Information for patients

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1 Having a bronchoscopy Introduction You have been given this leaflet because your doctor has recommended you have a bronchoscopy. A bronchoscopy is a medical procedure where a flexible tube called an endoscope is used to look inside the trachea (windpipe) and lungs. This leaflet will provide you with details about having a bronchoscopy. When you attend please ask us questions if there is anything you do not understand. Please note that the time on your appointment letter is when you need to arrive at the department and not the time you will have your procedure performed. You can expect to be in the department for up to four hours. Please do make sure that you bring a dressing gown and slippers with you. We also advise that you do not bring young children to the unit as we do not have facilities to entertain them. What is a bronchoscopy? A bronchoscopy is an examination of the breathing passages/tubes (airways) of your lungs. The bronchoscopy is done with a thin tube-like instrument with a mini camera at its tip, called a bronchoscope. The bronchoscope enables your doctor to see inside the breathing passages of your lungs and if needed take samples of mucus (phlegm) or tissue from inside your lungs. Why do I need a bronchoscopy? Your doctor will explain why you need the bronchoscopy but some of the common reasons why the examination is carried out include: Information for patients Infection - specific samples from your lungs can help your doctor to find the cause of infections and give you the right treatment. You doctor can also use the bronchoscope to clear some of the mucus from your breathing passages. Bleeding - your doctor can look inside your breathing passages to determine where the blood the you are coughing up is coming from. An abnormal Chest X-ray - there may be a narrowing of a breathing passage or a spot on your lung that your doctor wants to investigate with the bronchoscope and take small samples to find the cause.

2 Persistent cough - samples taken during a bronchoscopy and an examination of the breathing passages can sometimes help to determine the cause for a cough that does not clear up with usual medication. Noisy breathing - a bronchoscopy can help to see if narrowing of your breathing passages or irregular movement of your vocal cords (voice box) is causing additional breathing sounds. Is there an alternative test that I could have instead of the bronchoscopy? There are similar tests that can be done, but they will not give your doctor as much detailed information. You could have breathing tests, x-rays and CT-scans of your lungs and these tests will give additional information about your lungs. A bronchoscopy gives more specific information to your doctor by looking inside your breathing passages and obtaining samples. What do I need to do to prepare for the bronchoscopy? You will need to provide an up-to-date list of all your medications, allergies and any medical conditions. Your doctor will review this with you. It is important to let your doctor know if you are taking any blood thinning medication such as Warfarin, Aspirin or Clopidogrel, or if you are diabetic. You should not eat or drink anything for four hours before the procedure and it is better not to smoke beforehand. Please make sure you bring an up-to-date list of all the medication you are taking when you attend for your appointment. What will happen before the examination? When you arrive, the nurse will explain the procedure and answer any questions you may have. You will be asked to wait and this may be for some time depending on how busy the unit is, we will try to inform you of any significant waiting times. You will be asked to sign a consent form. In the room where you will have your bronchoscopy, your oxygen levels in your blood and your heart rate will be monitored with a probe (loose clip) on your finger. A cannula (tiny plastic tube) will be inserted into one of your veins and you may be given medication in the vein to make you feel sleepy. You may also be given some oxygen. What happens during the examination? Before the procedure starts, a nurse will attach monitors to one of your fingers to record your pulse and oxygen level, as well as monitors of your blood pressure and heart rhythm. You will be given an injection of intravenous sedation and painkiller through a small needle in the back of your hand or arm. These medicines (known as a conscious

