Having a Bronchoscopy

  • Reference Number: HEY-211/2018
  • Departments: Endoscopy

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should have been 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.

 PLEASE DETACH THE INFORMATION CHECKLIST AND BRING IT WITH YOU

What is a Bronchoscopy?

A slim flexible tube with a light on the end (bronchscope) is passed through your nose, through your larynx (voice box) and allows the doctor to look directly at your trachea (windpipe), bronchi (branches of the airways) and into some areas of your lungs and allows samples (biopsies) to be taken. The doctor watches the view on the TV monitor.

Why do I need a Bronchoscopy?

You have probably been troubled by some symptoms, which have led to your doctor advising a Bronchoscopy.

How do I prepare for the test?

Please read the 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. Complete the health questionnaire sent/given to you as fully as possible.

It is important that you do not have anything to eat or drink for 6 hours before your test.

If you have diabetes (especially taking insulin) or you have serious heart, lung or kidney problems, or concerned that a health problem you have may be affected, then contact the Endoscopy Department at the hospital where you are having your examination (see contact numbers).

Warfarin – These are blood thinning tablets and usually have to be stopped for a period of time before your test, please contact your Endoscopy Department for advice.

Pregnancy – It is important that you inform us if there is a possibility that you may be pregnant. Any information you share with us will be kept strictly confidential.

Latex – Please inform the department if you have a confirmed latex allergy as this will affect your appointment time.

Creutzfeldt-Jakob disease/variant Creutzfeldt-Jakob disease (CJD) – Commonly known as mad cow disease – Please inform the department if you have been notified that you are at risk of CJD/vCJD for public health reasons.

Clopidogrel (Plavix) – Please inform the department if you are taking these tablets as these may need to be stopped prior to your procedure.

If you take any of the following blood thinning tablets please contact the Endoscopy Department before your appointment for further advice: Apixaban, Rivaroxaban, Dabigatran, Argatroban, or Edoxaban.

What happens to me in the Endoscopy Department?

Our friendly reception staff will greet you on arrival. They will let a nurse know that you have arrived. Occasionally there may be a delay in your appointment time due to an emergency taking place. If there are any delays you will be notified as soon as possible and be kept informed. A nurse will collect you from the waiting room and explain what will happen next. You will be given an approximate time of when you may be collected to go home. It is advisable to leave any valuables at home.

We will ask you questions about your general health and work through the health questionnaire you have completed for us. Please feel free to ask questions. The endoscopist will meet you and explain the test to you. You will both sign a consent form. This is to show that you understand what will happen and agree to the procedure being performed. If you have any queries or worries, please tell us.

We will check your blood pressure, pulse, and oxygen levels, before your test. If you wear glasses or dentures, you will be asked to remove them.

You will be taken to the examination room where you will be given a local anaesthetic throat spray. If you are having sedation, the needle will be placed in the back of your hand or arm. You will be made comfortable on a bed in an upright position.

A fine plastic tube will rest by your nostrils to give you some extra oxygen. A probe will be placed on your finger to monitor your oxygen levels and pulse rate. If you are having sedation it will be given at this time and you will feel sleepy.

Do I need sedation?

Yes. People have sedation to keep them comfortable while the doctor carries out the test. Sedation is given through a needle in the back of your hand or arm. It makes you feel sleepy and relaxed but does not put you to sleep. You can still respond to what is happening.

Do I really need someone with me after sedation?

Yes. This is very important. The sedation given can have effects, which last some 24 hours after the test. You can become forgetful and also sleepy again. Your test may be cancelled if you do not arrange to have someone to collect you and stay with you for the next 24 hours.

We strongly recommend that for the next 24 hours you:

  • Do not drive.
  • Do not return to work or operate machinery.
  • Do not sign any important and/or legal documents.
  • Are not left alone, you may be at risk of injuring yourself.
  • Are not left alone to care for children.

If you are an outpatient, the person accompanying you will be contacted to collect you. If you are an inpatient you will be transferred back to your ward.

