bronchoscopy examination room, you will sit on an examination trolley. You will usually be sitting fairly upright. The doctor will insert a cannula (plastic tube) into your arm or hand, and give you some sedation. Local anaesthetic will then be sprayed at the back of the throat, which may make you cough. The spray can taste quite bitter. The throat may feel as if it is swelling up as the local anaesthetic takes effect. You may then be asked to sniff some local anaesthetic gel up your nose to help to complete the numbing of the airways. The doctor will then put the bronchoscope into the mouth or nose, and down into the throat. They will then spray a little more anaesthetic on to the voice box, which will cause you to cough a little. If the bronchoscope is passed through the mouth, you will be asked to bite on a mouth guard to prevent accidental damage to the bronchoscope. The bronchoscope is then passed through the voice box into the airways (see picture). More local anaesthetic may be sprayed on to the airways at this point, to ensure the test can be completed comfortably. Will it hurt? There will be times when you feel some discomfort, but no pain. Will I be able to breathe? Yes. The doctor will be with you whilst performing the examination and, if necessary, you will be given some oxygen through a soft plastic tube into the other nostril. During the test, you will have a small device attached to your finger to monitor your heart rate and oxygen levels. When the airways are numb, the breathing passages will be examined individually to ensure they are normal. If everything is normal, the procedure lasts about 20 minutes. If any abnormality is seen, some samples may be taken. This may include biopsies, brush specimens, or washings obtained by putting a little warm salty water into the airways and then sucking it out again. If these procedures are undertaken, the whole test will last a little longer. Will there be any after-effects? After the examination, your throat is numb, it will NOT be safe to eat and drink until about an hour afterwards, when the local anaesthetic has worn off. You may also find some traces of blood in your phlegm. This usually settles without further treatment. If it doesn t, please contact your GP. You may also find your throat is a little sore and your voice hoarse. Please do not blow your nose hard after the procedure, as it may cause your nose to bleed.

4 All these symptoms should pass within 24 hours, and by the following day, you should be back to normal. Occasionally patients may develop a chest infection after the procedure. Please see your GP if you start to become more poorly. This may include, for example, coughing mucky phlegm or becoming more breathless or feverish. Occasionally a patients oxygen levels may drop during the procedure and they may require extra oxygen for some time afterwards. If you are an outpatient, there is a small chance you may need to be admitted to hospital. This is more likely to happen if your oxygen levels are not normal before the procedure. After your bronchoscopy Please expect to remain in the Unit for up to 3 hours. You may wish to bring a newspaper, or book with you to read. You will be able to go home on the same day as the examination. As you will not be able to drive after the examination, you should make arrangements for a responsible adult to collect you from the unit. When you get home, rest quietly for the rest of the day. You should also: Ensure that a responsible adult stays at home with you for 24 hours. If you live alone, please make sure someone is with you until the next day. If this is a problem, please telephone the nursing staff prior to your procedure. Drink plenty of fluids, but not too much tea or coffee. Eat a light diet, eg. soup or sandwiches. Avoid greasy or heavy food as this may cause you to feel sick. Lie flat if you feel faint or dizzy. For at least 24 hours after your examination you must not: Drive. Your insurance company may refuse to meet a claim if they feel you have driven too soon. Go back to work. Lock yourself in the bathroom or toilet, or make yourself inaccessible to the person looking after you. Operate any domestic appliances or machinery. Drink alcohol. Make any important decisions, or sign any important documents. Be responsible for looking after small children. Watch too much television, read too much, or use a computer, as this can cause blurred vision.

5 When will I know the results? You will not normally receive the results of the procedure on the day. If you have had biopsies or samples taken, these will have to go the laboratory for further examination. In this instance, you may be asked to attend another outpatient appointment, or you may be written to with the results. Extra procedures Sometimes it may be necessary to obtain some additional specimens at the time of the test. These will involve an extra procedure, which will be explained to you and will take a little longer. Transbronchial lung biopsies Rarely, the doctor may need to take some biopsies from the substance of the lung. If biopsies are necessary, there is a small chance (3 in 100) of puncturing the lung (a pneumothorax) during the test. We may need to perform a chest x-ray about an hour after the procedure if this test is performed. If you do have a pneumothorax, it does not usually need to be treated, but in rare cases, a tube may be inserted into the chest to allow the lungs to re-inflate. You will need to be admitted to hospital if this happens. This problem occurs less than 1 in 100 cases. There is a small risk of bleeding associated with this procedure. Transbronchial needle aspiration (Wang) If the lymph glands in the centre of the chest are enlarged, a needle can be used to obtain some samples from these glands, which lie outside the airways. Often this is achieved simply by passing a needle through the standard bronchoscope (known as a Wang needle biopsy). There is a small risk of bleeding associated with this procedure (less than 1 in 50 cases), and a very small chance of puncturing the lung (see transbronchial biopsies above). Endobronchial ultrasound guided lymph node sampling (EBUS) If the lymph glands in the centre of the chest are enlarged, it is sometimes necessary to use a slightly different bronchoscope to obtain a sample from these glands, which lie outside of the airways. This bronchoscope has a special built-in ultrasound probe, so the doctor can locate lymph glands outside the airway. The doctor can then obtain some extra specimens using a biopsy needle. This bronchoscope is a little wider than the standard device and will need to be put through the mouth. You will need to be lying nearly flat for this procedure. There is a small risk of bleeding (less than 1 in 50 cases), and a very small chance of puncturing the lung during this test (see transbronchial lung biopsy section).

6 If you have any queries, or require further information, please contact the Endoscopy Unit on or for booking/appointment queries on P1961/0338/ /VERSION8 Copyright. Any external organisations and websites included here do not necessarily reflect the views of the Trust, nor does their inclusion constitute a recommendation.