3 sedation), will relax you and may make you drowsy but will not necessarily put you to sleep. You will hear what is said to you and be able to respond to any instructions given to you. A nurse will sit by your head and monitor you for the whole of the procedure. Your doctor will then insert the bronchoscope either through your nose or mouth to the back of your throat and numb your voice box with local anaesthetic. While your voice box and breathing passages are being numbed, you may cough: this usually settles down when the local anaesthetic takes effect. The coughing may cause you some discomfort during the procedure. The doctor will look inside the breathing passages and take samples. You may be given more anaesthetic or sedation during the procedure if you or the doctor feels that it is needed. What happens after the examination? You will be looked after by a nurse until you are awake enough to leave. Your breathing rate, pulse and blood pressure will be checked and you may have a chest X-ray. You may cough up small amounts of blood and please let the nurse know if you cough up more than a tablespoon of blood, have chest pains or difficulty breathing. You should not eat or drink until the feeling in the back of your throat has returned, usually after around two hours. It is common to have a mild sore throat, hoarseness and cough after the procedure. If you have had sedation it is essential that you arrange for a responsible person to take you home after the test and this must be someone known to you and not a taxi or minicab driver. If you do not make these arrangements we may have to cancel the procedure. Because of the effects of the drugs used it is important that you have someone to stay with you and that you do not drive, return to work, operate machinery, sign any legal documents or drink alcohol for 24 hours afterwards. Having sedation will also mean that you may be in the department for up to four hours. Your escort may like to ring the department on the telephone number at the bottom of this information before coming to collect you. Please ask them to ring two hours after your appointment time so a collection time can be agreed. In some cases the doctor may give you some initial results of your bronchoscopy when you are awake before you leave. When will I get the results of the test? The results of the samples will take several days to be processed and an outpatient appointment will be made to discuss the results.

4 Are there any risks? A bronchoscopy is a safe procedure with little risk and complications are relatively rare. There is a small risk of infection and bleeding associated with the procedure. Air can also sometimes leak into the space surrounding your lung during the procedure but this is not usually a problem and the air can be taken out with a needle and syringe or in some instances a drain (little plastic tube) needs to be inserted and left inside for a couple of hours to drain the air out. Occasionally patients take longer to recover after the procedure and may need to be admitted to hospital for observation. If you experience bleeding, pain or fever after the examination, please contact us directly: St. Mark s Hospital: or ACAD/Central Middlesex Hospital: or In the case of an emergency contact your GP or attend your local Accident & Emergency Department. Privacy and dignity The Trust follows guidelines from the Department of Health with regard to separate male and female waiting areas. This means that once you have completed your admission paperwork, relatives or friends cannot wait with you in these areas. We would therefore ask that your relative or friend waits in our main reception or goes home and rings to confirm when they can collect you. Your admission nurse will be happy to advise you on waiting times and contact details. We usually advise patients that they may be in the department for up to four hours. Valuables and make up Lockers are available for your personal belongings (a 1 coin is required which is refundable at St Mark s Hospital only) but please do not wear jewellery, bring valuables or large amounts of money as the Trust is not responsible for any losses. Please do not wear make-up or nail varnish when you come for your appointment. Interpreters If you need an interpreter at your appointment please contact the department before your appointment on the telephone number at the bottom of this information so one can be booked for you. Car Parking At St Mark s Hospital parking is available in the multi-storey car park and outside the entrance to the Hospital. Car parking charges apply and pay and display is in operation please do bring with you some change.

5 At Central Middlesex Hospital car park 1 (visitors car park) is accessed from Central Way. Car parking charges apply and pay and display is in operation. Contact details This leaflet has been produced by staff in the endoscopy department of The North West London Hospitals NHS Trust. Please do not hesitate to telephone the endoscopy department at St Mark s on or Central Middlesex Hospital on For more information regarding the hospitals and how to get here please visit: Other sources of information are available at: General Trust Information Patient Advice and Liaison Service (PALS) PALS is a confidential service for people who would like information, help or advice about the services provided by any of our hospitals. Please call between 10am and 4pm or Please note that this service does not provide clinical advice so please contact the relevant department directly to discuss any concerns or queries about your upcoming test, examination or operation. For a translation of this leaflet or for an English version in large print, audio or Braille please ask a member of staff or call

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