What happens during the test?

As the tube is passed down your throat more anaesthetic is passed down the bronchoscope to numb your voice box. This may make you cough but will not interfere with your breathing. It usually takes 15 20 minutes to examine all areas fully. It is very common for small samples of tissue (biopsies) to be taken for analysis in the laboratory. They are removed painlessly with a tiny pair of forceps. You will be settled and relaxed. Most people cannot remember having the test done.

How can I help myself?

You can help by listening to the instructions your nurse gives you. By staying calm and relaxed, the test goes quickly and easily. Try to control your breathing by taking slow deep breaths. This helps to stop the feeling that you want to cough.

What happens when the test is finished?

If you have had sedation, you will need to rest on a trolley in the recovery room for approximately 30 minutes. After 1 hour you will be helped to a chair and given a cold drink. Your relative or friend will then be contacted to collect you. It is quite likely that the back of your throat will feel sore for the rest of the day.

Can there be any complications or risks?

Complications after a bronchoscopy are rare but can include a reaction to the drugs given for sedation, bleeding or pneumothorax (collapse of the lung). Common problems, which are not serious, include a slight nosebleed, sore throat, and streaks of blood in your phlegm.

Sedation

Some people, for reasons we still do not fully understand, are particularly sensitive to this drug. The breathing can be too shallow and too slow. In these cases we stop the examination, give more oxygen and if required we can give an antidote, which reverses the effect of the sedation. This is usually all that is needed and the person recovers with no ill or lasting effects.

In some cases, when people have another serious illness e.g., heart disease, stroke, unstable angina, severe asthma or chronic bronchitis, the sedation drug can cause difficulty in breathing. This is rare and is why we monitor breathing and heartbeat throughout; and why we give oxygen by nasal tubes.

If you would like more information, please ask your nurse or endoscopist.

When do I get my results?

The Recovery nurse will explain your test and if we have taken any samples to you and (if you wish) to your carer. There will be a written discharge form with any instructions that you need to follow. Your hospital doctor or GP will receive a copy of the results. Results from a biopsy may take up to 21 days to reach your doctor. You will have an appointment with your consultant to get any further results.

Further information

If you require further information about your test, your GP, consultant, and the Endoscopy Department is a valuable source of information.

Further information about your rights with regards to consent can be found in the following documents:

  • Department of Health (2001), Guide to Consent for Examination or Treatment.
  • Department of Health (2001), Consent – What you have a right to expect.
  • A Guide for Adults. (Available from the Endoscopy Department.)
  • A Guide for Relatives and Carers. (Available from the Endoscopy Department.)

These are free of charge.

For additional general information, you can visit the Department of Health section on the GOV.UK website. They also provide documents specifically regarding consent.

Useful contact numbers

The Endoscopy Department, Castle Hill Hospital (01482) 622069. (Direct line) Monday – Friday, 8.00am – 5.00pm.

The Endoscopy Department, Hull Royal Infirmary (01482) 674790 Monday – Friday, 8.00am – 5.00pm.

Ward 100, Hull Royal Infirmary Out of hours telephone: (01482) 674860.

What do the words in the leaflet mean?

  • Biopsy: A sample of tissue is taken for analysis.
  • Consent: This is the agreement between you and the endoscopist.  You are agreeing to have investigations or treatment and that you understand the purpose, benefits, alternatives and risks. You and the endoscopist during this process sign a consent form.
  • Endoscopy Department: The place where your procedure takes place.
  • Endoscope: A tube for looking inside the body.
  • Endoscopist: This can either be your consultant, an experienced and trained doctor or an experienced and specially trained practitioner.

Acknowledgements

This leaflet has been written with the help, support, advice and collaboration of:

  • Consultants of the Department of Gastroenterology.
  • Consultants of the Surgical Department.
  • Staff of the Endoscopy Department.
  • Patients attending the Endoscopy Department.

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.